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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (nRec-O-Phone): 639-4175 Business Phone: 635.4171
Inspection: �/( _G t� – r •
Footing CeZing iSusp. C ng Sprink Rough in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Strutt. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beare Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
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Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. B6. -Elect.
Date Requested: ,4- c Time: —AM K4
Address: .__41 { _
Builder: 6 S,/J Permit #: 3;(:'
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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ector, 7 Y Date: '� `Of
APPROVED DISAPPROVED _APPROVED SUBJECT TO ABOVE
Call For Reinsp.
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WASHINGTON COUNTY RESTRICTED
Department of Land Use&Transportation
y Electrical Inspection Section ELECTRICAL ENERGY
155 North First Avenue, #30-12
Hills) 97124 APPLICATION
Information: (503 64040--3434 700 Fax: (503)693-4412
PLEASE . . •
Please c. . sections, a . Permit No. ���� ���.._ (��(� ('
1. Location of Installation Date
Address_`-I I(g b S L,0 1--I ✓ i�), T—T—
Ctry TC-1-R2D Zip Code 91 L7—1-_ 4. Type of work:
Map No. _ Tax Lot RESIDENTIAL Restricted Energy Fee 540,00 �
Thomas Map Book: Page _ _ Section __ (for all systems)
Check type of work Involved:
Directions -----------.____r -- _—
�T -- Audio and Stereo Systems'
i Commercial Residential Burglar Alarm
Telephone Systems' ,
Tenant Name A 1 I 1 Garage Door Opener"
(if commercial) _�o"t 1 I�I-� , 0f. L RO �pur Fire Alarm
F Heating,Ventilation and Air Conditioning Systems'
Vacuum Systems'
f 2. Contractor application:
�' Other
Electrical Contractor k-wo17&- C'01.11.1�
Addressp- ---- - COMMERCIAL fee for each system $40.00
City Q c�1.� [ r lr _ Stated t2 Zip 97y 3 (see OAR 918-260-260)
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Date LJ - Job Number py7 Z L ��— Check type of work Involved:
Property Owner
Contractor's License No. _'9/() KEZ /0-/-9(a
Contractor's Board Reg. No. _ Cooler controls
Clock Systems
Phone No. —';03- L =Z 7 '-FR Data Telecommunications Installations
HVA(Alarm Installation
3. Owner application:
Instrumentation
Print Owner's Name Phone No. T Intercom and Paging System
Landscape Irrigation Control*
Address Medical
Nurse Calls
City State Zip Outdoor Landscape Lighting*
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This permit Is issued under OAR 918-320-370. The applicant agrees Protective Signaling
to make only restricted energy Installations(100 volt amps or less) Other
under this permit and to do the following: --- ----"-�
1. Oniy use electrical licensed persons to do Installations where
required. (Cer'ain residential and other transactions are exempt Number of Systems
from licensing. These have asterisks('). All others need licens-
Ing.)
�� 2. Call for an inspection when all the installations r.nder this permit 'No licenses are required. Licenses are required for all other installations.
are ready for Inspection. j
Sft 3. Purchase separate permits for ail Installations that are not ready 5. Fees t
for Inspection when the inspector Is out to Inspect under this
permit. Enter fees $
4 Assume responsibility for assuming that all corrections requlr^d
by the Inspector are done,and
5. Assume responsibility f-n calling for a final Inspection when all of 5% Surcharge (.05 X total above) $ __ Z
the corrections are completed.
The person signing this permit must be the applicant or a person Trust Account $
authorized to bind the applicant. II l
Signature --� ---- Total $ t L l
Authority if other than_,'olicant . . _. _ This permit becomes null and void If the work authorized by the
permit Is not commenced within leo days from date of Issuance
E For Inspections call of such permit or If the work authorized Is suspended or abandoned
540-3561 or 693-4415 at any time after work Is commenced fnr a period of 180 days.
Electrical Permits are non-refundable and non-transferable.
24-hour recorder, one working day In advance of need
8L24-114
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CITY OF 'T I GARD — Rc.,cE I v-r OF PnYMti:N'T RF:'CF I FST NO. t95---267-`
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CHECK mmnL1NT 4r-.. O;,,
NAME t KUlrHly, WALLACE F3. CAMA AMCIUNT 0. 00
A1)1)RESE3 t 5903 5F 49-rH F'AYME:'NT DATF e 0E;/217/99
PORTi_AND, (JR S1.1110I V I f-�I ON
9 7 206•-•
PURF'CIS OF F'AYMF'N AMOUNT PAID PURPOSE OF PAYMENT OMOLINT
N."I.r r_,TRIC'44l_ PERMIT 40. 00 S1. BUILD VIED 2Vigo
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94160 tiW HALL. HI_.VD / JOHN ANDF:R-9011 "PRO C.-JOLF"
TO TAt... AMOUNT PAID _ - - - > 42- 00
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