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Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd. e L �� - b / /Y1
Tigard, OR 97223 PERMIT # 1 tJ
Phone (503) 639 -4171 DATE ISSUED 3 "I �' /
A' l/
� �i FAX (503) 684 -7297
- TDD No. (503) 684-2772
CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BY ll l
PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTALLATION 4. TYPE OF WORK
(537 b s . RecrC I
Address Q `n RESIDENTIAL — Restricted Energy Fee $40.00
T 1 Gt!'(J' c: Q q (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. CONT CTOR APPLICATION ❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System•
Contractor L'1)► nA 57 S ^- ❑ Vacuum Systems*
[ ❑ Other
Address 1 `\ 0 1/4A,. / • f (fitneit pof 1.. 02. '1 Z 0
Date II $ ( 7 COMMERCIAL — Fee for each system $40.00
11 (SEE OAR 918 - 260 -260)
Property Owner AnOC-wS MG^cA he^^ /0— Check Type of Work Involved:
Contractor's Board Reg. No. L 34 ❑ Audio and Stereo Systems
❑ Boiler Controls
Phone # 2 Z 7 C' 5 - 7 / ❑ Clock Systems
3. OWNER APPLICATION ❑ Data 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
121- 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
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 this permit must be the applicant or a person a. Enter Fees $ l4 G . U 0
authorized to bind the applicant.
b. 5% Surcharge (.05 x total above) $ 0 0
Signature
TOTAL $ 2 00
Authority if other than applicant
ENERGAP.CHP