Permit Support Document (166) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
. " COMMUNITY DEVELOPMENT Permit#: ELR2017-00004
-f-f ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439ril1 ¢� III
Date Issued: 01/04/2017
Parcel: 2S112DD01600
Jurisdiction: Tigard
Site address: 15575 SW SEQUOIA PKWY 180
Project: BFit Subdivision: PACIFIC CORPORATE CENTER Lot: 4
Project Description: Voice&Data Cabling. 1/4/17,Reprinted to show scope of work&permit fees paid.
Contractor: SAFE TECHNOLOGY GROUP INC Owner: PACIFIC REALTY ASSOCIATES
6400 NE HWY 99 STE G375 ATTN: N PIVEN
VANCOUVER,WA 98665 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 360-699-2130 PHONE:
FAX: 360-719-1527
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/04/2017 $75.00
12%State Surcharge-Electrical 01/04/2017 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: a Clock Systems: 0
Data&Telecommunications: ire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 Total $84.00
Other Desc: Required Items and Reports(Co ns)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTE •': •r-.•• law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-1/10 through OAR 952-b. e e l0. You may obtain a copy of the rules or direct questions to OUNC • _ .3.2 2.1987 or 1.800.332.2344.
Issu'dBy: __ C' 4 I__ Permittee Sig : ,;:)-/1-i/
OWNER INSTALLATION ONLY
�J
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15575 SW SEQUOIA PKWY 180, TIGARD, OR,
97224
Record Type: Record ID:
Commercial - Electrical Limited Energy ELR2017-00004
Inspection Type: Inspector:
198 Low voltage final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor