Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
s L : . DEVELOPMENT SERVICES PERMIT #: ELR1999 -00216
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 09/20/1999
SITE ADDRESS: 12950 SW PACIFIC HWY 1A PARCEL: 2S102CB -03101
SUBDIVISION: FREWINGS ORCHARD TRACTS ZONING: C -G
BLOCK: LOT: 021 JURISDICTION: TIG
Project Description: Add burglar alarm
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: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: BURG ALARM X
• TOTAL # OF SYSTEMS: 1
Owner: Contractor:
HENDERSON, MARILYN DOROTHEA BRINKS HOME SECURITY
JENSEN HUDSON TRUSTEE 8059 SW CIRRUS DR
11795 SW KATHERINE ST BEAVERTON, OR 97008
TIGARD, OR 97224
Phone: Phone: 641 -0574
Reg #: SUP 2650JLE
LIC 00044421
ELE 34166CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT GEO 09/20/199E $60.00 99- 318449 Elect'I Final
5PCT GEO 09/20/199E $4.20 99- 318449
Total $64.20
ORIGINAL
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 -re set forth in OAR
952 - 001 -0010 through OA' 952 - 001 -0080. You may obtain copies of these rules or dire. , questions to OU at (503)
246 -1987. 1 / 6
Issued b (. Permittee Signature ,/ LI L � 0i_
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 /V A DATE: 9 O2 '
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 Rec'd:
TIGARD OR 97223 PRINT OR TYPE
V - 503 - 639 -4171 X304 Permit #:F-LR/ !' A/6
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
1 Le itkol c(-Iarl SP.rL rep S (FOR ALL SYSTEMS)
JOB St e Address Ste
ADDRESS qSb }r �� j �, j / Check Type of Work Involved:
C t ard 1 6r / Ppne 77 ❑ Audio and Stereo Systems
Name � "/ /
�
) ❑ Burglar Alarm
Pi nk leY� ` /� ,O �' L ❑ Garage Door Opener*
OWNER Maili Address y � � - sf
1 ! W � St-rl ' ❑ Heating, Ventilation and Air Conditioning System*
C,, jJSt� ate p I I # v I Phone #
Name „r ❑ Vacuum Systems*
1 Other
�nnl�s �ome.,Se.ra,�.ri ❑
CONTRACTOR if A r ss
(} � , I .rt 1Nr. TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior issuance s b!y/S�t' e 3 P h pn� �? Fee for e system $60.00
copy of f all licenses �� � (SEE OAR 918-260-260)
are required if Or- ! r. B r _ ,1 x, / AP.-11?
Type expired in C.O.T. ` ' // 4I (� Check T e of Work Involved:
data base). Electrical ntr L f #� 16. [l l ❑
�L� (Q Audio and Stereo Systems
C.O.T. or Metro h ∎C , / /Cp aits,- ❑
Lf. /D Boiler Controls
Owner's Name
❑ Clock Systems
OWNER - Mailing Address
APPLICANT ❑ Data Telecommunication Installation
City /State Zip Phone # ❑
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 ❑ HVAC
permit and to do the following:
❑ Instrumentation
1. Only use electrical licensed persons to do installations where required.
Certain residential and other transactions are exempt from licensing. ❑ • Intercom and Paging Systems
These have asterisks( *). All others need licensing;
❑ Landscape Irrigation Control*
2. Call for inspections when installation under this permit are ready for
inspection at 503-639-4175; ❑ Medical
3. Purchase separate permits for all installations that are not ready for an ❑ Nurse Calls
inspection when the inspector is out to inspect under this permit;
4. Assume responsibility for assuring that all corrections required by the ❑ Outdoor Landscape Lighting*
inspector are done, and;
❑ Protective Signaling
5. Assume responsibility for calling for a final inspection when all of the l Jl l alai m
corrections are completed. Other
Permits are non - transferable and non - refundable and expire if work is not
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.
■51) ataxia.... FEES:
Signature ENTER FEES $ [ Db . h // h
5% SURCHARGE (.05 X TOTAL ABOVE) $ 1 1 • �I p
Authority if other than Applicant TOTAL $ /9 ' / - 0
i:\dsts \forms\resele.doc 3/98