Permit •
CITY OFTIGARD
DEVELOPMENT ������U������
-- - ---' -'-' - ' SERVICES
'~~-- ELECTRICAL PERMIT -
~— 13125 SW Hall Blvd., � �, ^-' '' RESTRICTED ENERGY
PERMIT #: ELR97-0150
DATE ISSUED: 05/27/97
PARCEL: 2S104DD-02600
SITE ADDRESS...:12873 SW RIDGEFIELD LN
SUBDIVISION •MOUNTAIN HIGHLANDS #2 ZONING:R-4.5 PD
BLOCK • LOT •023 JURISDICTN:
Project Description: IRRIGATION SYSTBN C0MOL
_
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:CLOCK HVAC ^ PROTECTIVE SIGNAL..:
INSTRUMENTATION.: OTHER..: ::
TOTAL # OF SYSTEMS: 0
Owner: FEES
JEFF & CINDY RODGERS type amount by date recpt
10889 SW DOVER CT PRMT $ 40.00 JMH 05/27/97 97-294981
TIGARD OR 97223 5PCT $ 2.00 JMH 05/27/97 97-29498
1
Phone #: 639-3049
Contractor:
OWNER • $ 42.00 TOTAL
REQUIRED INSPECTIONS
Elect'l Final
Phone #:
Reg #..: 000009
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permitee Signature
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 6A/001-��1
than 180 days. sued By
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 for inspection 639-4175
CIJY OP TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by: ..5 ' % 7
13125 SW HALL BLVD Date Rec'd: ,_,Iece--v,
TIGARD OR 97223 PRINT OR TYPE �-� �
V - 503-639-4171 F - 503 - 684.7297 X304 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Cali'd q7 -�P C y
WILL NOT BE ACCEPTED 1 a . 11-
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL U
/ ■ ft / Restricted Energy Fee $40.00
% /i Al- a-!/t (FOR ALL SYSTEMS)
JOB Street Address Ste #
ADDRESS I X73i.J Rid ffiz (. 1 Check Type of Work Involved:
City /State on e # ❑ Audio and Stereo Systems
1 kii 23 s - q4(1
Name ❑ Burglar Alarm
JJ ,F4 Ctild [Z ❑ Garage Door Opener*
OWNER Mailing Address A
/ 2 6 So. V. 1 L41 ❑ Heating, Ventilation and Air Conditioning System*
City /State i i■ Zip _ Phone #
1.661' 1 772 C - P 410 ❑ Vacuum Systems*
Name
Other / /) k----"
Mailing Address g ddress i
TYPE OF WORK INVO VED - COMMERCIAL
(Prior to issuance a City /State Zip Phone # Fee for each system $40.00
copy of all licenses (SEE OAR 918 - 260 -260)
are required if Oregon Contr. Brd Lic. # Exp. Date
expired in C.O.T. - - ype of Work Involv- •:
data base). Electrical Contr. Lic. # Exp. Date
❑ Audio and Ster • Systems
C.O.T. or Metro Lic. # Exp. Date
❑ Boiler Co • rols
One ' men
(� 8eAA ❑ C - k Systems
OWNER - Mailing Address ❑ �
APPLICANT L 2.87 3 Si. Rt -Q i L Data Telecommunication Installation CV/State. Ctate. /j i Phone #
/ Gt. v-a' q Z73 -S2 c 'r�'� ' Fire Alarm Installation
This permit is issued under OA'E 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:
MI rumen I :tion
1. Only use electrical licensed persons to do installations where required.
Certain residential and other transactions are exempt from licensing. ❑ Inter •m 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 L. • • - = : Lighting*
inspector are done, and;
❑ Protective S aling
5. Assume responsibility for calling for a final inspection when all of the
corrections are completed. ❑ Ot i
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 ust be the_applicant or a person * No licenses are required. Licenses are required for all other installations
author ez d to bind the applican
• FEES:
.gnati4- ENTER FEES $
5% SURCHARGE (.05 X TOTAL ABOVE) $
Authority if other than Applicant TOTAL $
i:\resele.doc 12/96 —
Permit #: _</ , - „ :0 / ;7,-, P- 4)-';!
/ 7.3 c ` / / M C A
y ✓�� Address: f
Q . ' = 1
'mom,.
' -. ' Z q
' Issued by: !�� Date �!
1x59% r �/ ! V /. //
Statement: Information Notice to Property Owners
About Construction Responsibilities
•
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B:
r�X 1. I own, reside in, or will reside in the completed structure.
I 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
ri 3A. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
a / -
3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify' -that the above i ormation is correct and that I have read and do understand the Information
Notice to ' roperty Owners a out-OW ruc ion Responsibilities on the reverse side of this form.
Sy? - 0/
c re fi applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
• •
• grOOrrnstIon NoVcs 2c Prrupeqiy Owneve
abou2 CoruslirucRkpn nesponsbNKkas
Note: This information Notice to Property Owners about Construction Responsibilities
was develop& by the Construction Contractors Board in accordance with ORS 701.055(5).
If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure,
you can prevent many problems by being aware of the following responsibilities and areas of concern.
IMPLOYE'R RESPOMEllEallUTIES:
If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the
construction or improvement of a residential structure, you will, in most instances, be ruled to be an employer and the people
you hire will be employees. As the employer, you must comply with the following:
Creg,ocr:I's with Thirg te As an employer, you mast withhold income taxes from employee wages at the time employees
are paid. You will be liable foi the teA, payments even if you don't actually withhold the tax from your employees. For more
information, call the Oregon Dept. of Revenue at 945-8091.
Unamp]oyinera`i, Ansuzance tP, As an employer, you are required to pay a tax for unemployment insurance purposes on the
wages of all employees. For more information, call the Oregon Employment Division at the Department of Human Resources
at 378-3524.
Wor'•cers' cornpemecrn iirc.:17irqrrrice As an employer, you a-e subject to the Oregon Workers Compensation Law, and must
obtain workers' corapensatio. i. for your employees. If you fail to obtain workers' compensation insurance, you may
be subject to penalties and w c liable for all claim costs if one of your employees is injured on the job. For more information,
call the Workers' Compensa;on Division at the Department of Consumer and Business Services at 945-7888.
111,f1, nternall SS77%,7: As an amplcyer, you must withhold federal income tax from employees' wages. You will be
liable for the tax payment eve :f yen r didn't actually withhold the tax. For more information, call the Internal Revenue Service
at 1-800-829-1040.
LESPONSCISP.,STES /AMP) AREAS OF COMCERN:
Code complkurace: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements
that may be brought to your attention through inspections.
LiaMity and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for
accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
re-done.
Time to supervise employees: Make sure you have sufficient time to supervise your employees.
Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and finish
trades, and to notify building officials at the appropriate times so they can perform the required inspections.
If you have additional questions, write or call the Construction Contractors Board (PO Box 14140, Salem, OR 97309-5052,
503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
prop-own .prn4
1 /94
6/9/00 Activities for Case #: ELR97 -00150 .
3:40:51 PM
•
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRA003 Application received 5/27/97 5/27/97 J *H 5/27/97
ELRA010 Permit created 5/27/97 5/27/97 J *H 5/27/97
ELRA100 Staff review 5/27/97 5/27/97 J *H 5/27/97
ELRA799 Elect'I Final 5/27/97 J *H 5/27/97
ELRA500 (F) Issue permit 5/27/97 JMH PASS J *H 5/27/97 mailed
ELRA580 Expired by limitation 5/3/00 HAP DONE No Hold AKJ 5/3/00
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