10575 SW HALL BLVD 10575 SW HALL BLVD
CITY OF TIGARD
DEVELOPMENT SERVICES ELECTRICAL PERMIT -
13125 SW Hall Blvd., Tigard, OR 97223 (503)639.4171 RESTRICTED ENERGY
PERMIT #: EL_R97-O336
DATE ISSUED: 11/20/97
PARCEL: 1 S 135AA-O.3600
SITE ADDRESS. . . : 10575 SW HALT..- Sl VD
SUBDIVISION. . . . :METZGE:R ACRE TRACTS "ZONING: R-- 12
BLOCK.. . . . . . . . . . . LOf. . . . . . . . . . . . . JURISDICTN: TIG
Pro j ec+, Description: Installation of protective Signaling at commercial site.
A. RESIDENTIAL--------- B. COMMERCIAL------ ------ --- - -___.-----------------.---_..-.
AUDIO R 9TFREO. . . : AUDIO R STEREO. . : INTERCOM & PAGING. . :
BURGLAR ALARM. . . . : BOILER. . . . . . . . . . : LANDSCAPE/IRRIGAT. . :
GARAGE OPENER. . . . . CLOCK. . . . . . . . . . . . MEDICAL. . . . . . . . . . . . .
MVAC. . . . . . . . . . . . . : DATA/TELE COMM. . : NURSE CALLS. . . . . . . . :
VACUUM SYSTEM. . . . : FIRE ALARM. . . . . . : nuTDOOR L ANDSC LITE:
OTHER: : : HVAC. . . . . . . . . . . . : PROTECTIVE SIGNAL. . : X
I NST RUMENTAT ION. : OTHER. . : . .
TOTAL # OF SYSTEMS: 1
Owner: -----________.__.___.-.___________.______.________._----•__-- FEES --_-_--------_-__._
JOHN WRIGHT type amoi-int by date recpt
10575 SW HALL BLVD PRMT $ 40. 00 TJH 11/20/97 97-301094
L IGARD OR 97223 `=,PCT $ 2. 00 T rH 11/x0/97 97-301094
Phone #:
Contractor:
ADT SECURITY ALARMS $ 42. O0 TOTAL
703 NE HANCOCK
--- ---- REQUIRED INSPECTIONS
--_
PORTLAND OR 97212 Ceiling Cover, Low Voltage Insp
Phone #: 284-3265 Wall Cover Elect' 1 Final
Reg #. . : 000599
Thii permit is issued subject to the regulations contained in the Tigard Municipal Codp, State of Ore. Specialty Codes and all other
applicable laws. All work will he 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 rule adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OuR 9`,2-001-8080. You may abtain copies of
these rules or directquestionsquestions to OUNC at (583)246-1987.
T ,spied by-7`"� '�--=_ _-_— ___ _ Permittee SignatUred&�
--------------------OWNER INSTALLATION ONLY_-.-_-._.----_____.____-_____---__.__.
[tie installation is being made on property I own which is not intended for
tiTley Iease, or, rent.
OWNER' S SIGNATURE: __. �. DATE:
------------------------CONTRi)CTOR INSTALLATION ONLY------------------
SIGNATURE
---------------.--SIGNATURE OF SUPR. ELEC' N: _ plLLC cam. _ ._ DATE:
L-I CENSE NO: _ 70 3`JLk
++++++++++++++++++++++-+++++++++++++++++++++•F+++++++++++++++++++++++++++++++++++•+
Call 639-4175 by 7:00 P. M. for an inspection needed the next bi_isiness day
+++.4-+++-1-++++++++++++++++.+++++++++++++++++++++++++++++++++++++++++++++++++++++ f++
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Recd by _7 f aY15L'f1
13125 SW HALL BLVD Date Recd Il 12o 11) _
TIGARD OR 97223 177-C PRINT OR TYPE
V- 503-639-4171 X304 Perrnit#: Q_0'�- 33(,
F- 503-684-7297 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust
WILL NOT BE ACCEPTED
Name of Deve opment Project TYPE OF WORK INVOLVED - RESIDENTIAL. ONLY
— —
� �✓' yI Restricted Energy Fee........................................ $40.00
l int + (FOR ALL SYSTEMS)
JOB Street Address / Ste#
ADDRESS :heck Type of Work Involved
Cit /State -� Zip Phone ❑ Audio and Stereo Systems
Narr ❑ Burglar Alarm
OWNER Mailing Address Garage Door Opener-
City/State Zip Phone# ❑ Heating,Ventilation and Air Conditioning System'
Name El vacuum Systems"
IMT SECURITY SYSTEMS,W.
703 HANCQCK ❑ other
PORNANI oRY1212 _
CONTRACTOR Mailing Address D031294.32%
TYPE OF WORK INVOLVE[) -COMMERCIAL ONLY
(Prior to issuance a City/Stale Zip Phone# Fee for each system.............................................. $40.00
copy of all IicEnses (SEE OAR 918.260-260)
are required If Oregon Contr.BrdLic . '// Exp Date
expired in C.O T. ' V� Check Type of Work Involved:
data base). Electrical Contr. Lic.# Exp Data
�.�Q� ❑ Audio and Stereo Systems
C.O.T.or Metro Lic.# Exp. Date
❑ Boiler Controls
OwnerName
❑ Clock Systems
OWNER - .ress
` Data Telecommunication Installation
APPLICANT _ n
City/State _ Zip Phone# ❑
Fire Alarm Installation
This permit is issued under OAE 918-320-370.This applicant agrees to ❑
make only restricted energy installations(100 volt amps or less)under this HVAC
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 Control'
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;
Protective Signaling
5. Assume responsibility for calling for a final inspection when all of the ❑
corrections are completed. Other
Permits are nontransferable and non-refundable and er.pire If work is not
started within 180 days of issuance or if work is suspended for 180 days Number of Systems
The person signing for this permit must be the applicant or a person No licenses are required Licenses are required for all other installations
authorized to bind the applicant.
FEES:
ENTER FEES
Si C�re
5%SURCHARGE(.05 X TOTAL ABOVE)
Authority if other than Applicant -- TOTAL 4 .
IWstsve-We,doc 1197