Permit CITY OF TIGARD
itv, IA\ DEVELOPMENT SERVICES
� -. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 ELECTRICAL PERMIT —
RESTRICTED ENERGY
PERMIT #: ELR96 -0339
DATE ISSUED: 10/31/96
PARCEL: 1S126OC -01107
SITE ADDRESS...: 09400 SW WASHINGTON SQUARE RD #MERV
SUBDIVISION ZONING:C —G
BLOCK • LOT °
Project Description: Installing a data telecommunications system — 2nd floor
RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO...: AUDIO & STEREO..: INTERCOM & PAGING..:
BURGLAR ALARM BOILER LANDSCAPE /IRRIGAT..:
GARAGE OPENER CLOCK MEDICAL °
HVAC • 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
LAKE ELECTRONICS type amount by date recpt
124 SE 11TH AVE PRMT $ 40.00 B 10/31/96 96- 285982
5PCT $ 2.00 B 10/31/96 96- 285982
PORTLAND OR 97214
Phone #: 503 -234 -3044
Contractor:
— $ 42.00 TOTAL
REQUIRED INSPECTIONS
Ceiling Giver Elect'1 Service
Phone #: Wall Co -r Elect '1 Final
Reg #.
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other P - r m i t e e S i g n at ur e
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. 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 : DATE: -
LICENSE NO:
Call for inspection — 639 -4175
Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd. �J //_
Tigard, OR 97223 PERMIT # i- j i
�l(X - 03'i
/ ✓
6.4 0, Phone (503) 639 -4171 I 0 _ 31 — e
, I I I FAX (503) 684 -7297 DATE ISSUED
TDD No. (503) 684 -2772 Q '/�� /► ��
CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BY 8 , Y i ,'„'
PLEASE COMPLETE ALL SECTIONS
/1. LOCATION OF I TALLATION ^^AA 1; sr�' ar 4. TYPE OF WORK
ii 5 ^ b ZKJ Ove lV�vr W J� j . �re.
(FOR ALL SYSTEMS)
Add
1
r Lax
r RESIDENTIAL — Restricted Energy Fee $40.00
�� p 1 7 1 City J State Z 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'
� �+�yp � � ❑ Heating, Ventilation and Air Conditioning System'
Contractor C' e . l.- e-/ ❑ Vacuum Systems*
Address Pf - C. 5C �� ❑ Other
Date 0 '(� COMMERCIAL — Fee for each system $40.00
\ (SEE OAR 918- 260 -260)
Property Owner J ►'%, 5 A 0. - r ' Check Type of Work Involved;
Contractor's Board Reg. � N 7 o. -, D ❑ Audio and Stereo Systems
Phone # J 9 — 30'I LI ❑ Boiler Controls
('OS)?"
❑ Clock Systems
3. OWNER APPLICATION 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:
❑ Protective Signaling
1. Only use electrical licensed persons to do installations where required. (Certain
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 I
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. $fl
The person signing for this permit must be the applicant or a person a. Enter Fees $ io
authorized to bind the applicant.
b. 5% Surcharge (.05 x total above) $
Signature or0
TOTAL $ [2 —
Authority if other than applicant
ENERGAP.CHP
A.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
Plbg.Und/FIr/Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other: 3 .4420.- 4-4 t✓
Date:(/ ! < A.M. P.M. 4 Entry:
Address: " V ��, / ,. �
� f w
Tenant: Q�,, C�-7 Ste: MST:
OOwn:d-4P-e. 7 ! / -- ga(0 MEP:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR: 4
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/
1t/ /G�1 .2 C .._ ,..9,-
,e 11�7 C )---..„.,.____i_. 9
/ -5 Inspector: / -P.- � �, - Datey/
/APPROVED DISAPPROVED /CALL FOR REINSP. CO
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