Permit Support Document (11) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
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11. COMMUNITY DEVELOPMENTk, Permit#: ELR2019-00141
t x ) Date Issued: 07/31/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
6r- Parcel: 1 S1266C01506
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Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD 420
Project: US FIRE INSURANCE Subdivision: None Lot: None
Project Description: JOB#67953 LOW VOLTAGE DATA DROPS. 8/1/2019: REPRINT permit to change project name and
description.
Contractor: CHRISTENSON ELECTRIC INC Owner: TOWMAN ONE EMBASSY CENTRE LLC
17201 SACRAMENTO ST BY TOWMAN LLC
PORTLAND, OR 97230 25425 BASCOM AVE STE 230
CAMPBELL, CA 95008
PHONE: 503-419-3344 PHONE:
FAX: 503-419-3695
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/31/2019 $75.00
12%State Surcharge-Electrical 07/31/2019 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 1 Fire Alarm: 0
HVAC: 0 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 through _952-001-0090. You may obtain a copy of the rules or direct questions-to-Qt .1.987_nui.80n.332.9344 __
Issued By: 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.