Permit _ Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 PERMIT # e�R —0,P l P-
�i���u
Phone
FAX (503) 684-7297 1 - DATE ISSUED ////
-- - TDD No. (503) 684 -2772 '
CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BY 1 tf (,2 m 1
PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTALLATION 4. TYPE OF WORK
3 7 a o Si Ui C.; oLein c,iuure i1
A 1370
dress RESIDENTIAL — Restricted Energy Fee $40.00
- O g (FOR ALL SYSTEMS) _ - `' C �P� " J
(,�/
City State Zip Check Type of Work Involved: /w( Q"(`J
PERMITS ARE NON - TRANSFERABLE AND NON - REFUNDABLE AND EXPIRE IF WORK [ �Jio and Stereo Systems*
/
IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR � y
180 DAYS. Bur lar Alarm
2. CONTRACTOR APPLICATION ,,, / arage Door Opener*
l ting, Ventilation and Air Conditioning System*
Contractor Type f��, V uum Systems*
rAP Other
Address
GARY'S VACUFLO, INC. 775 - 2042 COMMERCIAL — Fee for each system $40.00
9015 SE FLAVEL, PTLD, OR 97266 (SEEOAR918 260 - 260)
DATE: I f / /S / y'S JOB# Check Type of Work Involved;
OWNER:'- c rrA o -m�� int .
CLE 26728, JLE 985, CCB: 69047 ❑ Audio and Stereo Systems*
❑ Boiler Controls
Phone # ❑ 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:
1. Only use electrical licensed persons to do installations where required. (Certain ❑ 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.
❑ 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 a. Enter Fees $ / v 0 v
authorized to bind the applicant.
q:klik - b. 5% Surcharge (.05 x total above) $ a , 2C - 2 ---
Signature - — - -- — O
TOTAL $ T; . v -
Authority if other than applicant
ENERCAP.CHP