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Permit
17, • ,CITY OF TIGARD ELECTRICAL PERMIT — COMMUNITY DEVELOPMENT DEPARTMENT RESTRICTED ENERGY 13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171 PERMIT #: EL R96 -10221 DATE ISSUED: 07/10/96 PARCEL: 151260C -01403 SITE ADDRESS...: 09300 SW WASHINGTON SQUARE RD SUBDIVISION ZONING:C- -G BLOCK LOT Project Description: • 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: - - -- -- - - - -- FEES --- MAY DEPARTMENT STORES , . type amount by date recpt 611 OLIVE ST PRMT $ 40.00 CJS 07/10/96 96- 281454 SPCT $ 2 °00 CJS 07/10/96 96- 281454 ST. LOUIS MO 63101 Phone #: Contractor: - - - -- - - -- CDT SECURITY ALARMS $ 42.00 TOTAL 703 NE HANCOCK REQUIRED INSPECTIONS PORTLAND OR 97212 Wall Cover Elect'1 Final Phone #: 503 -284 -3265 Elect' 1 Service Reg #.. : 59944 This permit is issued subject to' the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other Permitee Signature , 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 LL�r��' LP s " - than 180 days. Issued By - -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: FYI C4-1 16S DATE: C" LICENSE NO: Call for inspection — 639 -4175 • 1, r r4 Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION , 13125 SW Hall Blvd. Tigard, OR 97223 PERMIT # FL R96 - o as h� il � Phone (503) 639-4171 ',All FAX (503) 684-7297 DATE ISSUED /O - TDD No. (503) 684 -2772 // CITY OF TIGARD Inspection (503) 639-4175 , ISSUED BY 0 f I`e_..S . -J, m / CA , PLEASE COMPLETE ALL SECTIONS 1. LOCATION OF INSTAL ' TIO , n 4. TYPE OF WORK Addr a , / RESIDENTIAL — Restricted Energy Fee $.00 / ' 7/.0 / ©r I 40 9 -a3 (FOR ALL SYSTEMS) City / State Zip Check Type of Work Involved: PERMITS ARE NON - TRANSFERABLE AND NON - REFUNDABLE AND EXPIRE IF WORK ❑ Audio and Stereo Systems IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. ❑ Burglar Alarm 2. CONTRACTOR APPLICATION ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* Contractor AIN CEry_ )RITY SYSTEMS. lM Vpe ❑ Vacuum Systems* 703 NE HANCOCK ❑ Other Address PORTLAND, OR 97212 (503) 284.3265 Date 7- d , 9.4 COMMERCIAL — Fee for each system $40.00 (SEE OAR 918- 260 -260) Property Owner /21117e/K T Check Type of Work Involved: Contractor's Board Reg. No. • C j 9 Ti ❑ Audio and Stereo Systems ❑ Boiler Controls Phone # ❑ Clock Systems 3. OWNER APPLICATION ❑ Data Telecommunication Installations - ❑ Fire Alarm Installation A � fey 4: I Eeljael / -,_c ❑ 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 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 5. FEES corrections are completed. The person signing for t : • • it must be the applicant or a person a. Enter Fees $ • 46 autho ized to -' - . /.p' ant. �� b. 5% Surcharge (.05 x total above) $ 06 Signature TOTAL $ d O Authority if other than applicant ENERGAP.CHP