Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
-,, A DEVELOPMENT SERVICES PERMIT #: ELR2005 -00170
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/27/2005
PARCEL: 2S114BB -21000
SITE ADDRESS: 10223 SW KENT CT ZONING: R -7
SUBDIVISION: RIVERVIEW ESTATES NO. 2 LOT: 054 JURISDICTION: TIG
Project Description: Audio, phone, cable, network.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: X 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: HONE,CABL : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
ADDY, DANIEL P AND MICHELLE S JIM BUNCH CO.
10223 SW KENT CT 16055 SW WALKER RD #106
TIGARD, OR 97224 BEAVERTON, OR 97006
Phone: 503- 620 -9338 Phone: 503- 348 -9547
Reg #:
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 6/27/2005 $75.00
[TAX] 8% State Surcha 6/27/2005 $6.00
Total $81.00
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 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: '!, /�+CJ 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-503- 639- 4175-by 7:00 a:m- for -an- inspection - that-business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
04/25/1996 11:20
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Own ctItistal le tion: This installation is being made on property that 1 own whicli is not 201 amps to 400 arops : :,uLi !.:c.; • . 2
Owner si gnoturc • _ Date: nraacti circuits -new. olteratiou. or c;"1':::lt''::-
Cinnt.a.c name: • without service or leod.aa fez . . ,
, each branch circuit I i '_i
Miscellaneous (service or feeder not itictiiticii)
-- - Purim or irrign circle. ! I 5;i.-•:•0 I ', .2
IntiuStr121 plant pea hour I 73.75 ;
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