Permit • = CITY OFTIGARD
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� DEVELOPMENT SERVICES ELECTRICAL PERMIT
RESTRICTED ENERGY
PERMIT #: ELR98 -0255 '
DATE ISSUED: 09/15/98
PARCEL: 25113AB -00600
SITE ADDRESS °.° :16170 SW UPPER BOONES FERRY RD #BLD°
SUBDIVISION. °°° :FANNO CREEK , ACRE' TRACTS ZONING :I —L
BLOCK ° LOT JURISDICTN: TIG
Project Description: Installation of data telecommunications system.
A. RESIDENTIAL - -- -- B. COMMERCIAL - - --
AUDIO &. STEREO. ° °: AUDIO & STEREO ° °: INTERCOM & PAGING ° °:
BURGLAR ALARM °°°°: BOILER LANDSCAPE /IRRI GAT. .:
GARAGE OPENER. ° ° °° CLOCK „ °.. MEDICAL ° ° ° ° ° ° ° ° ° „ ° °°
HVAC ° ° ° ° °o °.. ° ° ° °° DATA /TELE COMM ° ° :X NURSE CALLS .. ° ° ° °
VACUUM SYSTEM •FIRE ALARM......: OUTDOOR LANDSC'LITE:
OTHER: HVAC PROTECTIVE SIGNAL ° °:
INSTRUMENTATION.: OTHER..: ° °
TOTAL # OF SYSTEMS: 1 -•
Owner: - •--- - ---•- - _ - __ - - - _ - -- -_ FEES --- - __ _ _ - ---
PACTRUST type amount by date recpt
15115 SW SEQUOIA PKWY STE° 200 PRMT $ 40.00 DEB 09/15/98 98-309167
PORTLAND•OR 97224 SPOT $ 2.00 DEB 09/15/98 98- 309167
Phone #: 6246300
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Contractor: - - - - -- - - --
FLLEN /FAIR INC $ 42. TOTAL_
9020 SW GEMINI
— - - -- REQUIRE :D INSPECTIONS - - - - - - --
BEAVERTON. OR 97008 Ceiling Cover Low Voltage Insp
Phone # :. 646-0533 Wall Cover Elect' 1 Final
' Reg #. ° ° 47238
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. 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 issu -. r, or ark is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rule adopted by the
Oregon Ut• ity Notificatio Center. Those rules are set forth in OAR 952 -•'ti1 -0010 through OAR 952 -001 -0088, You may obtain copies of
these rules or direct questions to OUNC a (503)246 -1987.
Issuec: by Perm ittee Signature vV
---------- -• - -- -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' tel: DATE:
LICENSE NO :
++++++++++++++++++++++++++++++- F+ + + + + + + ++ ++ + + + + + + + + + + + + + + + + +++ 1- 1-4- + + + + + +++ + + + ++ + ++
Call 639- -4175 by 7 :00 P.M. for an inspection needed the next business day
+ ++ ++ + + + + + + + + ++++ •+• +++++++++++++++++++++++++++++++ + + ++ + + + + + + + + + ++ ++ + + + + + + + + ++ + +++
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CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by: ill ` ,
13125 SW HALL BLVD Date Rec'd: _ 0- /5
TIGARD OR 97223 PRINT OR TYPE /1
V - 503 - 639 -4171 X304 Permit #: EL i29T -025
F - 503 - 684 -7297 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee $40.00
- 30 \ (\ C ro.t v1L T-r(1C,. (FOR ALL SYSTEMS)
JOB Street Address Ste #
Check Type of Work Involved:
ADDRESS Iun Svc► LI,otu - t2Sc-evr�r� .
City /State Zip Phone-it ❑ Audio and Stereo Systems
Name) ❑ Burglar Alarm
OWNER Mailing Address ❑ Garage Door Opener*
City /State l Zip I Phone # ❑ Heating, Ventilation and Air Conditioning System*
Name I ❑ Vacuum Systems'
ti""A I Ca-1 t -1-"-. ❑ Other
CONTRACTOR Mailing Address
C V - ) .C) 5.,l C - .'e ■v�. �tr■V.¢ -- TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a it /State Zip Phone # Fee for each system $40.00
copy of all licenses Q.a ` MOO$ t94b -0533 (SEE OAR 918 - 260 -260)
are required if Oregon Contr. Brd Lic. # Exp. Date
expired in C.O.T. y,'a;1)g 51 qa Check Type of Work Involved.
data base). Electrical Contr. Lic. # Exp. Date
— a58CLE \O /c ❑ Audio and Stereo Systems
C.O.T. or Metro Lic # Exp Date
0 3555 "Rig ❑ Boiler Controls
Owner's Name
❑ Clock Systems
OWNER - Mailing Address
APPLICANT Er 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; •
❑ 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 Landscape Lighting'
inspector are done, and;
❑ 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 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 applicant
/ _/ FEES: � 1
.f i ∎/- TYD- -� &v C �{/ 7` 66 ENTER FEES $ — fD. 00
Sgn 5),,,o '
e
5% SURCHARGE (.05 X TOTAL ABOVE) $ a 00
Authority if other than Applicant TOTAL $ LIP. O°
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