Permit Support Document (3) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' COMMUNITY DEVELOPMENT Permit#: ELR2018-00055
and OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 04/10/2018
Tt{;a1RT? 9
Parcel: 2S 101 AB03100
Jurisdiction: Tigard
Site address: 12115 SW 70TH AVE 102 f- - /p 4
Project: TVFR OCC Health u••!vision: 2012-009 PARTITION PLAT Lot: 3
Project Description: Voice, Data and coax install. 8/9/2018: REPRINT permit to correct suite number.
Contractor: AZIMUTH COMMUNICATIONS INC Owner: TIGARD TRIANGLE PARTNERS LLC
PO BOX 508 18187 SIERA DR
WILSONVILLE, OR 97070 LAKE OSWEGO, OR 97034
PHONE: 503-639-0110 PHONE:
FAX: 503-639-0115
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04/10/2018 $75.00
12%State Surcharge-Electrical 04/10/2018 $9.00
Type of Use: COM Misc Administration Fee 08/09/2018 $45.00
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 $129.00
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 0 52-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: "'32L/
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 503.639.4175 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.