Permit Support Document (31) CITY OF TIGARDELECTRICAL RESTRICTED ENERGY PERMIT
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COMMUNITY DEVELOPMENTg. l t ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.24 • '
} Permit#: ELR2019-00154
Date Issued: 08/21/2019
Ti
,_ ,/v /Q <OWParcel: 2S 101 DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY, STE#10
Project: Academy Of General Dentistry Subdivision: VARNS ACRES Lot: 9
Project Description: Relocate existing sensors for HVAC System. 8/26/2019: REPRINT permit to correct address from suite 100 to 10.
Contractor: ARJAE HVAC AND MECHANICAL SERVICES LLC Owner: TRIANGLE POINTE TWO LLC
8545 SE MCLOUGHLIN BLVD 901 NE GLISAN ST, STE 100
MILWAUKIE, OR 97222 PORTLAND, OR 97232
PHONE: 503-231-7717 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/21/2019 $75.00
12%State Surcharge-Electrical 08/21/2019 $9.00
Type of Use: COM
Class of Work: ADD
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm: 0
HVAC: 1 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 throug A, 95 - -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: 01V 1—f
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.