Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' :. COMMUNITY DEVELOPMENT Permit#: ELR2016 00237
Date Issued: 10/04/2016
T t GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.24 ixParcel 2S1036D11700
„ft- orJurisdiction: Tigard
Site address: 12610 SW 121ST AVE ,
Project: Dave Nix SO#5219 Subdivision: 2008-056 PARTITION PLAT Lot: 1
Project Description: Wiring for audio,coax,security. 10/5/16: REPRINTED permit to show change of address from 12630 SW 121st Ave
to 12610 SW 121st Ave.
Contractor: LEWIS AUDIO VIDEO Owner: NIX, LOY C&MARSHA A
2112 PORTLAND RD. NIX, DAVID C
NEWBERG, OR 97132 12630 SW 121ST AVE
TIGARD, OR 97223
PHONE: 503-538-1190 PHONE:
FAX: 503-538-5419
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/04/2016 $75.00
12%State Surcharge-Electrical 10/04/2016 $9.00
Misc Administration Fee 10/05/2016 $45.00
Type of Use: SF
Class of Work: NEW
Total Number of Systems:
Audio&Stereo: N
Security Alarm: y
Garage Door Opener: N
HVAC: N
Vacuum System: N
Other: N
Other Desc: Total $129.00
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.
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Issued By: 71r-de....."4* Permittee Signature: '
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.