Permit Support Document (39) CITY OF TIGARDELECTRICAL RESTRICTED ENERGY PERMIT
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I/{'-> COMMUNITY DEVELOPMENT Permit#: ELC2017-00887
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/01/2017
Parcel: 2S113AB00500
Jurisdiction: Tigard
Site address: 16083 SW UPPER BOONES FERRY RD 200
Project: Liberty Mutual Insurance Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37
Project Description: New tenant improvement. 12/20/2017: REPRINT permit to change description to include modifying existing fire
alarm system.
Contractor: PRIME ELECTRICAL SERVICES LLC Owner: G&S FC LLC
3312 SE BELLA VISTA PL 16083 SW UPPER BOONES FERRY RD,
VANCOUVER,WA 98683 STE
TIGARD, OR 97224
PHONE: 503-318-5170 PHONE:
FAX:
FEES
Description Date Amount
Specifics:
Services or Feeders-200 amps or less 12/01/2017 $201.40
Type of Use: COM Branch Circuits w/Purchase Service or 12/01/2017 $578.76
Feeder
Class of Work: ALT Signal circuit or Limited Energy Panel 12/01/2017 $75.00
Total Number of Systems: 12%State Surcharge-Electrical 12/01/2017 $102.62
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 $957.78
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: ` `� �7 "�! "Alfie Permittee Signature: if 11/4/4/
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.
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
16083 SW UPPER BOONES FERRY RD 200,
TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Electrical ELC2017-00887
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor