Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° ;, 2 COMMUNITY DEVELOPMENT Permit #: ELR2010 -00166
TIGARDi 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/25/2010
Parcel: 2S101 BB01500
Jurisdiction: TIGARD
Site address: 12254 SW GARDEN PL, BLDG# 1
Subdivision: PARK 217 Lot: 0
Project: Derm Path
Project Description: Data telecommunications
FEES
Owner:
WALTON CWOR PARK BC 8 LLC Description Date Amount
BY TTA/EPROPERTYTAX DEPT 325, PO BOX Restricted Energy Permit 08/25/2010 $75.00
4900 12% State Surcharge - Electrical 08/25/2010 $9.00
PHONE:
Contractor:
ALLPHIN COMMUNICATIONS INC
23220 SW BOSKY DELL LANE
WEST LINN, OR 97068
PHONE: 503 - 638 -9000
FAX: 503 - 638 -9100
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: y Fire Alarm: N
HVAC: N Instrumentation: N Total $84.00
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 or 1.800.332.2344. A
Issued By:L 7-'m— Permittee Signature: ZIN TI / '- "
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 an inspection that business day.
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.
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Electrical Permit Application •-. � ` . ' •
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TIGARD
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DESCRIPTION wrWOms b0 ` __
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� ' 401 amps *5v^ inopS /611.54 2
intended for sale, lease, rent, mexchu"ge, ma:codingo`Vasw7 670, and 70|
Branell &culls .. new, alteration, or extensiot!_
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Address; Au > 66.25/ lir _.______
--'-- -- ----- u,� hr 65.25/ hr
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( ) Inspections for which tio fee is 90.00/m
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08/21/2010 SAT 10:27 FAX 503 638 9100 Allphin Cokunications Z002/003
. E lectncal Permit Application - City of Tigard
Page 2 - Supplemental Infoimatlon
LIMITED ENERGY PEKMIT FEES:
RESIDENTIAL WORK ONLY:
I'ee for VIII residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
L� Burglar Alarm •
❑ Garage Door Opener
❑ Heating, Ventilation and Air Conditioning System'
VACUUM Systems''
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system •
(SEE OAR 918 - 309.0000)
Check Type of Work Involved:
•
❑
•
Audio and Stereo Systems
Boiler Controls •
Clock Systems
Data Telecommunication Instal lation
❑ Fire Alai Installation
❑ I- IVAC
11 I nstru mentatton
interconm. and Paging Systems
❑ Landscape Irrigation Control*
Medical
n Nutsc (. ,Zlls
(� Outdoor .Landscape Lighting*
[_) Protective Signaling
❑ Other
Total number of commercial systems:._.......
No licenses are required. Licenses are required
for all other installations
1: I I i« r,'I ruiils I I.( l'cun0, \I'P.ihc U7 ul 0