11490 SW GREENBURG ROAD 3
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11490 S.O. Greenburg .load _
CITY
OF TIGARD __ MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2001-00102
DATE ISSUED: 04/0212001
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 1S135CA-02302
SITE ADDRESS: 11490 SW GREENBURG RD
SUBDIVISION: BOETCHERS ADDITION ZONING: R-12
BLOCK: LOT: 003 JURISDICTION: TIG
CLASS OF WORK: AL-TFLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R1 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERSICOMPRESS ORS_ HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LP —� 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 -30 HP: REPAIR UNITS:
FIRE DAPAPERS?: 30 - 50 HP: WOOD,TOVES:
GAS PRESSURE: 5u + HP: CLO DRYE.'.S:
FURN < 100K BTU: _ AIR HANDLING UNITS _ OTHER UNITS:
FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Remarks: Uas piping to range.
Owner: _ FEES — ^
JANIS YOUTH PROGRAMS, INC Type By Date Amount Raceipt
121 NE 8TH. AVE PRMT CTR 04/02/20( $72.50 272001000C
PORTLAND, OR 97232 5PCT CTR 04/02/20( $5.80 272001000C
Total _ $78.30
Phone: --
Contractor: _
GEORGE MORLAN PLUMBING
9806 SW TIGARD ST
TIGARD, OR A7223 REQUIRED 04SPEClIONS
Gas Line Insp
Phone: 771-1145 Final Inspection
Reg #:LIG 02734
PLM 26-60P
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other 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. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0080, You may obtain copies of these rules or direct questions to OUNC by
calling (503)246-9 �
Issue By' ! Permittee S ,�
'Signature: � YajA/-77G'N+ 6 IL
Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day
P.01
MAR-27-2001 15:14
10/11/ZUUU US-d' 1.1.1, _ ��11
MeellaniCal per-nut Application
- _—
-- Duerecetvu) 3�9 Q
t '
City of Tigard
Projocthppl no.: Fapire dude
W d. g Dalc ts:u:d ljy: Rrcapt no.•
r ryo/I cord Addrtss: 13125 S Mall Blvd.Tigird.OR 9122..3 ---
P1►bne (50]1 X39 4t 1 -y (� cue rile era' Paysnenl type:
on 599-1960laC(��eY`/ / putldtn�,pet�u:no. - —
.tt,
r-and use approva]:
0 Multi-family Q Tcnant improvement
O 1 &2 fturily dwelling Of accessary Comrnercio��uu.stn+l 0 0),er:__
O Now constru•cuon &Addi6GW?]tc-CiOrJ1tCPluement t
t -7
i t '
C Indicate 1,171
CgWprne0t quand(iet in boxes below Ind,'ate t1le do.lu
Job address' L Q_y11L.1_ value of nil tneehsnicaj materws•equ'rm:nt.Libor, overhead,
t
no.: Suite Co.. - pro5t.Value S -_
Bldg
Tax nlapltax lot/account no' See ehecUist fnr important application inlorrafthOn snd
l.ae - ylock; Subdty_isUOO: jurisdietian's fee schedule for residential perntit fec.
Project mune:
Clry/councy: 7.IP: t r
Oeu Icon and l I uan of Work on praruscs: -�� Fee(to.) ToW
r Dexo tion Qh• Aas.onlyAtx.onlJ
Est.date of complrti n/iMpect}on At.:
Ail handling unit CFM
Ttniril improvement of change of use. _ -
Is esilu"spice heated orconditinncdt 0 Yes ONO A,rcon iuoninets►teplsnrequued)
Is unsling speer irsulattdl Dyes ❑No nllcrou- o�n o�estsu"g FIvA systeta
poticr/rorcrressors
t $ate boiler peJeur no.: ,BTU/H
' _��- Tons
Business name �_
Ftr emo c d,❑puVduct smo►e detectors
G-_Address Neer pus19(site ulan re uued)
l�.r 5 e ZTT Installlrep ace IUMAMOUMLI__BTUrtt
1 Phone _
Fix- jo E-iTu'l• Including ductworWvent lino C1 Yes O No
CCB to- LastaMeplac rc oukttcawn—fuspcndcd.
.eau.or floor mounted
Gry/metro UG no.: - VeAt fora Rance orJtcr an urttau
None(please Print)' ersO
Absorpuonuniu eTwr+ --
Chinas --
Name: - t",ompscsson HP
Address: rifalIDemtat et=Laust and.elttIII011an:
—�--- Stalc: � ADD!ianccvent
Cirr --- Jryerc Aust
Phone F I E-rn : Moods,Type V Wret lirthen/t+aan+!
hood fire tuppfWin"eys:em
J Sth1ust fan wpm to gle duce(haul fes)
Nemr Lei q� �'t t�rhsust tytten> >rt Iron heating or n
3 �
L p+suLag address: Fuel piping am istrr on(up rn 4 ouuets)
C1 ry _
SIALIC ZIP.. �. 17pe LPG NG Oil
Phone: Fax �L.-rn.vl: Fuel t u: addtuonal ovu 4 wtku
t'roce m piping(ichtmsuc rrquu
momNumber of cutlets
Name: taer lasted sppllmcc or equlptnent
Address DecorattverIrcplaee
----- e. Z tnsus-type
City -- � _, State: lam' oo seovdpelletuove
Phone ,f r 6 mail: -
r. VUIK:
AppGeancs signature: _ — -
Name(pnnU: Ptxn-,it fee ..................$
- cam^
N VI jundcnw erre}i��tardy.plat cad IIeJd4'-M far w ' Souee:Tho perrut app!,eation Minimum t'_.................
OYw J Mut.r(]rd t I ewes if a permit is dot obtained plan rtviev(u
Grit rad e.mta i.r I s►ithin 110 days after it has been Sate Nteharp
aocepted U complete_ TOTAL r
Mersa et rrarru.r r.r....•� v1
Arns+,t w0•�d11 faAdIC0P4
pi' ear r�f�r�--__'•••--
TOTAL P•01
CITYOF T I GA R D MECHANICAL PERMIT'
DEVELOPMENT SERVICES PERMIT#: M27/0 00136
DATE ISSUED: 1
1513 1
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
PARCEL: 1 S135CA-02302
SITE ADDRESS: 11490 SW GREENBURG RD
SUBDIVISION: BOETCHERS ADDITION ZONING: R-12
BLOCK: LOT: 003 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS HOODS: 1
FUEL TYPES _ 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?. 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS _ OTHER UNITS:
FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Install Type II Residential I tchen Hood
Owner: ---- FEES
JANIS YOUTH PROGRAMS, INC Type By Date Amount Receipt
12.1 NE 8TH. AVE PRMT CTR 4/27/01 $72.50 272001000C
PORTLAND, OR 97232 5PCT CTR 4/27/01 $5.80 272001000C
Total $78.30
Phone: --
Contractor: _
AIR DIRECT
3439 NE SANDY BLVD
STE 665 ___REQUIRED INSPECTIONS
PORTLAND, OR 97232 Mechanical Insp
Phone:380-5163 Final Inspection
Reg #: LIC 129757
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issua~ice, or if work is suspended
for more than 180 days ATTENTION Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503)246-9189
Issue By: _ _ Permittee Signature: < <- T_
Call (503) 639-4175 by 7:00 P.M. for inspections needed the next busines day
Mechanical Permit Application
Date received: tq- Permit no.? cc i 3
City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223
Phone: (503) 639-4171 Date issued: By: Receiptno.:
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: Building permit no.:
7tQ�J & mily dwelling or accessory U Commercial/industrial U R1uki-f.unily U'frn.uv improvementstruction U Addition/alteration/replacement U Usher.
Job address: 1 C : Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: profit. Value$
Lot: Block: Subdivision: 'See checklist for important application information and
Project name: jurisdiction's file schedule tier residential permit fee.
City/county:— C - ZIP:
Description and lot ion of work on Rremises:
fi'M(PA.) Total
Est date ofcomplelion/inspection: Description Qty. Res.only Res.only
Tenant improvement or change of use;
Air handling unit CFM_` _
Is existing space heated or condiyoned? Yes U No it conditioning(site plan require ) _
Is existing space insulated?Ives U No .1teruTlIontingng C systemrsit no.:
Business name: t`L Tons E3TU/H
�Address: c 1�t - �- \� er uct smoke detectors -
Cit ` .Y State:ffd ZIP: C,- eat pump(c pa-f n mqutrecT`
Phone:-)k (O Fax: E-mail:�,; \ i c� Z nsta Urep ace urnac urner
^.CB no,: j i1:Ile/e ao�,c�,•,� Including duetwork/vent liner Q Yes U No
nsta rep ac notate eaters-suspen e
City/metro lic.no.: wall,or floor mounted
Name(please print): r, Vent fora iance of er t an furnace
Refrigeration:
it IME 0 a 144.11 Absorption units. BTU/H
Name: �',n� Chillers lip _
Compressors HI'
Addnss: 1 \ _ V. 7C�
v ronmenta exhaust an ventilation,
City: uc Slate: ZIP: Appliance vent
Phone. , Fax: E-mail: )ryer ex aust
on s,Type i rrs. its ham
hood fire suppression system 11
Name: Exhaust fan with single duct(bath fans)
Mailing afldre`• Exhaust system apart from lagan or AC
City i_ - State: ZIP: Fuel p p nq and distribution(up to 4 out ets)
Phone. I : , - - I mail: Type. _---LPG NG __ Oil _
Foci piping cacti additional over 4 outlets
Process piping(sc ematicrequirc )
Number of outlets
Name: - - ter silloed appliance or equipment:
Address _ _ Decorative fireplace
City--- - 4tatc: !.I!': nsert-type �-
Phone: oo stove•pe et stove
I ,��. E-nwil:
Applicant's signature, c .� k, Date: 1 (h er.
othev
Name(print): j�lc _ --
Nd all Jurisdictions accept credit cards,please call jurddiction for more Information. Permit fee.....................$ _
U visa U MasterCard Notice:This permpermit
i application Minimum fee................$
Credit card numtwt. I expires if a permit s not obtained Plan review(at _•-_ %) $
Expires within 180 days after it has been State surcharge(8%)....$
Now of cardholder as shown on credit cad — accepted as complete. TOTAL
s ................I...... -
Cardholder sianeuvr Amount
410J6U 1601K'OM
MECHANICAL PERMIT FEES '
COMMERCIAL FEE: SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
- Description Price Total
TOTAL VALUATION: FEE: - Table 1A Mechanical Code _ Ory (Eel Amt _
$1.00 to$5,000.00 Minimum tee$72.50 1) Furnace to 100,000 BTU
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and including ducts&vents 14.00 _
$1.52 for each additional$100.00 or 2) Furnace 100,000 BTU+ _
fraction thereof,to and including includtq ducts&vents 17.40
_ $10,000.00. 3) Floor Furnace
510,001.00 to$25,000.00 $148.50 for the first$10,000.00 and including vent 14.00
$1.54 for each additional$100.00 or 4) Suspended heater,wall heater
fraction thereof,to and Including
$25000.00. or floor mounted heater 14.00
_ -- -- --
$25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vent not included in appliance permit
6.80
$1.45 for each additional$100.00 or - -
fraction thereof,to and including 6) Repair units
12.15
_ $50_000.00.
$50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: Boller Heal Air
$1.20 for each additional$100.00 or For items 7-11,see or Pump Cond
lfraction thereof. footnotes below. Comp* " _-
- 7)<3HP;absorb unit
---'--' ER
_ --- to 100K BTU _ 14.00
ASSUMED VALUATIONS PER APPLIANCE: 8)3-15 HP;absorb
Value Total unit 100k to 500k BTU 25.60
Description: Q Ea Amount 9)15-30 HP;absorb
Furnace to 100,000 BTU,Including 955 unit.5.1 mil BTU 35.00
ducts&vents - 10)30-50 HP;absorb
Furnace>100,000 BTU including 1.170 unit 1-1.73 mil BTU 52.20
ducts&rants 11)>50HP:absorb
Floor fumace includin 955 vent unit>1.75 mil BTU 87.20
Suspended heater,wall heater or 955 12)Air handling unit to 10,000 CFM
floor mounted heater 10.00
Vent not Included In applicence 445 13)Air handling unit 10,000 CFM+
e 17.20
permit
Repair units V 955 14)Non-portable evaporate cooler
<3 hp;absorb.unit, 10.00
to 100k BTU _ _ - - 15)Vent fan connected to a single duct
3-15 hp;absorb.unit, 1,700 6.80
101k to 500k RTI16)Ventilation system not included In
15-30 hp;absorb.unit,501k to 1 2,310 a liance ermit 10.00
mil.BTU _ 17)Hood served by mechanical exhau^I
30-50 hp;absorb.unit, 3,400 10.00
1-1.75 mil.BTU 5 725 18)Domestic Incinerators 17 40
>50 hp;absorb.unit,
>1.75 mll.BTU19)Commercial or Industrial type Incinerator
Air handling unit to 10,000 cfm _ 656 69.95
Alr handling unit>10,000 cfm 1,170 20)Other units,including wood stoves
Non- ortable ova orate cooler 656 _ 10.00
Vent fan connected to a single duct 446 _ 21)Gas piping one to four outlets
Vent system not Included in 656 5.40
__Milan ermit 22)More than 4-per outlet(each)
Hood seryed by mechanical exhaust 656 1.00
Domestic Incinerator 1 170 Minimurn Permit Fee$72.50 SUBTOTAL: $
Commercial or industrial Incinerator 4,590
Other unit,Including wood stoves, 656 8%State Surcharge $
Inserts,etc. _
Gas Piping 1-4 outlets 360 25%Plan Rev.aw Fee(of subtotal; $
Each additional outlet - 83 Required for ALL commercial permits only
TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $
VALUATIONS
Other InsaecQons and Fees:
1 Inspections outside of normal business hours(minimum charge-two hours)
$72 50 per hour
2 Inspections for which no fee Is specifically indicated (minimum charge-half hour)
$72 50 per hour
3 Additional plan review required by changes,additions or revisior to plans(minimum
charge one-half hour)$72 50 per hour
State Contractor Boiler Certification requlred.or units>200k BTU.
"Residential A/C requires site plan showing placement of unit.
I`fists\formsV'nech-fees.doc 10111/00
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24"liour Inspection Line: 639-4175 Business Line: 639-4171 --- -"
� BUP
Date Requested Z— AM _PM BLD
Location / �/� ny -��t l'�ti+-� Suite __ MEC
Contact Person _ •� Ph ,� �S PLM
1
Contractor_ �- it el e I Ph �'� �iS��'"� SWR _
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing
Foundation Access: FP
Ftg Drain
Crawl DrainSIAN
Inspection Notes:
Slab
Post&Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing —�_ ---- ---
Insulation
Drywall
Drywall Nailing
Firewall -
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Niisc.
Final -- �—"
PASS PART FAIL —• --- -
PLUMBING
Post& Beam -- - --- —
Under Slab
Top Out _----- ---_._ - --
Water Service
Sanitary Sewer ----
Rain Drains
Final --- --_ -- ---
PASS ART FAIL
�TAECHA%�-
floaL&aeam
as Line �_-
Sn empers
rPASS
PART FAIT_
SIXPCIRICAL --- - - --
Service
Rough In
UG/Slab
Low Voltage
Fire Alarm _
Final
PASS PART FAIL
317E
Backfill/Grading
Sanitary Sewer
Storm Drain ( I Reinspection fee of$ required before next inspection. Pay at City H 13125 SW Hall Blvd
Catch Basin ( (Please call for reinspection RE: ( le to Inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk
Other Date �` —__ Inspector -_ _ _Ext
Final
I PASS PART FAIL- DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 ---------- ----
SUP — ---------
-Date Requested_____. _—_AM-- PM BLD
Location ' L _ / Suite . _ MEC --
Contact Person L Ph PLM
Contractor— �- Ph .,:Z�1� /"j�_ SWR
BUILDING --� Tenant/Owner ��,j���/� /i.c: -�r'��n/ � ELC
Retaining Wall ELR
Footing - "-----`-
Foundation NOT REQUESTED FPS �_F
Ftg Drain
Crawl Drain I► FOUND DURING RESEARCH SGN
Slab NO INSPECTION(S) IN FILE SIT
Post&Beam - —-- — ----
Ext Sheath/Shear
Int Sheath/Shear - --------------_.-._.. __-.
Framing
Insulation
Drywall Nailing -------- --- .,— - -- - --- --
Firewall � -1
Fire Sprinkler / - ab _(� Z-4
_'C.��i _77__ __ _-_-_ --------_ _-- --
Fire Alarm
Susp'd Ceiling —
---- ----------------
Roof
Misc _ __ _ ►�_cL
Final _ e , _
PASS PART FAIL. �j[LZ I
PLUMBING
Post& Beam r--__ - ------ -
Under Slab -�-
Top Out
Water Service
Sanitary Sewer
Rain Drains 5-Q 1 0k S S
Final
PASS PART FAIL
MECHANICAL
Post& Beam - -
Rough In -'
Gas Line - ---
Smoke Dampers
Final - -
PASS PARTAIL
ELECTRICAL
Service
Rough In
UG/Slab _
ow Voltage .Se-C.v r t y/
-
al
PASS PART
Backfill/Grading ---- --- ---
Sanitary Sewer
Storm Drain ( Reinspection fee of$ — _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line I 1 Please call for reinspection RF I I Unable to inspect-no access
ADA
Approach/Sidewalk
Other s1_ ��ector
Date t _ Ext
_^
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY GF TIGARD
DEVELOPMENT SERVICES EL-FCTRICAL PERMIT —
13125 SW Hall Blvd., Tigard,OR 97223 (503)539.4171 RESTRICTED ENERGY
PERMIT #: ELR98-0019
DATE ISSUED: 02/02/98
PARCEL: 1 S 135CA--02302
SITE ADDRESS. . . : 1149O SW GREENBURG RD
SUBDIVISION. . . . :BOETCHERS ADDITION ZONING:R-12
BL0C,V.. . . . . . . . . . . LOT. . . . . . . . . . . . . :003 TURISDICTN: TIG
Pr o.)e c t De s c r i pt i on: Install protective signaling for an existing tenant occpy.
A. RESIDENTIAL---------- B. COMMERCIAL----------------------------------------
AUDIO & STEREO. . . : AUDIO & STEREO. . : INTERCOM & PAGING. . :
BURGLAR ALARM. . . . : BOILER. . . . . . . . . . : LANDSCAPE/IRRIGAT. . :
GARAGE OPENER. . . . . CLOCK. . . . . . . . . . . . MEDICAL. . . . . . . . . . . .
HVAC. . . . . . . . . . . . . : DATA/TEL.E COMM. . . NURSE CALLS. . . . . . .
VACUUM SYSTEM. . . . : FIRE ALARM. . . . . . : OUTDOOR LANDSC L-.ITF:
OTHER: : : HVAC. . . . . . . . . . . . : PROTECTIVE SIGNAL. . : X
INSTRUMENTATION. : OTHER. . :
TOTAL # OF SYSTEMS: 1 I
Own�'r: -------------------------------------------------------- FEES --_-------------
,JANIS YOUTH PROGRAMS INC type amot-in' by date recpt;
738 NE DAVIS PRMT $ 40. 00 BED 02/02/98 98--302960
PORTLAND OR 97232 SPCT $ 2. 00 GED 02/02/98 98-302960
Phone #: 233-6090
Contractor: -------------------------------------------_.._-------------.-- ...--__ ----..
PROTEC INC $ 42. 00 TOTAL
2920 SW DOLPH COURT
SUITE #4 -- ---- REQUIRED INSPECTIONS ------- -
PORTLAND OR 97219 Low Voltage Ins
Phone #: 293-2134 Elpct' 1 Final
Reg #. . : 000554 —
This persit is issued subject to the regulations contained in the Tigard Municipal Code, Statp of Ore. Specialty Codes and all other
applicable laws. All work will he done in accordance with approved plans. This pereit will expiry if work i5 not started within 180
days of issuance, or if work is suspended for sore than 181 days. ATTENTION.- Oregon law requires you to follow rule adopted by the
Oregon iltility Notification Center. Those rules are set forth in OAR 952-011-0/L0 through OAR 952-001-0080. You say obtain copies of
these rules or direct estisof �t 1513126-1987, j
Iss�ted by t� Permittee Signati.tre��?_-rf, e _
---------_-------------OWNER INSTALLATION ONLY--------------------------------
The installation is being made on property I own which is not intended for
style, lease, at, rent.
OWNER' S SIGNATURE: DATE:
----------------------------CONTRACTOR INSTAL.L_ATTON ONLY— ---------------______._-. _.-.-
9I GNATURE OF SUPR. ELEC' N: _ . DATE s �'
LICENSE NO:
+ s -r+++++++++++++++++++++++++++++++++....i.++++++++++++++++++++++++++++++++++++++++
':all 639-4175 by 7:00 P. M. for an inspection needed the next bi_Isiness day
++++++++++++.....++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++...
CITY OF ,JGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Recd by:
13125 SW HALL BLVD Date Rec'd:
TIGARD OR 97223 PRINT OR TYPE Permit#:�'� �1CC�Ir tl
V- 503-639-4171 X304
�'��
F - 503-684-7297 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
A (FOR ALL SYSTEMS)
,SOB Street Address Ste# Check Type of Work Involved.
ADDRESS lit'A 1)s-r (:AItee.A{.)P-4, (Zv
CityiState I Z10 Phone# ❑ Audio and Stereo Systems
<
Na , — ❑ Burglar Alarm
J P 0 1�0 ti t� �'r- �V[Jtr'1 S ❑ Garage Door Opener'
OWNER Mailing Address
I-st it SI-. ❑ Heating,Ventilation and Air Conditioning System'
Qity/State Zip Phone#
—_- — o Tt 9-113 . 3 31-6e 4 ❑ Vacuum Systems-
Name
Other -- ---- —------------
O t P c_ �...� C. ❑ --
CONTRACTOR Mailing Addre.s TYPE OF WORK INVOLVED-COMMERCIAL
_�LILV S,.4 Cr SrE
(Prior to issuance a City/State Zip Phone it Fee for eacn system.............................................. $40.00
copy of all licenses r O rLAt�- 'L!y ti 3.11.1 (SEE OAR 918-260-260)
are required if Oregon Contr.Bird Lic # Exp Date
expired in C O T 41't R 4 9 5? Check Type of Work Involved
data base) Electrical Contr. Lac # JE
ate L� Audio and Stereo Systems
3 - yl 7 C r-F- r L
COT or Metro Lic # ateL� Boiler Controls
—_ --�
,5142'
5nrer Name R ❑
Clock Systems
OWNER - Mailing Address
� Data Telecommunication Installation
APPLICANT
City/State Zip Phone# t 1 Fire Alarm installation
This permit is issued under OAE 918-320-370 This applicant agrees to tt—IJ HVAC
make only restricted energy installations(100 volt amps or less)under this LJ
permit and to do the following ❑
Instrumentation
1 Only use electrical licensed persons to do installations where required
Certain residential and other transactions are exempt from licensing ❑ Intercom and Paging Systems
These have asterisks(') All others need licensing,
❑ Landscape Irrigation�,ontrol'
2 Call for inspections when installation under this permit are ready for
inspection at 503-639-4175; ❑ Medical
3 Purchase separate permits for all installations that are not ready for an Nurse Calls
inspection when the inspector is out to inspect under this permit,
4 Assume responsibility for assuring that all corrections required by the
Outdoor Landscape Lighting'
inspector are done,and, r-7{
LJ Protective Signaling
5 Assume responsibility for calling for a final inspection when all of the ❑
corrections are completed Other
Permits are non•traosfereble and non-refundab.e and expire if work is not
started within 180 days of issuance or if work is suspended for 180 days _Number of Systems
T I
person signing for this p "it must be the applicant or a person No licenses are required Licenses are required for all other installations
aut onzeo to bind the applic nt
& / v Al 0
ENTER FEES
Si nature l
] q y 5%SURCHARGE(05 X TOTAL ABOVE) $
TOTAL $
Authority if other than Applicants
tresele dor 12196