11730 SW 116TH AVENUE i
ADDRESS:
11730 ,SW Avojuf
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CITY OF TICAL ®
DEVELOPMENT SERVICES
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 ELECT RICAL PERMIT
RESTRICTED ENERGY
PERMIT #: EL-R960301.
DATE ISSUED: 10/07/96
PARCEL-: 1Sl3)4CD---10500
SITE ADDRESS. . . : 11730 SW 1. 16TH AVE
SUBDIVISION. . . . : BLJRLWOOD NO. 4Z ON I l\lG: R—4. 5
BLOCK. . . . . . . . . . . i_OT. . . . . . . .14p�
Project Description: Bl-trglar alarm ok..
A. RESIDENTIAL------------- B.
AUDIO & STEREO. . . : AUDIO
&
A STEREO. . : INTERCOM & PkCGING. . :
BURGLAR ALARM. . . . : X BOILER. . . . . . . . . . : I._AND5CAPE/IRRIGAT. . :
GARAGE OPENER. . . . - CL.00K. . . . . . . . . . . . MEDICAL. . . . . . . . . . . . .
HVAC. . . . . . . . . . . . . . DATA/TELE COMM. . . NURSE CAI-A-5. . . . . . . . :
VACUUM SYSTEM. . . . : FIRE AL,ARM. . . . . . : OUTDOOR L.ANDSC LITE:
OTHER- HVAC. . . . . . . . . . . . . PROTECTIVE SIGNAL. . :
INSTRUMENTATION. : OTHER— :
TOTAI_ # OF SYSTEMS: 0
Owner: FEES
JFROME DAVIS type amol-tilt by date rec-pt
11.730 SW 116TH PRMT $ 40. 00 JDA 1.0/07/96 95284815
5PCT $ 2. 00 JDA 10/07/9!S 96-284815
TIGARD OR 97223
Phone #- 590-6139
Contractor:
ADT SECURITY AL-ARiviS $ 42. 00 TOTAL
703 NE HANCOCK REQUIRED INSPECTIONS
PORTI.-AND OR 97212 Wall Cover Elect' ]. Final
Phone #. 503-2843265 Elect' 1 Service
Reg #. . : 59944
This peroit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Code . and all other Permite(e Signat i.tre
applicable laws. All work will be done in accordance with
approved plans. This pereit will expire if work is not started
within 180 days of issuance, or if worn: is susprided for sore
than 180 days. I ssf-ted Y,
-jWNF_R INISTALI.-OT ION
The installation is being made on property I own which is not intended for
sale, lease, or rpn*:.
OWNER' S SIGNATURE: DATE:
......-----------------------COl`1,rr3qCTOR INSTALLATION ONL.Y-----------------------------------
SIGNATURE OF SLI'E'R. El_.EC1N: DATE:
l_.ICENSE 1\10:
Call for inspection 639-4175
Community Development RES''RIOTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd. PERMIT# 1.L Q t?3y
Tigard, OR 97223 A
Phone(503)639-4171 nA-i E ISSUED-----. 0 7 I
FAX(503) 684-7297;M0 TDD No. (503)684-2772
CITY OF TIGARD Inspection (503)639-4175 ISSUED BY ----
�s
IJ
PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTALLATION � 4. TYPE OF WORK
y� . . . . . .
— RESIDENTIAL—Restricted Energy Fee . $40.00
Addr ry��� (FOR ALI SYS][NAS)
City a State Zip Check fype of Work InvQ1y 1:
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 Burglar Alarm
180 DAYS.
If
Garage Door Opener*
2. CONTRACTOR APPLICATION r] Heating,Ventilation and Air Conditioning System*
Contractor __ i ype 41�' Ll Vacuum Systems*
gCIIttITY SYSTEMS,ING ❑ Other
703 NE HANCOCK
Address_ 11 AND.ANO.OR-44142---
(503)284.326+5 COMMERCIAL—Fee for each system . . . . . . . . • 1.40.00
Date (SEE OAR 918-260-260)
Property Owner `' S.11s56lYl•3stf��i�+ln�1Y€d:
_sZ! 17— __ El Audio and colsStereo Systems
Contractor's Board Reg. No.
❑ Boiler Controls
Phone# _ ___ _ ❑ Clock Systems
❑ Data Telecommunication Installations
3. OWNER APPLICATION )/' / G [] Fire Alarm Installation
c�/[/ _(O/ %_ ❑ HVAC
Print Owner's Name Phone Na ❑ Instrumentation
I] Intercom and Paging Systems
Address ❑ Landscape Irrigation Control*
City State Zip ❑ Medical
El Nurse Calls
This permit is issued under OAR 918.320.370.This applicant agrees to maki only EJ Outdoor Landscape Lighting*
restricted energy Installations(100 volt amps or less)under this permit and to do the
following: ❑ Protective Signaling
1. only use electrical licensed persons to do installations where required.(Certain (� Other
residential and other transactions are exempt from licensing.These have —
asterisks(*).All others need licensing).
2. Call for an inspection when all of the installations under this permit are ready
C1 for Inspection at 503-639-4175. ❑ Number of Systems
cc l Purchase separate permits fo.all Installations that are not rrrady for inspection
f— when the inspector Is out to Inspect under this permit. No licenses are required. Licenses are required for all other installations.
cn
4. Assume responsibility for assuring that all conet.lions required by the Inspector
>_ are done,and
I--
5. Assume responsibility for calling for a Mal Inspection when all of the 5. FEES
corrrrtions are completed. n
wThe Person signing for this pe 11i n- the applicant or a persotl a. Enter Fees $ 4D rJ
.-� authorized to hind the appL .t
h. 5% Surcharge(.05 x total above) $ L:�- d U
Signature TOTAL
Authority if ,Ther than applicant
FNERGAP.CHP