Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
, DEVELOPMENT H B SO RV 2CES 639 -4171 DATE ISSUED: E �R�9 9990240
SITE ADDRESS: 16586 SW 72ND AVE B -11 PARCEL: 2S113AA -01100
SUBDIVISION: ROSEWOOD ACRE TRACTS ZONING: I -L
BLOCK: LOT: OOD JURISDICTION: TIG
Project Description: Install protective signaling.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
PACIFIC REALTY HONEYWELL INC
15350 SW SEQUOIA PKWY 15495 SW SEQUOIA
SUITE 300 STE 100
TIGARD, OR 97223 PORTLAND, OR 97224
Phone: Phone: 968 -3300 ORIGINAL
Reg #: SUP 941 -JLE
LIC 00057824
ELE 26207CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT KJP 10/14/199E. $60.00 99- 319077 Elect'l Final
5PCT KJP 10/14/199€ $4.00 99- 319077
Total $64.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other 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. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952- 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
Issued by Permittee Signature -7. G4'� -K6
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: /emu DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
rg „_ RECEIVED �y
£0'd OCT 121999 096T 86S £0S • � I 617:9T 6661 - TO -nnr
CITY OF TIGARD
•
COMMUNITY DE I leTED ENERGY ELECTRICAL APPLICATION Date ec
13125 SW HALL BLVD Recd:
PRINT OR TYPE 11. �Y�
TIGARD OR 97223 permit #: E L �77 ! - uVQ
V - 503 - 639 X304 Cust.Call'd:
F - 503- 598 -1960 INCOMPLETE OR ILLEGIBLE APPLICATIONS
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDE O NL
R estricted Energy Fee
k T F . i
OR ALL SYSTEMS)
6 t l Qe.>r � 41 �` Ste#
ADDRESS m ..j.,/ "
JOB I / Check Type of Work Involved:
i
y � / � ,, � ^ � ' City/State NM Phone # D Audio and Stereo Systems
p ir 1 " - 7 v • • ' • : Burglar Alarm
CO f f - 0 . d /Q )5 • • liilliMill ❑ Garage Door Opener"
,g/ j OWNER ❑ Heating, Ventilation and Air Conditioning System'
City /State ® Phone #
❑ Vacuum Systems'
Name ❑
Other
HONEYWELL
CONTRACTOR Mailing Address #100 TYPE OF WORK INVOL - COM MERCIAL ONLY
15495 SW •k • ' . Fee for each system b60.00
copy o
Phone #
(Prior of all licenses issuance a P ity /State 968 -3300 (SEE OAR 918- 260 -260)
f Portland • : � '
Oregon Contr. Brd Lie. # Ex .. Date Check Type of Work Involved:
are required C.O.T. 27 00
expired in C.. Electrical O Contr. Lic. # Exp. Date ❑ pip and Stereo Systems •
data base). 2 6 - 2 1.7 - _ 1 _ 1;
C.O.T. or Metro Lic. # Exp. Date ❑ Boiler Controls
. 1 1.1
Owner's Name ❑ Clock Systems •
OWNER - ❑ Data Telecommunication Installation ❑
APPLICANT Phone #
City /State Fire Alarm Installation
This permit is issued under OAE 918. 320 -37 This applicant agrees to HVAC
make only restricted enemy installations (100 volt amps or less) under this
permit and to do the following: • ❑ Instrumentation
1. Only use electrical licensed persons to do installations where required. Intercom and Paging Systems
Certain residential and other transactions are s ng Pt from licensing. ❑
These have asterisks(*). ❑ Landscape Irrigation Control"
2. Call for inspections when Installation under this pemdt.are ready for ❑ Medical at 503- 639.4175;
3. Purchase separate permits for all installations that are not ready for an ❑ Nurse Calls
inspection when the inspector Is out to Inspect under this permit; ❑ Outdoor Landscape Lighting*
4. Assume responsibility for assuring that all corrections required by the Protective Signaling
inspector are done, and;
5. Assume responsibility for caning for a final inspection when all of the Other
corrections are completed.
Permits are non - transferable and ran - refundable and expire if work is not Number of Systems
started within 180 days of issuance or if work is suspended for 180 days.
The person signing for this permit must be the applicant or a person
• No licenses are required. Licenses are required for all other insmNations
authorized to bind the applicant.
EEO: 60.00
ENTER FEES $
Signature `906 SURCHARGE (.05 X TOTAL. ABOVE) $ 14 ' g�
TOTAL b to y
Authority if other than Applicant
i•ww.kuvms resele.doc 9198