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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639.4175 Business Phone: 639-1 '71
Inspection: 4..�
Footing Susp. Ceiling Sprink, Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL: 4
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: S Time: AM PM
Address: 114G —_3
Builder: -0 Permit #:
CL2`�5-oo�r
THE FO LOvG CORREPTIONS A�REQ R 5:
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. APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
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Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd.
Tigard,OR 97223 PERMIT# E L 2 9-q'—DUF 9
Phone(503)639-4171
FAX (503)684-7297 DATE ISSUED_
TDD No. (503)b84-2772
CITY OF TIOARD Inspection (503) 639-4175 ISSUED BY r/&c A dt
r PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTALLATION 4. TYPE OF WORK
Add
�res RESIDENTIAL—Restricted Energy Fee. . . . . . . . . 540.00
, 7�� (FOR At I SYSTEMS)
■
i City State Zip Check Tie of Work Involved:
+qc PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND EXPIRE IF WORK
IS NOT STARTED WITHIN 100 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR ❑ Audio and Stereo Systems
1111 100 DAYS. Burglar Alarm
2. CONTRACTOR APPLICATION Garage Door Opener'
AA El Heating,Ventilation and Air Conditioning System'
Contraclor,fQ�'IL/�CS_ U+y _ ype�_"�00 _G, 4 ❑ Vacuum Systems`
7
Address
7{057 di
s,�✓. ,e v'.- _/_ 4s14� pt �y_ Other
Dale 7.Z S s _A -__ COMMERCIAL—Fee for each system . X40.00
(SF1 ()AR x)18-2G0-2110)
Property Owner / q2'
- T--�—v---- �'�---�=� "' �''?° _ Check Type of Wurk Involved:
Contractor's Board Reg. No. -2-1 ❑ Audio and Stereo Systems"
Phone# -_6-i r _ Q S -- - ❑ Boiler Controls
--- ❑ Clock Systems
3. OWNER APPLICATION ❑ Data Telecommunication Installations
❑ Fire Alarm Installation
v 0 Y(;JTHVAC
nnP' t C7w er's Name Phone No ❑ Instrumentation
Address ❑ Intercom and Paging Systems
❑ Landscape Irrigation Control'
City state Zip ❑ Medical
This Ixermit Is Issued under OAR 918-320.370.This applicant agrees to make only ❑ Nurse Calls
restricted energy Installations(100 volt amps or less)under this perrnit and to do the ❑ Ouldr mr I andscape Lighting'
following:
1. Only use electrical licensed persons to do installations where required.(Certain El Protective Signaling a
residential and other transactions are exempt from licensing.These have ❑ Other
asterisks(•).All others need licensing). -- -- --
2. Call for an Inspection when all of the Installations under this permit are ready
for inspection at 503-639-4175.
❑ Number of systems
3. Purchase separate permits for all instillations that are not ready for Inspection '
when the inspector is out to inspect under this permit. •No licenses are required. Licenses are required for all other Installations. V
4. Assume responsibility for assuring that all corrections required by the inspector ---
are done,and
5. Assume respnnsihility for calling for a final inspection when all of the corrections 5. FEES d
are completed.
The person signing for this permit must he the applicant or a person a. Enter Fees
authorized to bind the applicant. $---�---
b. 5`%r 51-ircharge (.05 x total above) $
Signature
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TOTAI $
Authority if other than applicant
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° CITY OF TIGARD OF PAYMENT REGFIVIT NO. :95-8,666911 6
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CHECK gMl]IJNT s 42. �'•` •' E
r NAME a BRINKI S HOME SECURTTYr INC CASH AMOUNT Il. ovi
ADD14ESS a E11I159 E . W. CIRRI_I4, DR. PAYM6:N'1' DATE a 07/31/95 �
A' BEAVE-RTO7N OR. gIJBD I V I;I CIN e
y 97008__
'r "•, PURE•06F: OF F,FiYMF-.NT mmnLINT PAID P(JRPM;E OF PAYMENT AMOUN r FSA I t)
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G. E:Lk:C'fRICAL PERMIT 40. 00 >T. BUILD PER .... ._�_. C:'. AQP
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11485 S. W. L OMITA AVE. TIC-1ARD OR.
! TC1'f m— AMOUNT PAID 00
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