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i:\records\microflrn\targets\huilding.doc
CITY OF TIGARD
R DEVELOPMENT SERVICES F 1 ECTRICAL PERMIT -
13125SWHall Blvd., Tigard,OR91223 (503)63 RESTRICTED ENERGY
PERMIT #: ELR97-0142
* �+� DATE ISSUED: 05/13/97
PARCEL: 1 S 135BD-01200
Ni d 8b
r SITE ADDRESS. . . :09800 SW SHADY I...N
SUBDIVISION. . . . . ZO"ING:C-G
tai BLOCK,. . . . . . . . . . : LO(. . . . . . . . . . . . . JURISDICTN: TIG
, u.
- i1 +TAU A110N OF DATA TELECOMMICAiIO� SYSTEM Description.
--------------------------------
A. RESIDENTIAL--- ---- H. COMMERCIAL------
AUDIO & STEREO. . . : AUDIO & STEREO. . : INTERCOM 8 PAGING. . :
Y' BURGLAR ALAP.M. . . . . BOILER. . . . . . . . . . . LANDSCAPE/IRRIGAT. . :
A
GARAGE OPENER. . . . . CLOCK. . . . . . . . . . . " MEDICAL. . . . . . . . . . . . :
HVAC. . . . . . . . . . . . . . DATA/TELE COMM. . : X NURSE CALLS. . . . . . . .
l ypj VACUUM SYSTEM. . . . : FIRE ALARM. . . . . . : OUTDOOR LANDSC LITE
+ !' OTHER: . . HVAC. . . . . . . . . . . . : PROJf I I IVE SIGNAL_. .
d_ I NS'f RUME NTAT I ON. : OTHER. . .
TOTAL # OF SYSTEMS: 1
Owner: __________.______--_-_--__-_-- -_-__.____.__----__..__ -__-.-- FEES
NW COMMUNICATIONS type amorant by date recpt
9804 SW SHADY LN PRM1_ $ 40. 00 DRA 05/ 13/97 97-294509
TIGARD OR 97223 SPCT $ 5'. 00 DRA 0.5/13/97 97-29450
9
Phonp #:
Contractor: ---. ------------------------ -----•----------------------------------
VANDER STOEP ELECTRIC $ 42. 00 TOTAL_ y
;.'3765 THIRD ST NE
- -- ---- REQUIRED INSPECTIONS
- ----
AURORA OR 97002 Ceiling Cover Elect' l Service
Phone #: Wall Cover Elect' l Final
Reg #. . : 00094
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Perm ee Si gnatr_trE
applicah) lzw.. All work will be done in accordance with
approved plan4. This permit will expire if work is not started
within IN days of issuance, or if work is suspended for more I s _
11 ' than IN days. s r_i e d B y
•,,, -----------------------------OWNER INSTALI_ATION
�!r The i,;-tallation is being made on pr operty I own, which is not intended for
° sale, lease, or- rent.
OWNER' S SIGNATURE: —_ _. _..__ _ --.----.-_ _. DATE:
-
--------------
--------CONTRACT ION 0
SIGNATURE OF SLrrJR. EL_EC' Na T- -- -- -- DATE-
LICENSE
ATE:LICENSE NO:
a Call for inspection - 639--4175 r
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CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Recd 4: _20
13125 SW HALL BLVD Date Rec'&-L—J
TIGARD OR 97223 PRINT OR TYPE
a V-503-639-4171 X304 Permit#:
F-503-684-7297 INCOMPLETE OR ILLEGIBLE APPLICATIONS L:ust.Call'd:� I
WILL NOT BE ACCEPTED !
Name of Development Project TYRE OF WORK INVOLVED-RESIDENTIAL _
Restricted Energy Fee........................................ $40.00 i
(FOR ALL.SYSTEMS)
JOB Street Address Ste#
ADDRESS Check Type of Work Involved:
_
C t to Zip Phone# u Audio and Stereu Systnms •
Name Burglar Alarm
4 OWNER Mailing Address - E] Garage Door Opener'
City/State Z.ip Phone!/
EJ Heating,Ventilation and Air Conditioning System'
Name D Vacuum Systems'
h1A0DF_P_ STof f' CLO r II Other---
.ONTRACTOR �9�iling Address
- , &T TYPE OF WORK INVOLVED-COMMERCIAL
(P2 for to issuance a Citl/State Zi P one# Fee for each system..................................... 00......... $40.
copy of all licenses ( r,L) ?(, `�7 60 �7D-y j (SEE OAR 918-260-260)
are required if Oreon Contr Brd Lic # Exp.Date
expired in C.O T �3�'j`I 17 Check Type of Work Involved:
data base). Ec(_ricl Conti. c # Exp Cafa.14-
F-1 Audio and Stereo Systema
C.O or Metro Lic.# Exp. Date
>4 'g ' r /'/ �l Boiler Controls
Owner's Name
OWNER- Clock Systems Mailingg Address 1
APPLICANT Data Telecommunication Installation
City/State Zip Phone# r�
LJ Fire Alarm Installation
I This permit is issued under CAE 918-320-370.This app;+cant agrees to '1
make only reztricted energy installations(100 volt gimps or less)under this f_ J HVAC
permit and to do the following
Instrumentation I
1. Only use elect6Ical licensed persons to do installations where required
Certain residential and other transactions are exempi from licensing. lJ Intercom and Paging Systems
These have asterisks('). All others need licensing,
2. Cell for inspections when installation under this permit are ready for
❑ Landscape Irrigation Control'
inspection at 503-639-4175; Medical
I
? 3 Purchase separate permits for all installations that are stet ready for an ❑ i
inspection when the inspector Is out to inspect ander this permit; Nurse Calls
'i
4 Assume responsibility for assuring that ail correction-required by the Outdoor Landscape Lighting*
inspector are done,and,
Protective signaling
5 Assume respensibillty for calling for a final inspection when all of the
corrections are completed. ❑ Other
Permits are non-transferable and non-refundable and expire if wort is-of
started within 180 days of issuance or If work is sus,'ended for 180 d.�,. _ _—Number of Systems
The person signing for thi permit must be the oppOcant or a person No licenses are required Licenses are required for all other installations
authorized to bind the ap Ica e ---
FEES
Signature ENTER.FEES
6%SURCHARGE(.05 X TOTAL ABOVE)
Authority it other than Applicant TOTAL =` 57
i Vesele doc 12/96