Permit \,; * IGINAL ELECTRICAL PERMIT -
CITY TIGA s�i RESTRICTED ENERGY
rA DEVELOPMENT SERVICES PERMIT #: ELR1999 -00324
`- "I ! 13125 SW Hall Blvd., Tigard, OR 97223 (503) : "�•_ 'z � DATE ISSUED: 1/3/00
r� PARCEL: 2S110CD -00104
SITE ADDRESS: 11725 SW QUEEN ELIZABETH ST * ** �
SUBDIVISION: KING CITY NO. 2 �!Y ZONING:
BLOCK: LOT: �,V RISDICTION: KIN
Project Description: Installation of irrigation control.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPEIIRRIGAT: X
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: Contractor:
JOHN D. MEDAK CEDAR LANDSCAPE
VIUHKOLA, JENNIFER 14145 SW GALBREATH DR
4029 NE SANDY BLVD. SHERWOOD, OR 97140
PORTLAND, OR 97213
Phone: 287 -5718 Phone: 625 -3700 •
Reg #: LIC 75535 _
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT DEB 1/3/00 $60.00 00- 320825 Elect'l Final
5PCT DEB 1/3/00 $4.80 00- 320825
Total $64.80
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 o low rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -• • -0010 throug ' OAR 952 - 001 -0080. You may obtain copies of these rules or direct quest •ns to OUNC at (503)
24: -1987.
I - sued by i # I / �� 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 639 -4175 by 7:00 P.M. for an inspection needed the next business day
•
CITY OF TIGARD R MgED ENERGY ELECTRICAL APPLICATION Rec'd b .
/YIOtc.�/
13125 SWHALL BLVD Date Rec'd: / 7-''
TIGARD OR 97223 DEC 3 0 PRINT OR TYPE
V - 503 -639 -4171 X304 1999 Permit #: ea/9 5 . 2 y
F - 503 - 598 -1960 COMMUNITY DEVELOPMENT IN WILL BE ACCEPTED CATIONS Cust.Cali'd:
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
J _ /,� (�, Restricted Energy Fee $60.00
CG�()l W , „(� e?L. (FOR ALL SYSTEMS)
JOB Street Address Ste
ADDRESS f ,x-'. A , t, U/ Check Type of Work Involved.
.ci)y /State „, D � Zjp , S/ f Phone # ❑ Audio and Stereo Systems Yy
Nanfe/ l I 9' ❑ Burglar Alarm
C 01 QM die Corn
❑ Garage Door Opener'
OWNER Mailing Address
City /State Zip Phone # ❑ Heating, Ventilation and Air Conditioning System'
Name ❑ Vacuum Systems*
• Ce Lord5cape ❑ Other
CONTRACTOR M ilin Address
PI /1jj - a- akrectA Or TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a /State I //�� Zi P ho e # Fee for each system $60.00
copy of all licenses c e rc tX�cr' t;1 7 iy 0 6? ,3 (SEE OAR 918 - 260 -260)
are required if Oregon Contr. Brd Lic. # Exp. Da
expired in C.O.T. 5e y a Check Type of Work Involved:
data base). Electrical Contr. Lic. # Ex p. ate
68Y3 6 pp ❑ Audio and Stereo Systems
C.O.T. or Metro Lic. # rl1/3 Exp. ❑
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;
2. Call for inspections when installation under this permit are ready for
Z Landscape Irrigation Control*
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
I
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.
J„ - FEES:
tT/1115r . _
���iiip� ENTER F $
• nature ��U �/ `�
SURCHARGE (.05 X TOTAL ABOVE) $ Y. 50
Authority if other than Applicant TOTAL $ l 50
i:\dsts \forms\resele.doc 3/98
. .
laid KING CITY
15300 S.W. 116th Avenue, King City, Oregon 97224 -2693
■ Phone: (503) 639 -4082 • FAX (503) 639 -3771
Notice To Contractors Working In King City
Due to an intergovernmental agreement with the City of Tigard, many building related permits
for projects in King City are issued and inspected by the City of Tigard.
If your permit application DOES NOT REQUIRE PLAN REVIEW, simply complete the
appropriate application legibly and submit it to the King City staff. The King City staff will
collect all fees and fax the application to the City of Tigard. City of Tigard staff will then create
the permit, issue the permit, and perform inspections. Please indicate on the permit application
whether you would like the Tigard staff to call you when the permit is ready for issuance or
whether you prefer it to be mailed without any notification. Any incomplete or illegible
application will be returned to King City staff for correction and no processing will occur until a
complete, legible application is received.
If your permit application DOES REQUIRE PLAN REVIEW, this form must be signed by a
King City staff person. King City staff will simply sign this form indicating land use approval..
Take this signed form to the City of Tigard Development Services Counter located at 13125 SW
Hall Blvd, Tigard, to submit applications and plans. Development Services Technicians are
available at 639 -4171 Ext. 304 should you have any questions concerning submittal
requirements. All permit fees will be assessed and collected at the City of Tigard.
The City of King City hereby authorizes applicant to pursue permits at the City of Tigard
Building Department for the following project: OYe _ • .i _ 4 . _ , % 71.
located at: / /135 51-3 &cla .
/Zei w
King City Representativ
1:'DSTS XCI \ST DOC