10440 SW CENTURY OAK DRIVE STE 44 r
0
�J t4 G v
J iw �.
1-4
i
wi
s Lit P;r
13 �
r r y L
r
,. _ o
Im
tv
\, (� ve '7vC K 'i7 F1 h
tj!
� ' 1
(` V
v
X
10440 SW CENTURY OAK DRIVE
CITY OF TIGARD
DEVELOPMENT SERVICES
13125 SW Hall Blvd., Tigard, OR 97223 (503)639.4171
N�i�-
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by:
13125 SW HALL BLVD Date Recd
TIGARD OR 97223 PRINT OR TYPE r (-ky7.
V- 503-639-4171 X304 f c Permit#: / 7
F - 503-684-7297 �1I� -I INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED -RESIDENTIAL
Restricted Energy Fee....................................... $40.00
(FOR ALL SYSTEMS)
JOB Street Address '*'
Check Type of Work Involved:
ADDRESS
Cite Phone# _ E] Audio and Stereo Systems
— --�-~
Name /� /► ,tA L, ilk
Burglar Alarm
. MA I k I L L ry ' PV Y' _ Garage Door Opener-
OWNER Mailing Address
Heating,Ventilation and Air Conditioninq System'
City/State Zip Phone#
-- E] Vacuum Systems*
Name
A91 SFLI!RITY SERYL q.talc. Other _-- ------------
CONTRACTOR Mailing AddreNRl!RHD,OR 9".17 TYPE OF WORK INVO'.VED -COMMERCIAL
(iO3)T84 3265 — — -- -
Fee for each system...... ...................... $40.00
(Prior to issuance a City/Slate Lip Phone#
(SEE OAR 918-280-260)
copy of all licenses
are required if Orego r r # Exp to Check Type of Work Involved
expired in C O 1'.
data base) Electric I Conti L c xp.Fate
LICIO
7 Audio and Stereo Systems
C.O.T.or Metro Lic # E)O Date
n Boiler Controls
Owner's Name ❑
Clock Systems
OWNER - Mailing Address ❑
Data Telecommunication Installation
A^PI_ICANT
City/State Zip Phone# J
Q Fire Alarm Installation
This permit is issued under OAE 918-320-370 This applicant agrees to HVAC
make only restricted energy installations(100 volt amps or less) in&v this
permit and to do the following: F_� Instrumentation
1 Only use electrical Iicena sd persons to do installations where required.
Certain residential and other transactions ire 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 503.538-4176; Medical
3 Purchase separate permits for all Installations that are not ready for an EJ Nurse Calls
inspection when the inspector is out to inspect under this permit,
d Assume responsibility for assuring that all corrections required by the
Outdoor Landscape Lighting'
inspector are done,and, E] Protective Signaling
5 Assume responsibility for calling for a final inspection whon all of the
corrections are completed. Other
Permits are non-transferable and nnn refur.lable and expire if work is not
start5tureyjf
of issuanc r i`work is s pended for 180 days Number of Systems
The his pe must be th pplicant or a person No Iicen res are required Licenses are required for all other installations
authppli t — -- -----
FEES:
ENTER FEES s�U
Sig
SURCHARGE(.05 X TOTAL ABOVE) $ r?'
Cro
Authority if other thanApplicant _ J TOTAL $ --
Vesele doc 12199