Permit CITY OF �
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, 11. 13125 SW Hall Blv� Tigard, OR97223 (503) 63941 RESTRICTED ENERGY
PERMIT #: ELR97-0161
DATE ISSUED: 06/09/97
`��� PARCEL: 2S103BB-09900
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SITE ADDRESS....:12040 SW 122ND CT
SUBDIVISION -YE—OLDE WINDMILL ZONING:R-4.5
BLOCK ^ LOT ^20 JURISDICTN: TIG
Project Description: install burglar alarm
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO...: AUDIO & STEREO..: INTERCOM & PAGING..:
BURGLAR ALARM ^X BOILER ^ LANDSCAPE/IRRIGAT..:
GARAGE OPENER : CLOCK...........: MEDICAL
HVAC ^ DATA/TELE COMM..: NURSE CALLS
VACUUM SYSTEM : FIRE ALARM ^ OUTDOOR LANDSC LITE:
OTHER: :: HVAC ^ PROTECTIVE SIGNAL..:
INSTRUMENTATION.: OTHER..: ::
TOTAL # OF SYSTEMS: 0
Owner: — FEES
HENDERSON JOSEPH & JUDY JOSEPH type amount by date recpt
12040 SW 122ND CT PRMT $ 40.00 TAT 06/09/97 97-295653
TIGARD OR 97223 5PCT $ 2.00 TAT 06/09/97 97-29565
3
Phone #:
Contractor:
BRINKS HOME SECURITY $ 42.00 TOTAL
8059 SW CIRRUS DR
REQUIRED INSPECTIONS
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BEAVERTON OR 97008 Ceiling Cover Elect'l Service
Phone #: 641-0574 Wall Cover Elect'l Final
Reg #..: 000444
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This permit is issued subject to the regulations contained in the _ '
Tigard Municipal Code, State of Ore. Specialty Codes and all other Pe i 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 �� �y '^� , ALIAlir
t 18N days Issued By
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OWNER INSTALLATION ONLY i
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
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Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 L/�"l PERMIT # � 7'v/(1�/
*will Phone (503) 639 -4171 / jC
...41„,„:7,.,.. rp ily„� I ∎' FAX (503) 684 -7297 DATE ISSUED [J
=••' 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
p 2 (Q fa L 4 -- g
Address-, RESIDENTIAL — Restricted Energy Fee $40 00
City U State Zip Check Type of Work Involved:
PERMITS ARE NON - TRANSFERABLE AND NON - REFUNDABLE AND EXPIRE IF WORK ❑ Audio and Stereo Systems
IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR
180 DAYS. Bur Alarm
❑ Garage Door Opener*
2. CONTRACTOR APPLICATION ❑ Heating, Ventilation and Air Conditioning System*
Contracto HOME SECURI ALARM ❑ .Vacuum Systems*
Address 8059 S .W. CIRRUS DRIVE, BEAVERTON 97008
❑ Other
Date @( COMMERCIAL — Fee for each system $40.00
(SEE OAR 918 - 260 -260)
Property Owner A .. , I mo , \Alia- -,i1.: Check Type of Work Involved:
Contractor's Board • =g. No. 0/1/1/121 ❑ Audio and Stereo Systems
❑ Boiler Controls
Phone # .(503) 641 -0574 ❑ Clock Systems
❑ Data Telecommunication Installations
3. OWNER APPLICATION ❑ Fire Alarm Installation
❑ HVAC
Print Owner's Name Phone No ❑ Instrumentation
❑ Intercom and Paging Systems
Address
❑ Landscape Irrigation Control*
City State Zip ❑ Medical
❑ Nurse Calls
This permit is issued under OAR 918- 320 -370. This applicant agrees to make only
restricted energy installations (100 volt amps or less) under this permit and to do the ❑ Outdoor Landscape Lighting*
following:
Protective Signaling
1. Only use electrical licensed persons to do installations where required. (Certain
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 ,,ll
corrections are completed. G IJ
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 % 7°2- TOTAL
Authority i other than applican
ENERGAP.CHP
5/10/00 Activities for Case #: ELR97 -00161
1:20:47 PM EXPIRED
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRA003 Application received 6/9/97 6/9/97 TAT 6/9/97
ELRA010 Permit created 6/9/97 6/9/97 TAT 6/9/97
ELRA700 Ceiling Cover 6/9/97 TAT 6/9/97
ELRA720 Wall Cover 6/9/97 TAT 6/9/97
ELRA730 Elect'I Service 6/9/97 TAT 6/9/97
ELRA799 Elect'I Final 6/9/97 TAT 6/9/97
ELRA500 (F) Issue permit 6/9/97 TAT PASS TAT 6/9/97
ELRA845 Request inspection research 3/28/00 JMT DONE No Hold - JMT 3/28/00
• ELRA580 Expired by limitation • 4/18/00 HAP DONE No Hold AKJ 4/18/00
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