Permit Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
/ 13125 SW Hall Blvd.
Tigard, OR 97223 PERMIT # ,E,ZR y S- ep0,f ,
■ r A I I Phone
FAX (503) 684 -7297
TDD No. (503) 684 -2772 DATE ISSUED �� /��9s
A �/�/
CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BYEj�f�pd�i�```°)
. • .. : PLEASE. COMPLETE ALL SECTIONS
w,_
1. LOCATION OF INSTALLATION ' - 4 -- TYPE OF -WORK - -:.. -- ..- - - --
1 - ally - a . w. Sculls RI Ytoad
Address , — Restricted Energy Fee 'iin :_i
` ��. C` 6c (FOR ALL SYSTEMS)
City I State Zip Check Type of Work Involved: �>
PERMITS ARE NON - TRANSFERABLE AND NON - REFUNDABLE AND EXPIRE IF WORK * V ` 9
IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR ❑ Audio and Stereo Syste s
180 DAYS. ❑ Burglar Alarm
2. CONTRACTOR APPLICATION ❑ Garage Door Opener*
Hare, ,, ❑ Heating, Ventilation and Air Cone itioning System*
Contractor 4 CT, �;i ( • — • Type 4 L4) Va ll Gcre I iati - Ah ❑ Vacuum Systems*
Address q <1i 5.11) I,: -..4 - 1– �, 1(/�/ a- ❑ Other
O l� / 66 - 1. ta•AL.Rf. N, OR 970 - /665
Date COMMERCIAL — Fee for each system $40.00
• II (SEE OAR 918 - 260 -260)
Property Owner S/ V, ,t�ce /•f
,J -I. oSP 7LAL ee > o y eilir Check Type of Work Involved:
Contractor's Board Reg. No. // C €l7 S iU8 • 31 Ill) ❑ Audio and Stereo Systems*
^ s / r D ❑ Boiler Controls
� Phone # o[ L y ❑ 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 ❑ Outdoor Landscape Lighting*
following:
1. Only use electrical licensed persons to do installations where required. (Certain ❑ Protective Signalin
residential and other transactions are exempt from licensing. These have Other S4( vk ,1 Ci f'G1 l '/ ` iv f f rot e.r t- ear),
asterisks( *). All others need licensing). 1 I I )
2. Call for an insp when all of the installations under this permit are ready �������� U� f { -hS�
for inspection at 503-639-4175.
❑ I 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 $ 30.0 4
authorized to bind the applicant.
' r 4th — I i ce,ris -c. no. 311_ o C b. 5% Surcharge (.05 x total above) $ g• Q O
Signature
TOTAL $ IP - Q 6
Authority if other than applicant
ENERGAP.CHP
5f V,N Ce/4T - - S`/yA( Po - G
• CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: A. M. P.M. MST:
Location: D.-- / / i 1■ BUP:
Tenant: • . „ ,. _l • ! 1 Suite: 2 -00 Bldg: MEC:
r
.Contractor: is �'! � � I Phone: ( 7 70 - 7 7. 7 PLM:
Owner: Phone: ELC:
ELR: cf$' 0
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam PostBeam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service • MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Approved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL FINAL
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O Call for reins.. • 1 0 Reinspec on fee of $ required before next inspection El Unable to inspect
Inspector: Date: -S ` 7 � 7 ` . g`a pxt Page of
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