Permit (74) IN N CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit*: ELR2018-00041
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/12/2018
Parcel: 1 S 134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 205
Project: PMG SCHOLLS PEDIATRICS Subdivision: None Lot: None
Project Description: JOB#66871 INSTALL VOICE/DATA DROPS
Contractor: CHRISTENSON ELECTRIC INC Owner: PROVIDENCE HEALTH&SERVICES-ORE
17201 SACRAMENTO ST ATTN: REAL ESTATE&CONSTRUCTION
PORTLAND, OR 97230 4400 NE HALSEY BLDG 2 STE 190
PORTLAND, OR 97213
PHONE: 503-419-3344 PHONE:
FAX: 503-419-3695
FEES
Description Date Amount
Specifics:
Restricted Energy Permit 03/12/2018 $75.00g
12%State Surcharge-Electrical 03/12/2018 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 1 Fire 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(Conditions)
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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through 2,952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.22332.1987 or 1.800.332.2344.
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Issued By: ' , Permittee Signature: .8
OWNER INSTALLATION ONLY
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 503.639.4176 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.