Permit -CITY OF TIGARD
ELECTRICAL PERMIT —
COMMUNITY DEVELOPMENT DEPARTMENT RESTRICTED ENERGY
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 - 4171 PERMIT #: EL R9 6 — 0 149
DATE ISSUED: 05/13/96
PARCEL: 2S101AA -09001
SITE ADDRESS...: 12585 SW 68TH AVE
SUBDIVISION WEST PORTLAND HEIGHTS ZONING:C —P
BLOCK LOT .29
Project Description: Roth office building
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO...: AUDIO & STEREO..: INTERCOM & PAGING. °:
BURGLAR ALARM • BOILER LANDSCAPE /IRRIGAT..:
GARAGE OPENER • CLOCK • MEDICAL •
HVAC • DATA /TELE COMM..:X NURSE CALLS •
VACUUM SYSTEM • FIRE ALARM OUTDOOR LANDSC LITE:
OTHER: .. HVAC • PROTECTIVE SIGNAL..:
INSTRUMENTATION.: OTHER..: ..
TOTAL # OF SYSTEMS: 1
Owner: FEES
J T ROTH CONST INC type amount by date recpt
12540 SW 68TH PARKWAY, SUITE B PRMT $ 40.00 JSD 05/10/96 96- 279260
SPCT $ 2.00 JSD 05/10/96 96- 279260
TIGARD OR 97223
Phone #: 639 -2639
Contractor:
DAVID ARMSTEAD $ 42.00 TOTAL
115 LAWRENCE ST
REQUIRED INSPECTIONS
EUGENE OR Ceiling Cover Elect'l Final
Phone #: 541 -345 -2749 Wall Cover
Reg #. ° : 105562
This permit is issued subject to the regulations contained in the ed/Ve1
Tigard Municipal Code, State of Ore. Specialty Codes and all other Perm i t e e Signature
applicable laws. 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
than 180 days. Is ued B
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' N : DATE:
LICENSE NO:
Call for inspection — 639 -4175
.` Community Development RESTRICTED ENERGY ELECTRICAL ELECTRICAL APPLICATION
d . 13125 SW Hall Blvd. PERMIT #
E L-4' 9 6 �' CD/ 7
Tigard, OR 97223
//��n:�iy ;\ Phone (503) 639 -4171 0 S 6 6
.III FAX (503) 684 7297 DATE ISSUED
-- TD D No. (503) 684 -2772
CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BY �e
PLEASE COMPLETE ALL SECTIONS i
1. LOCATION OF INSTALLATION 4. TYPE OF WORK (5-t-IC9 6.- S
7 4 1 ..-e
/ z s40- s 4 4 P 6P<w4�
Address _ RESIDENTIAL — Restricted Energy Fee $40.00
/�y4�..e, Oie (FOR ALL SYSTEMS)
City State Zip Check Type of Work Involved:
PERMITS ARE NON - TRANSFERABLE AND NON - REFUNDABLE AND EXPIRE IF WORK ❑ Audio and Stereo Systems
15 NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK 15 SUSPENDED FOR
180 DAYS. ❑ Burglar Alarm
❑ Garage Door Opener*
2. CONTRACTOR APPLICATION
/� ❑ Heating, Ventilation and Air Conditioning System*
9c
Contractor i ./
C .J7' i' Type el ' ' ❑ Vacuum Systems*
❑ Other
Address l /J le ,f r EL:, •44 e en're
Date S lv -lo COMMERCIAL — Fee for each system $40.00
(SEE OAR 918- 260 -260)
Property Owner 4 /a-s iqeGlc fC Check Type of Work Involved;
Contractor's Board Reg. No. /4.).$73 ❑ Audio and Stereo Systems
❑ Boiler Controls
Phone # g f 3/f -rte 7 1- D'
Data Clock Systems
3. OWNER APPLICATION D" Data Telecommunication Installations
r� ❑ Fire Alarm Installation
/C
4 /41 t.4 /C ❑ HVAC
Print Owner's Name Phone No
❑ Instrumentation
Address ❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
City State Zip ❑ Medical
This permit is issued under OAR 918- 320 -370. This applicant agrees to make only ❑ Nurse Calls
restricted energy installations (100 volt amps or less) under this permit and to do the ❑ Outdoor Landscape Lighting*
following:
1. Only use electrical licensed persons to do installations where required. (Certain ❑ Protective Signaling
residential and other transactions are exempt from licensing. These have ❑ Other
asterisks( *). All others need licensing).
2. Call for an inspection when all of the installations under this permit are ready
for inspection at 503- 639 -4175.
❑ Number of Systems
3. Purchase separate permits for all installations that are not ready for inspection
when the inspector 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
5. Assume responsibility for calling for a final inspection when all of the 5. FEES
corrections are completed.
The person signing for this permit must be the applicant or a person a. Enter Fees $
authorized to bind the applicant. �.�
b. 5% Surcharge (.05 x total above) $ �
Signature TOTAL $
Authority if other than applicant
ENERGAP.CHP