Permit Support Document lEivis
q CITY OF TIGARD 67' /G` j ��� ELECTRICAL RESTRICTED ENERGY PERMIT
'` a COMMUNITY DEVELOPMENT Permit#: ELC2020-00140
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/10/2020
Parcel: 2S 115 BA02600
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY Z3
Project: Starbucks-418 Subdivision: 2004-015 PARTITION PLAT Lot: 2
Project Description: Low Voltage cabling for network. 4/16/2020:REPRINT permit to correct address from 16230,suite 140 to 16200,
suite Z3.
Contractor: LOW VOLTAGE SOLUTIONS OF OREGON Owner: SN PROPERTIES PARTNERSHIP
PO BOX 883 1121 SW SALMON ST
GLENDALE, OR 97442 PORTLAND, OR 97205
PHONE: 541-203-7582 PHONE:
FAX:
FEES
Description Date Amount
Specifics:. Signal circuit or Limited Energy Panel 03/10/2020 $75.00
12%State Surcharge-Electrical 03/10/2020 $9.00
Type of Use: CMS Misc Administration Fee 04/16/2020 $45.00
Class of Work: NEW
Total Number of Systems:
Audio&Stereo: Boiler Controls:
CCTV: Clock Systems:
Data&Telecommunications: Fire Alarm:
HVAC: Instrumentation:
Intercom/Paging: Landscape/Irrigation:
Landscape Lighting: Medical:
Nurse Calls: Protective Signal:
Security Alarm: Other: 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 OAR 952-001-0090. 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: / l ,'YV,-ems !1.¢—%i Permittee Signature: 6;11-/ i 1" 7/1 4/ t' '777-/C'1‘,/
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.