Permit _ ���
MN ELECTRICAL PERMIT -
RESTRICTED ENERGY
COMMUNITY DEVELOPMENT PERMIT #: ELR96-0280
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 p'03) 639-4171 . --'- DATE ISSUED: 09/12/96
PARCEL: 2S113AD-01700
SITE ADDRESS...: 16920 SW/72ND AVE, /'
SuauIVIGION RACT8 / ZONING:C G
T. ' ' -
Project Description: Instalang`limited energy stem for HVAC
__________________
!
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 LANDBC LITE:
OTHER: HVAC............:X PROTECTIVE SIGNAL..:
INSTRUMENTATION.: OTHER..:
TOTAL # OF SYSTEMS: 1
Owner: ------------ - FEES -----------
BINGHAM INVESTMENTS t ype amount by date recpt
3939 NW ST HELENS RD PRNT $ 40.00 B 09/12/96 96-283900
5PCT $ 2.00 B 09/12/96 96-283900
PORTLAND OR 97210
Phone #: 224-2676
Contractor: - - -------
- $ 42.00 TOTAL
REQUIRED INSPECTIONS -------
Ceiling Cover Elect'l Service
Phone #: Wall Cover Elect'l Final
Reg #..
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permitee Signature
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started
within \80 days of issuance, or if work is suspended for nure
than 180 days. Issued By
---- 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 APPLICATION
13125 SW Hall Blvd. . a /?/„ -- 6
Tigard, OR 97223 PERMIT # :� - l lS�
�
/�,�,n Phone
FAX (503) 6847 297 DATE ISSUED q_ I Z 1
j
�'9 ` TDD No. (503) 684 -2772
CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BY 0^ (14,.dy,...,v,„
PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTALLATION 4. TYPE OF WORK
qqZ.0 s, u-3 -- 7a A. sa.-k . $
Address • RESIDENTIAL — Restricted Energy Fee $40.00
1 , , _-, NS. , g' L CI (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 IS SUSPENDED FOR
180 DAYS. ❑ Burglar Alarm
❑ Garage Door Opener*
2. CONTRACTOR APPLICATION
/�
y � ��(�� ,� Ir El Heating, Ventilation and Air Conditioning System*
Contractor (. etitty . / Type J . A C' ❑ Vacuum Systems*
Address
3i s fv ,w , `atrtV. ak,A , I eri /t4OM . ❑ Other
[A / 01-121°
q
Date 1 1 i �' " 1 b COMMERCIAL — Fee for each system $40.00
(SEE OAR 918- 260 -260)
Property Owner 1'" Check Type of Work Involved:
Contractor's Board Reg. No. ❑ Audio and Stereo Systems
► g ❑ Boiler Controls
Phone # fZ,2 .. 3 ❑ Clock Systems
❑ Data Telecommunication Installations
3. OWNER APPLICATION
❑ Fire Alarm Installation
[21 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 El 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 El 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.
R] k 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 $ y 0. C
authorized to bind the applicant.
1 R N4, ' b. 5% Surcharge (.05 x total above) $ a.O
Signature �p
TOTAL $ �I , eb
Authority if other than applicant
ENERGAP.CHP