Permit Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 PERMIT # L 9.- 00
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/4 � 0 li Phone
FAX (503) 6847 297 DATE ISSUED p-119.5
c- ` - TDD No. (503) 684 -2772
CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BY j , ` 3
PLEASE COMPLETE ALL SECTIONS .
1. LOCATI • N 0 IN TA _ : TION / 4. TYPE OF WORK
.
Addr � / RESIDENTIAL — Restricted Energy' ` �8 �
(FOR ALL SYSTEMS) ®�
$40.00
� & 7 r `J ��jjT fj
City ! State / Zip rrr Check Type of Work Involved: 4e
PRMITS ARE S NOT STARTED W THN DAYS OF ISSUANCE ORDE WORK AND
SUSPENDED FOR
OR ❑ io and Stereo Systems*
180 DAYS. Burglar Alarm
❑ Garage Door Opener*
2. CONTRACTOR APPLICATION
❑ Heating, Ventilation and Air Conditioning System*
Contractor /407 Type ❑ Vacuum Systems* .
Address 743 /V�� �� e, ❑ Other
Date — — A COMMERCIAL — Fee for each system $40.00
(SEE OAR 918 - 260 - 260)
Property Owner / Check Type of Work Involved:
Contractor's Board Reg. No. 6 ❑ Audio and Stereo Systems*
❑ Boiler Controls
Phone ❑ Clock Systems
3. OWNER APPLICATION ❑ Data Telecommunication Installations
C .{ CI Fire Alarm Installation
6 l� lL Z� J ❑ 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 ❑ Outdoor Landscape Lighting*
following:
1. Only use electrical licensed persons to do installations where required. (Certain El 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 person signing for this permit must be the applicant or a person a. Enter Fees $ .0Z e
author - - - e'.. the applicant. ��,,,..��V ��
b. 5% Surcharge (.05 x total above) $ CP Z./
Signature $4.- dZ
TOTAL $
Authority if other than applicant
ENERGAP.CHP
2/29/00 Activities for Case #: ELR95 -00049
4:28:59 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRA003 Application received 7/13/95 SUE RECD TMP 12/22/95
ELRA010 Permit created 7/13/95 SUE PEND TMP 12/22/95
ELRA700 Ceiling Cover 7/13/95 • TMP 12/22/95
ELRA720 Wall Cover 7/13/95 TMP 12/22/95
ELRA730 Elect'I Service 7/13/95 TMP 12/22/95
ELRA799 Elect'I Final 7/13/95 TMP 12/22/95
ELRA500 (F) Issue permit 7/13/95 SUE PASS TMP 12/22/95
ELRA580 Expired by limitation 2/28/00 HAP DONE No Hold AKJ 2/28/00
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