Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
k DEVELOPMENT H P Tigard, ) 639 -4171 DATE PERMIT #: ISSUED: E�R99 99� - 90323
— 13125 SITE ADDRESS: 10255 SW 90TH AVE PARCEL: 1S135AB-00100
SUBDIVISION: TOWN OF METZGER ZONING: R -4.5
BLOCK: LOT: 005 JURISDICTION: TIG
Project Description: Installation of HVAC system.
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: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
. Owner: Contractor:
TIGARD TUALATIN SCHOOL DIST ARROW MECHANICAL
SCHOOL DISTRICT 23J 10330 SW TUALATIN RD
13137 SW PACIFIC HWY TUALATIN, OR 97062
•
TIGARD, OR 97223
Phone: Phone: RIGINAL
Reg #: LIC 00005193
ELE 34 -47CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT KJP 12/29/199c. $60.00 99- 320757 Elect'I Final
5PCT KJP 12/29/199c. $4.80 99- 320757
Total • $64.80
•
•
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 thro if AR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
Issued by • i Permittee Signature
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 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by:
13125 SW HALL BLVD Date Recd:
TIGARD `OR 97223 PRINT OR TYPE
V - 503 - 639 -4171 X304 Permit #: E L( 2 - I9'9 -03 34
F - 503 - 598 -1960 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee $60.00
M €Tt -6—E( .ScH co Cam- (FOR ALL SYSTEMS)
JOB Street Address Ste #
S S i J , a Check Type of Work Involved:
ADDRESS / d 2
City /State Zip Phone # n Audio and Stereo Systems
Name / n Burglar Alarm
V G 1-11.13- L/3'iJ .Scmor_ Dig 0 Garage Door Opener*
OWNER Mailing g ' Add ddrress
/3137 St.J Pry c iGiG 0 Heating, Ventilation and Air Conditioning System*
C' it /State i Phone #
l� 41rc 1l 1 2.23 6 tzi 230a
Name n Vacuum Systems*
/9ifCe PUG /4/11• C 4 1.- n Other
CONTRACTOR Mailing Address
/633 6 S w J t . n u r i o fis TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a City /State Zip Phone # Fee for each system $60.00
copy of all licenses T(Anu}/74' 0e_ ')7o G Z (012 - /SZA- (SEE OAR 918 - 260 -260)
are required if Oregon Conti. Brd Lic. # Exp. Date
expired in C.O.T. 051 9 3 % /-/3 VA Check Type of Work Involved:
data base). Electrical Contr. Lic. # Exp. Date
3 4 -47 GL( / o -( -Z& n A udio and Stereo Systems
C.O.T. or Metro Lic. # Exp. Date
2.4 7 (.. n Boiler Controls
Owner's Name
F Clock Systems .
OWNER - Mailing Address
APPLICANT n Data Telecommunication Installation
City /State Zip Phone # El Fire Alarm Installation
This permit is issued under OAE 918 - 320 -370. This applicant agrees to
make only restricted energy installations (100 volt amps or less) under this M HVAC
permit and to do the following:
n Instrumentation
1. Only use electrical licensed persons to do installations where required.
Certain residential and other transactions are exempt from licensing. 0 • Intercom and Paging Systems
These have asterisks(*). All others need licensing;
2. Call for inspections when installation under this permit.are ready for
0 Landscape Irrigation Control*
inspection at 503- 639 -4175; n Medical
3. Purchase separate permits for all installations that are not ready for an n N urse Calls
inspection when the inspector is out to inspect under this permit;
4. Assume responsibility for assuring that all corrections required by the n O utdoor Landscape Lighting*
inspector are done, and;
n Protective Signaling
5. Assume responsibility for calling for a final inspection when all of the
corrections are completed. 0 Other
Permits are non - transferable and non - refundable and expire if work is not f
started within 180 days of issuance or if work is suspended for 180 days. I Number of Systems
The person signing for this permit must be the applicant or a person * No licenses are required. Licenses are required for all other installations
authorized to bind the licant.
FEES: C Gy,, �"� �i
Signature .TER FEES $ �L/
.or y80
) o SURCHARGE (.A5 X TOTAL ABOVE) . $
Authority if other than Applicant TOTAL $ (Z / 8
is \dsts \forms \resele.doc 3/98