Permit SEP -01 -1995 1501 GARY'S UnCUFLO, INC. P.02 /�
ter- CD t" t w ■�rt�i -.k.-‘J.3) -.k.-‘J.3) RESTRICTED
® 131 as- c.1 r � ELECTRICAL
T r- Q ENERGY
Info APPLICATION
PLEASE PRINT
Please complete all sections. 1 through 5. ' Permit No. ie12 9S.-_ h l09
1. Location of installation Date
Address t �&�Lp 0.,11 v.�oC s - s- - 9s`
City Tr Zip Code 4. Type of work:
Map No. Tax Lot RESIDENTIAL DENTIAL Restricted Energy Fee $40.00
Thomas Map Book: Page Section (for all systems)
Check 1,ype of work Involved:
Directions all 017C04'Ipa -55+
Audio and Stereo Systems
Commercial 1 Residential Burglar Alarm
Telephone Systems'
Tenant Name Garage Door Opener
(if commercial) Fire Alarm
Heating, Ventilation and Air Conditioning Systems*
2. Contractor application: Vacuum Systems*
Other
Electrical Contractor -
r: 1111" S 1'A(.;UF[.O. INC. 775-2042 COMMERCIAL Fee for each system $40.0
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(see OAR 918-260-260)
t i l l lw S 1 I I. 1 �' I?.1 I' "!' .1) O l t 0 7 2 l i — l l , : _ / _ _ , J �O i . 5 Check type of work Involved:
r: L l 2072/4. , J I. v 985. (' (:' B: 110047 — Boiler Controls
Phone No. Clock Systems
- Data Telecommunications installations
3. Owner application: Fire Alarm Installation
HVAC
Instrumentation
Print Owner's Name Phone No. Intercom and Paging System
Landscape Irrigation Control'
Address Medical
Nurse Calls
City State Zip Outdoor Landscape Lighting'
This permit is issued under OAR 818 -320470. The applicant agrees Protective Signaling
to make only restricted energy installations (100 volt amps or less) Other
under this permit end to do the following:
1, Only use electrical licensed persons to do Installations Where
required. (Certain residential and other transactions are exempt Number of Systems
from licensing. These have asterisks ('). All others treed licens-
ing.)
2. Call for an inspection when ail the installations under this permit " No licenses are required. Licenses are required for all other installations,
are ready for Inspection.
3. Pdrehase separate permits for all installations that are not ready 5. Fees
for inspection When the inspector Is out to inspect under this G /� (�
permit. Enter fees $ (/
4. Assume responsibility for assuming that all corrections required
- 7 0
by the inspector are done, and
5. Assume responsibility for calling for a final Inspection when all of 5% Surcharge (.05 X total above) $ dor
the corrections are completed.
The person signing this permit must be the applicant ors person Trust Account $ �1�7 C
authorized ro bind the ap 1
Signature !
s 4. . I 0 Total $ L I d
Authority if other than applicant This permit becomes null and void If the work authorized by the
permit Is not commenced within 1130 days from date of issuance
For Inspections call of such permit or if the work authorized is suspended or abandoned
640 -3561 cc � at any time after work is commenced for a period of 180 days.
`�® °561 ®� t6D�>,7 "q °O�� Electrical Permits are non - refundable and non- transferable.
24-hour recorder, one working day in advance of need 6Lza tta
5/9/99 Activity for Case #: ELR95 -00109
8:34:01 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRA800 Case finaled 10/29/95 MJR YES MJR 3/1/96 see MST95 -0206
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