Permit CITY OF TIGARD
^ % h ,,� i �;�� DEVELOPMENT SERVI ELECTRICAL PERMIT —
RESTRICTED ENERGY
PERMIT #: ELR97 -0360
DATE ISSUED: 12/17/97
PARCEL: 2S1O2CB -00303
SITE ADDRESS...:13165 SW PACIFIC HWY
SUBDIVISION -NORTH TIGARDVILLE ADDITION ZONING:C —G
BLOCK • LOT •033 JURISDICTN: TIG
Project Description: Installation protective signaling.
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..:X
INSTRUMENTATION.: OTHER..: an
TOTAL # OF SYSTEMS: 1
Owner: FEES
BURGER KING type amount by date recpt
13165 SW PACIFIC HWY PRMT $ 40.00 TJH 12/17/97 97- 301843
TIGARD OR 97223 SPCT $ 2.00 TJH 12/17/97 97- 301843
Phone #:
Contractor:
PHILLIPS ELECTRONICS $ 42.00 TOTAL
(DBA FOR MASTER ALARM L.L.C.)
1110 NW FLANDERS REQUIRED INSPECTIONS
PORTLAND OR 97209 Ceiling Cover Low Voltage Insp
Phone #: 227 -0571 Wall Cover Elect'1 Final
Reg #..: 001253
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. 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 rule adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001-0010 through OAR 952 -001 -0080. You may obtain copies of
these rules or direct questions to OM at (503)246 -1987.
Issued by Permittee Signature 6 i _ 4,t.
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
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
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Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
' 0 13125 SW Hall Blvd. Eg�I 03U
Tigard, OR 97223 PERMIT # J f J1Y�
A Il � ,� Phone (503) 639 -4171 L� 1°1
=� I I FAX (503) 684 -7297 DATE ISSUED I�I
TDD No. (503) 684 -2772
CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BY ` +
PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTALLATION. _ .: _ _ . _ _ _ 4. TYPE OF WORK
PcLC& r3 I(S - .s. Wr Y y
Address RESIDENTIAL — Restricted Energy Fee $40.00
y-� ��
& 7 7Z � (FOR ALL SYSTEMS)
City lI State Zip Check Type of Work Involved:
PERMITS ARE NON - TRANSFERABLE AND NON - REFUNDABLE AND EXPIRE IF WORK ❑ Audio and Stereo Systems*
IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR
180 DAYS. ❑ Burglar Alarm
❑ Garage Door Opener*
2. CONTRACTOR APPLICATION
L ❑ Heating, Ventilation and Air Conditioning System*
Contractor G ���C (, Type gC�� J ❑ Vacuum Systems*
Address /((0 PI- CV • ,rci2s€ Arc 9 72e9� ❑ Other
Date /J l/ a./q] COMMERCIAL — Fee for each system $40.00
(SEE OAR 918 - 260 -260)
Property Owner Ecv e" / 6W q Check Type of Work Involved:
Contractor's Board Reg. No. /2.5736 I' ❑ Audio and Stereo Systems*
❑ Boiler Controls
Phone # 2_2 7- as ❑ 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 ❑ utdoor 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 erson signing for this permit must be the applicant or a person $ C?? P g g P PP P a. Enter Fees
authorized to bind the a plicant.
b. 5% Surcharge (.05 x total above) $ Z
Signature
TOTAL $ ( 7 ( 7
Authority if other than applicant
ENERGAP.CHP