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ELECTRICAL PERMIT-
CITY OF T I G A R D
RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT#: ELR1999-00315
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 12/21/1999
SITE ADDRESS: 12755 SW 69TH AVE 100 PARCEL: 2S101AD•02900
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 031 JURISDICTION: TIG
Proiect Description: Installation of protective signaling.
A.RESIDENTIAL 3.COMMERCIAL _
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL: Y,
INSTRUMENTATION: OTHER:
TOTAL#OF SYSTEMS: 1
Owner: Contractor:
ROTH, J T JR + THERESA A + SONITROL PACIFIC
ZOUCHA, MICHAEL S 1975 SW 6TH AVE
12600 SW 72ND AVE #200 PORTLAND, OR 97201
TIGARD, OR 97223
Phone: 639-2.639 Phone: 223-5822
Reg #: LIC 00053535
ELE 26370CLE
_ FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT GEO 12/21/199 $60.00 99-320589
5PCT GEO 12/21/199 $4.80 99-320589
Total $64.80
� RIGINAL
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR 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 adapted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 52-001-0080 You may obtain copies of these rules or direct questions to OUNC at (503)
246-1987
Issued bPermittee Signature
OWNER INSTALLATION ONLY
The installation is being made on property I own which is ,wt intended for sale. lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N ���,� T _ DATE: _� r
LICENSE NO:
Call 639-4175 by 7:00 P.M. for an ir.spection needed the next business day
RECEIVED
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Recd by:
13125 SW HALL BLVD DEC16 199 Date Recd:
TIGARD OR 97223 RINT OR TYPE r� 315—
F -503-684-4297 X304 COMMCIIMPL M ILLEGIBLE APPLICATIONS Custl'd Cal `/ Y� _
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED- RESIDENTIAL ONLY
(VY_V�l (k 1�(1 � Restricted Energy Fee........................................ S491"I
�` ' (FOR ALL SYSTEMS) $66-00
JOB Street Address Ste#
j� cproh p— Check Type of Work Involved.
ADDRESS r
City/State Zip Phone# ❑ Audio and Stereo Systems
_ % X �r C)11 c r '�
Name ❑ Burglar Alarm
❑ Garage Door Opener'
OWNER Mailing Address d 71
!)df.
/",) fes' ❑ Heating,Ventilation and Air Conditioning System'
City/Staten ZIrq�7 Phone#
Name t ( Vacuum Systems*
2_C_X ❑ Other e
CONTRACTOR ►ailing Address
\C1 - 'W (_�{_K ( 1-, 41 TYPE OF WORK INVOLVED -COMMERCIAL ONLY
(Prior to Issuance a City/Stat Zip Phone#r Fee for each system.............................................. lYdO
copy of all licenses �U'� 1_< } 3- a� (SEE OAR 918-260-260)
are required If Orego FGontr. Brd Lic.# Exo. Date Check Type of Work Involved.
expired In C.O.T. 3`,_),7 C,
data base) Electrical Contr.Lic.# Exp. Date
;'�(� "�(� `rte ❑ Audio and Stereo Systems
C.O.T.or Metro Lic.# Exp. Date
❑ Boller Controls
Owner's Name
❑ Clock Systems
OWNER - Meiling Address
APPLICANT ❑ Data Telecommunication Installation
City/Stale Tlp Phone# ❑
Fire Alarm Installation
Thls permit Is Issued under OAE 918-320-370 This applicant agrees tc
make only restricted energy Installations(100 volt amps or less)under this ❑ HVAC
permit and to do the following. ❑
Instrumentation
1. Only use electrical Ilcensed persons to do Installa!lons where rerndred.
Certain residential and other transactions are exempt from licensing ❑ Intercom and Paging Systems
These have asterisks('). All others need licensing;
❑ Landscape irrigation Control'
2. Cell for Inspections when Installation under this permit are ready for
Inspection at 503-6394176; ❑ Medical
3 Purchase separate permits for all Installations that are not ready for an ❑ Nurse Cells
Inspection when the Inspector Is out to Inspect under this permlt;
4 Assume responsibility for assuring that all corrections required by the ❑ Outdoor Landscape Lighting'
Inspector are done, and;
Protective Signaling
CL,
5 Assume responsibility for calling for a final Inspection when all of the
corrections are completed ❑ Other
~, Permits are non-transferable and non-refundable and expire If wurk Is not
—r started within 180 days of Issuance or If work Is suspended for 180 days Number of Systems
CIO
The person signing for this permit must be the applicant or a person No licenses are required Licensee are required for all other Installations
ILL) authorized to bind the applicant. -
-J
FEES:
Slgnaf:,re ENTER F°E9 sD CN
l 5%SURCHARGE(.06 X TOTAL ABOVE) f t
Authority If other then ppllcant TOTAL s� L KO
tdalsvesels doe 7H7