12156 SW GARDEN PLACE-1 i
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12156 SW GARDEN PI,
CITY OF TIGARD
DEVELOPMENT SERVICES
131258W Hall Blvd.,Tlperd,OR 97223 (503)63M171
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Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd. ELL-9_Iy 7— hl' J
Tigard,OR 97223 PERMIT# _ w
r Phone(503)639-4171 nn [�
FAX(503)684-7297 DATE ISSUED4
_
r TDD No. (503)684-2772
CITY OF TIGARD Inspection (503) 639-4175 ISSUED BY —
PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTALLATION 4. TYPE OF WORK
Add ess RESIDENTIAL—Restricted Energy Fee . . . . . . . . . 140.00
(FOR AI.L SYSTEMS)
City State Zip Check Type of Work Involved:
IPERMITS ARE NON-TRANSFERABLE AND NON-PEFUNDABLE AND EXPIRE IF WORK ❑ Audio and Stereo Systems
S NOl STARTS D WITHIN 180 DAYS OF ISSUANCE OR IF WORK,IS SUSPENDED FOR
190 DAYS ❑ Burglar Alarm
2. CONTRACTOR APPLICATION 0 Garage Door Opener*
1 \ , ❑ Heating,Ventilation and Air Conditioning System*
Contrac:torC � � I�fypeLI I�� � ❑ Vacuum Systems*
Address P75 W G* 1 C F t��tA U 10 1 ❑ Other—
Date_Ac f i I I� )1"I COMMERCIAL—Fee for each system . . . . . . . . . 140.00
(SEE OAR 918-260-260)
Property Owner IC Teck Tyne of Work Involved:
Contractor's Board Reg. No. �� _ ❑ Audio and Stereo Systems
^� ElBoller Controls
Phone:# __ aD `72-0CQO( __ ❑ Clock Systems
❑ Data Telecommunication Installations
3. OWNER APPLICATION ❑ Fire Alarm Installation
_ ❑ I-IVAr_
Print Owner's Name Phone No ❑ Instrumentation
Address — ❑ intercom and Paging Systems
❑ Landscape Irrlgallon Control*
City Slag Zip ❑ Medical
This permit Is issued under OAR 9 8-320.370.This applicant agrees to make only ❑ Nurse Calls
restricted enerpv Installations(1M toll amps or less)under this permit and to(to the ❑ Outdoor Landscape Lighting*
following
Protective Signaling
1. Only use elec tu,.I licensed per.ons to do installations where required.wvrtain
residential and(che.transartions are exempt from licensing.These have ❑ Othet
asteriskW).All others need licensing).
2. Call(or an insix,clion when all of the installations under this permit am ready
for inspection at 503-09.4175.
Y Number of Systems
1. Purchase separato permits for all installation%that are not r-ady for inspectinn
when the in%pec for is out to inspect under this permit. •No licenses are required. Licenses are required for all other installations
4 Assume responsibility for assuring that all corrections required by the inspector
are done,and
i. Assume responsibility for calling for a final inspection when all of the 5. FEES
corrections are completed.
I '
The person signing for this permit must be the applicant or a person a. Enter Fres $ L
authorized to hind the applicant.
b. 5% Surcharge(.05 x total above) $ _
Signature TOTAL $ 1
Authority if other than applicant
ENERGAP.CHP