Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I ' COMMUNITY DEVELOPMENT it Permit#: ELR2015 00222
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.243' • Ag-� Date Issued: 09/18/2015
/�� Parcel: 1 S135BB00800
Jurisdiction: Tigard
Site address: 10645 SW GREENBURG RD
Project: WO#50499-IFLY Subdivision: OAKBURG Lot: 27
Project Description: Low Voltage wiring and controls, 9/28/15:Reprintedermit to show address correction from 10655 to 10645 SW
Greenbur R J
(sta s and sensors for split systems only)
Contractor: JACOBS HEATING&AIR CONDITIONING Owner: EWING IRRIGATION PRODUCTS INC
4474 SE MILWAUKIE 3441 E HARBOUR DR
PORTLAND, OR 97202 PHEONIX,AZ 85034
PHONE: 503-234-7331 PHONE:
FAX: 503-296-5351
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/18/2015 $75.00
12%State Surcharge-Electrical 09/18/2015 $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 gh OAR• -a: -:490, You may obtain a copy of the rules or direct questions to OUNC by calli y -1 .232.1987 or 1.800.332.2344.
Issue By: , � / -��. Permittee Sig e: LAI< •
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.