Permit Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd.
A V Tigard, OR 97223 PERMIT # / k ?S . 0 1 96
7 � � �� " IN�fl�j P FAX (503) 684-7297 1 DATE ISSUED 9 - a 9- 96
TDD No. (503) 684 -2772 //
CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BY C r'�es Sek - iv‘../j L
PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTALLATION 4. TYPE OF WORK
(2 7040 ^c, CAD r /...1-3
Address — Restricted Energy Fee $40.00 cuj ®
Pp
(FOR ALL SYSTEMS)
City State Zip Chec " 'm y +? ork Involved:
PRMITS ARE S NOT STARTED WITHIN S 180 AYS OF ISSUANCE OR IF WORK D SUSPENDED FOR
OR E ❑ At to and Stereo Systems
180 DAYS. LY Burglar Alarm
❑ Garage Door Opener*
2. CONTRACTOR APPLICATION
❑ Heating, Ventilation and Air Conditioning System*
Contracto ' --N CQ•.j 1 Type .L C. Y9( 1/'i4 'a ❑ Vacuum Systems* .
Address /(l® N Cu R "!i1' J ❑ Other
Date 7(2-d mil. r COMMERCIAL — Fee for each system $40.00
J� ff f/Cce (SEE OAR 918-260-260)
Property Own er - :4y) 1'
Check Type of Work Involved:
Contractor's Board Reg. No. 43 j ? ❑ Audio and Stereo Systems*
❑ Boiler Controls
Phone 22_ 7 c )571 ❑ Clock Systems
3. OWNER APPLICATION ❑ Data Telecommunication Installations
❑ Fire Alarm Installation
❑ 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:
❑ 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 corrections 5. FEES
are completed.
The person signing for this permit must be the applicant or a person C9
P g g P PP P a. Enter Fees $ �� --
authorized to bind the applicant.
b. 5% Surcharge (.05 x total above) $ Z -c
Signature
TOTAL $ C i 2--
Authority if other than applicant
ENERGAP.CHP
05/30/2000 Activities for Case #: ELR95 -00146
10:52:19 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRA003 Application received 09/29/1995 CJS RECD TMP 12/29/1995
ELRA010 Permit created 09/29/1995 CJS PEND TMP 12/29/1995
ELRA730 Elect'l Service 09/29/1995 TMP 12/29/1995 ,
ELRA799 Elect Final 09/29/1995 03/20/1996 GS DIS GES 03/20/1996 NO SIGNOFF CARD
ELRA720 Wall Cover 09/29/1995 TMP 12/29/1995
ELRA700 Ceiling Cover 09/29/1995 TMP 12/29/1995
ELRA500 (F) Issue permit 09/29/1995 CJS PASS TMP 12/29/1995
ELRA580 Expired by limitation 03/05/2000 HAP DONE No Hold AKJ 03/05/2000
EXPIRE
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