15930 SW CENTURY OAK CIRCLE �o
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15936 SW CENTURY QF CIP,CLE
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
31:'b SW Bell Blvd.Tigard,Oregon 07223.9109 (503)939-4171
_ EXPIRED
44
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Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
1325 Hall Blvd.
Tigard,\JR 97223 PERMIT#
_Z 96 'O0q6'
Phone(503)639-4171
FAX(503)684-7297 DATE ISSUED 3- 1/ - q6-
TDD No. (503)684-2772 �—
CITY OF TIGARD Inspection (503)639-4173 ISSUED BY '
PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTALLATION 4. TYPE OF WORK
���� RESIDENTIAL—Restricted Energy Fee. . . . . . . . . 1,44.00(FOR ALL SYSTEMS)
City State Zip Check Tyne of Work Involved;
I
Involved;,
ARE NON-TRANSrERABLE AND NON•REFUNDARLE AND EXPIRE IF WORK
S NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR ❑ Audio and Stereo Systems
180 DAYS. RLJ�Urglar Alarm
2. CONT CTOR APPLICATIO EDt,arage Door Opener*
�� � ---� � 1:1 t-lea. -,Ventilation and Air Conditioning System*
Contractor ViL Il.11,.e � pe^ ❑ Vacuum Systems'
Address&s� �V• �C�C�v ❑ Other_ _ _+
Datall 7 COMMERCIAL —Fee for each system . . . . . . . . . {�QQ
` / OAR 9171.260 1.6t'1
Property Owner � � c,,� Check Type of Work
k Involved:
Contractor's Board Reg. No. + / 7 ❑ Alidio and Stereo Systems
❑ Boiler Controls
Phone# El Clock Systems
3. OWNER APPLICATION El
ElData Telecommunication Installations
❑ Fire Alarm Installation
❑ NVAC
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 11(X1 volt amps nr!essl under this permit and to du the ❑ Outdoor Landscape Lighting'
follcnving:
1. Only use electrical licensed p vrsons to do installations where required.(Certain El Protective Signaling
residential and other transactions are exempt from licensing.These have ❑ Other
asterisks(•),All others need licensing). --
1. Call for an Inspection when all of the installations under this pe mit are ready
for inspection at.Soo-639.4175. [] Numher of Systems
1 Purchase separate hermits for all installations that are not ready for inspection
when the inspector Ir nut 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 S. FEES
corrections are completed.
T he person signing for this permit must he the applicant or a person a. Enter Fees $
authorized to hind the applicant.
b. 5%Surcharge(.05 x tot,+r above) $
Signature
TOTAL $ 7
Aulhoritv if other than applicant
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ENERGARCHP