Permit CITY OF TIGARD
DEVELOPMENT SERVICES ELECTRICAL PERMIT —
RESTRICTED ENERGY
PERMIT #: ELR97 -0369
DATE ISSUED: 12/29/97
PARCEL: 2S1O2CB -00303
SITE ADDRESS...:13165 SW PACIFIC HWY
SUBDIVISION -NORTH TIGARDVILLE ADDITION ZONING:C —G
BLOCK • LOT •033 JURISDICTN: TIG
Project Descri pt ion : Installation of intercom /paging system.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO...: AUDIO & STEREO..: INTERCOM & PAGING.. :X
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..: ..
TOTAL # OF SYSTEMS: 1
Owner: FEES
JOHN POORMAN type amount by date recpt
13165 SW PACIFIC HWY PRMT $ 40.00 DRA 12/29/97 97- 302075
TIGARD OR 97223 5PCT $ 2.00 DRA 12/29/97 97- 302075
Phone #:
Contractor:
MUZAK LTD $ 42.00 TOTAL
2901 3RD AVE
STE 400 REQUIRED INSPECTIONS
SEATTLE WA 98121 -1042 Ceiling Cover Low Voltage Insp
Phone #: 253 -7573 Wall Cover Elect'1 Final
Reg it..: 000866
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 Utilit • •cation Center. Those rules are set forth in OAR 952-001 -0010 through OAR 952- 001-N80. You may obtain copies of
these rule or direct estions to OUNC at (5031246 -1987.
Issued
y P e r m i t t e e Signature �� Pry
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 Rec'd: /2
TI OR 97223 PRINT OR TYPE
V - 503 - 639 -4171 X304 Permit #: 6212.17
F - 503 -684 -7297 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL
Restricted Energy Fee $40.00
Bu v p - I C ,^ (FOR ALL SYSTEMS)
JOB Str a re s F !e I_ / "y Ste # Check Type of Work Involved:
ADDRESS T
C_it.State k pp z __ . _ hone # ❑ Audio and Stereo Systems
Na ❑ Burglar Alarm
OWNER Mailing Address ❑ Garage Door Opener'
City /State Zip I Phone # ❑ Heating, Ventilation and Air Conditioning System'
Name
Autivik,b-d p �✓1r I ❑ Vacuum Systems'
'PAhm+-stit t o ❑ Other
CONTRACTOR n9FSe 3 DC1 -d -) TYPE OF WORK INVOLVED - COMMERCIAL
(Prior to issuance a �f Y/S � _' ,�/� Zi Phone # Fee for each system $40.00
copy of all licenses t'��� V e- 47 Z3 - 1 C73 (SEE OAR 918-260 -260)
are required if Oregon Contr. Brd Lic. # . D to
expired in C.O.T. '9 CpCi ( � Check Type of Work Involved:
data base). Electrical ontr. L o il (
z ,( & U �I 6 g El and Stereo Systems
WOO -r ? 67
❑ Boiler Controls
Owner's Name
❑ Clock Systems
OWNER - Mailing Address
APPLICANT ❑ Data Telecommunication Installation
City/State Zip I 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
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. 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 applicant.
4/0 .._ / 1 11 °�
Signature ENTER FEES $ �' V
5% SURCHARGE (.05 X TOTAL ABOVE) $ v�
Authority if other than Applicant TOTAL $ t '
i:Vesele.doc 12/98 —