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6950 SW HAMPTON. Suite 220
CITY OF TIGARD
DEVELOPMENT SERVICES PERITIT-1-
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171
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Tl,,,S permit is issued subject to the regulations contained in the Tigard Minicipai Code, State of Ore. Specialty Codes and all Other
'icable 'Aws. All way+ will be done in irrordartrp with approved plans. This permit will expire if work is not started within Igo
iiays of issuarrp, or if wort, is suspended for more thAn 188 days. ATTENTION: Oregon In requires you to follow rule Ado by
Oregon Utility Notification Center. Thane are set forth in OAR 952-861-9818 through OW 9W-011-M88. You my ob" "e
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these rules or direct questions to
at (50246-1987.
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CITY OF I)GARD RESTRICTED ENERGY ELECTRICAL APPLICATION Recd by:_
13125 SW HALL BLVD Date Recd `Cr'"
TIGARD OR 97223 PRINT OR TYPE
V-503-639-4171 X304 Perm#:bzXq-��
F-503-684-7297 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'
WILL NOT BE ACCEPTED
Name of Development Project I TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
Restricted Energy Fee.................................................................... $40.00
(FOR ALL SYSTEMS)
JOEL Street Addre� Ste# Check Type of Work Involved
ADDRESS S cj Q- 37�C1
Cr /state Zip hone# Audio and Stereo Systems
Na ❑ Burglar Alarm
Garage Door Opener'
OWNER MallingAddress �]
EJCity/State Zip Phone# H-ating,Ventilation and Air Conditioning System'
Name ❑ Vacuum Systems'
ADI SECURITY SYS!EM&X
103 HANCOC� ❑ Other ___-_ _
CONTRACTOR Mailing AddresjU3)284 1765
'TYPE OF WORK INVOLVED -COMMERCIAL ONLY
(Prior to issuance a City/state -77TZip Phvne# Fee for each system.............................................. $40.00
copy of all licenses (SEE OAR 918-260-260)
are required if Oregon Conti.8r iy,# Exp.Date
expired in C.O T � Check Type of Work Involved:
data base). Electrical Contr Li .# Exp Date ❑
Audio and Stereo Systems
C.O.T or Metro Lic # Exp.Dete ❑
Boiler Controls
_ Owner's Name
❑ Clock Systems
OWNER - Mailing Address
APPLICANT ❑ Data Telecommunication Installation
CitylSta!e Zip Phone# ❑ Fire Alarm Installation
This permit is issued under OAE 918.320-370.This applicant agrees to ❑ HVAC
make only restricted energy installations(1 00 volt amps or less)under this
permit and to do the following: ❑
Instrumentation
I 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 Ilc!'rnsing;
❑ Landscape irrigation Control*
2 Call for inspections when installation under ,his permit are ready for
inspection at 503.639.4176; ❑ Medical
i-u,-neae sept ii.to permits for all installations that.ore not ready for an ❑ Nurse Calls
in,pectiun whr', ,,a 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;
�1 Protective Signaling
5 Assume responsibility for calling for a final inspection when all of the
corrections are completed ❑ Other
Permits are non-transferable n non- undable and expire if work is not
started within 180 days of su ce if work is suspended for 180 days Number of Systems
The person signing for p mi must be the applicant or a person No licenses are requlred Licenses are required for all other installations
authorized to t p cant
FEES;
L — ENTER.FEES S Y G
Si4naturif
5%SURCHARGE(.05 X TOTAL ABOVE) $ -;2 1 _
Authority, if other than Applicant — TOTAL $ _
i\dstslresele doc 7/97
3 -10
CITY OF TIGARD BUILDING INSPECTION DIVISION
24y-Hour Inspection Line: 639-4175 Business Phone: 639-4171
Wte Requested- 3 - � � �0 A.M.
CPM. � MST:
Location: (�' (�'
BUR
Tenant: i_^ Suite:22 6 Bldg: MEC:
Contractor: Phone: - 7
PLM:
0"mr _ _Phone: ELC:
-- F.LR:1?
SIT: _
BUILDING BLDG(con't) PLUMBING MECHANICAL (: �TRIC 4L SITE
Site Post/Beam Post/Beam 1'ost/13eam Cor/Semce Sewer/Storm
Footing Roof Undl'USlcr, Rough-Ir Ceiling V Vater Line
Slab Framing Top Chit Gas Line Rough-In UG Sprinkler
Foundation Insulation Sewer Hood.Duct Reconnect Vault
Bsmt Damp Drywall Sturm F,mace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear/Sheath Fire Spklr/Alm Crawl/Found Ih Heat Pump 'i;ow o
Approved Approved Approved ppm Approved
Appr/Sdwlk Not Approved Not Approved Not Approved Not Approved
FINAL FINAL FINAL FIN FINAL
❑Call for reit r (3 Reinspection fee of S �i required before
next insixxtion O Unable to inspect
Inspector: -_--__- Date g
_ _� 7! Pae of