Permit CITY OF T I G A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
� DEVELOPMENT SERVICES PERMIT #: ELR2000 -00083
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 04/19/2000
SITE ADDRESS: 15055 SW SEQUOIA PKWY 120 PARCEL: 2S112DA -00800
SUBDIVISION: ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Install protective signaling.
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: : HVAC: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER: :
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES AMERICAN SECURITY ALARMS
15350 SW SEQUOIA PKWY #300 -WMI 5411 SE MCLOUGHLIN BLVD
PORTLAND, OR 97224 PORTLAND, OR 97202 -4898
Phone: Phone: 231 -0303
Reg #: LAC 00058640
ELE 26- 283CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
5PCT GEO 04/19/200C $4.80 0001550 Elect'I Final
PRMT GEO 04/19/200C $60.00 0001550
Total $64.80
ORIGINAL
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 you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OA: ! 52 -00 1080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987. 1 dr /� /�
Issued by i « ✓i, '. - - Permittee Signature � JLz�i'r .L/G
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: /v/ DATE: 1 , — /9 - D o
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
____ -- t�/IUUY
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by:
13125 SW HALL BLVD Date Recd:
TIGARD OR 97223 PRINT OR TYPE
V - 503 - 639 -4171 X304 Permit #:fatReav
F - 503 - 598 -1960 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee $60.00
len Insurance Gompan (FOR ALL SYSTEMS)
JOB eat Address Ste
ADDRESS 15055 SW S % o O.PQYKW011, 2() Check Type of Work Involved:
yt to o "G P hon e # ❑ Audio and Stereo Systems RECEIVED
' of /s tti C1(, b� 2,. 51 -In3o
lame ❑ Bur lar g Alarm APR 1 7 2O00
1 7 46/r/e rY /72SSe---
OWNER TI�A�s ❑ Garage Door Opener* COMMUNITY DEVELOPMENT
,jty /St Zip Phone # ❑ Heating, Ventilation and Air Conditioning System
V / 93X3
Name n r1 N (� -� , n El Vacuum Systems'
A►, ej lju l S .o.unV Aka( ,..I�Y ❑ Other
CONTRACTOR Ming dd �5E YY�Cress
�� Lo In �IVt ._ TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a ity/ to Zip Phone # Fee for each system $60.00
copy of all licenses ()f i ( Q) y� (I a.3 -()30
,► 1` na (SEE OAR 918 - 260 -260)
are required if Oregon o9t Bid Lic. # Exp. Data
expired in C.O.T. bb,, / 2 29_0/ Check Type of Work Involved:
data base). Elect al Con Llc. # Exp. Date
rl o(p - 3 C /O-1 OD ❑ Audio and Stereo Systems
C.O.T o/� Metro Lic. # Exp. Date
o U %7 7-1-00 _ ❑- Boiler Controls
Owner's Name - -
n ' Clock Systems - r
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 El Landscape Irrigation Control*
inspection at 503 - 639.4175;
Medical
3. Purchase separate permits for all Installations that are not ready for an ❑
inspection when the inspector is out to inspect under this permit; Nurse Calls
4. Assume responsibility for assuring that all corrections required by the ❑ Outdoor Landscape Lighting*
Inspector are done, and;
S. 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. 1 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 applican
/ / FEES:
Sig ure
13ER FEES $ ( 0.00
O � SURCHARGE (s86X TOTAL ABOVE) $ 4.� 1)
Authority if other than Applicant TOTAL $ 6)4 -
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