Case File •
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10395 SW BONANZA WY
CI1YOFTIGARD ,,- ,
COMMUNITY DEVELOPMENT DEPARTMENT MASTER PERMIT
13125 SW Hall Blvd.Tigr.;d,Orapon 97223.8196 (503)839-4171 PERMIT # • MST93-0616 •
639-4171 DATE ISSUED: 01/06/94
PARCEL: 2S114BC-O49OO
SITE ADDRESS. . . : 10395 SW BONANZA WY
SUBDIVISION • RIVERVIEW ESTATES NO. 2 ZONING: R-7 PD
BLOCK • LOT •086
BUILDING -- -- -__._. __-. -•--.____.__.__ .
REISSUE: DWELLING UNITS: 1 BASEMENT -0 sf
CLASS OF WORK. r,NEW BEDRMS:3 BATHS:3 GARAGE •440 sf
TYPE OF USE. . . :SF FLOOR AREAS---------- REQUIRED SETBACKS --TYPE OF OF CONST. :5N FIRST • 1342 sf LEFT. . : 18 ft RIGHT. :6 ft
OCCUPANCY GRP. :R3 SECOND. . . :851 sf FRONT. :`0 ft REAR. . :27 ft
STORIES •2 THIRD •0 sf REQUIRED--------
HE I GHT •27 ft TOTAL------:2193:2193 s f SMOKE DETECTORS. :Y
FLOOR LOAD 40 psf VALUE $ • 108798 PARKING SPACES. . : 1
Remarks: PATH I
- --..._._._. PLUMBING
SINKS • 1 FLOOR DRAINS •0 BACKFLOW PREVNTRS. . :0
LAVATORIES 4 WATER HEATERS • 1 TRAPS :0
TUB/SHOWERS LAUNDRY TRAYS • 1 CATCH BASINS •0
;J TER CLOSETS. . :3 SEWER LINE (ft ) . :0 GREASE TRAPS •0
DISHWASHERS • 1 WATER LINE (ft ) . : 100 OTHER FIXTURES •0
GARBAGE DISP. . . : 1 RAIN DRAIN (f+ ) . :0
WASHING MACH. . . : 1 SF RAIN DRAINS. . : 1
--------------- MECi1PVICAL -__-._ _____._ -------• FEES
FUEL TYPES-------•------- UNIT HTRS. . :0 type amount by date rc>r 1.(
/HAS/ / / VENTS :0 TIF $ 152100 JF 01/06/94 -
MAX INPUT :0 BTU VENT FANS' :4 BPRT $ 455. 50 JF 01/06/94 -
FURN ( 100K . . :0 HOODS • 1 BPLC $ 296. 08 JLH 12/27/93 296. 08'7,70
FURN ) =100K . . : 1 WOODSTUVES. :0 BSPC $ 22. 78 JF 01/06/94 -
FLOOR FURN. . . . :0 CLO DRYERS. : 1 SSDC $ 280. 00 JF 01/06/94 -
BOIL/CMP ( 3HP:0 OTHER UN1TS: 1 PARK $ 500. 00 JF 01/06/94 --
GAS OUTLETS: 1 MPRT $ 45. 00 JF 01/06/94 -
Owner: --__.._....._._..__..____--_--.____.__ . __... .__. ._.__ .___ MPLC $ 11. 25 JF 01/06/94 -
MC CLELLAN HOMES INC M5PC $ 2. 25 JF 01/06/94 -
P O BOX 176 PPRT $ 155. 00 JF 01/06/94 --
PSPC $ 7. 75 JF 01/06/94 -
SHERWOOD OR 97140
Phone #: 625-0507
Contractor: _.__._._._.___. __..__....._.._.._ _.._... ._._.._.-....__..... ..___
MC CL.EL_LAN HOMES INC
P U BOX 176
SHERWOOD OR 97140
Phone #: 625--0507
Rey #. . : 55563
$ 3295. 61 TOTAL_
This permit is issued subject to the regulations contained in the REQUIRED INSPECTIONS
Tigard Municipal Code, State of Ore. Specialty Codes and all other Foot/found Insp Fireplace Insp
applicable laws. A11 work will be done in accordance with approved Post/Beam Struct Cas Line Insp
plans. This permit will expire if work is not started within 181 Post/Beam Meehan Insulat ion Ins)
days of issuance, or if work is suspended for more than 180 days. Plm/undslab Insp Gyp Board Insp
PLM/Underfloor Rain drain Insp
i r•', mittee Signature : '^,•'a.,. „Mc, - f�.,i Mechanical Insp Water Line Insp
Plumb Top Out Appr/Sdwlk Insp1 : Led By : / ..( Framing Insp Mechanical Final
i
Cell fer irrepeebiee 639 4176
1 _ _ ______ _____
f
CI1YOFTIGARD SEWER CONNECTION
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT I
13125 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)639-4171 PERMIT # • SWR93-0536
639-4111 DATE ISSUED: 01/06/94
PAFCEL: 2311413C-04900 I
SITE ADDRESS. . . : 10395 SW BONANZA W'!
SUBDIVISION : RIVERVIEW ESTATES NO. 2 ZONING: R-7 PD 1
BLOCK LOT :086
TENANT NAME •
USA NO : FIXTURE UNITS. . . :
CLASS OF WORK. :NEW DWELLING UNITS. . : 1
TYPE OF USE •SF NO. OF BUILDINGS: 1
INSTALL TYPE •BUSWR IMPERV SURFACE. . : : sf
Remarks: PATH I
Owner: -__ - -• _-- FEES -
MC CLELLAN HOMES INC type amount by date recpt
P 0 BOX 176 PRMI $ 2200. 00 JF 01/0L/94 -
INSP $ 35. 00 SF 01/06/94 -
SHERWOOD OR 97140
Phone f#: 625-0507
Lorrtractor: - --- _
CONTRAL . JR NOT ON FILE
Phone #: $ 2235. 00 TOTAL
Reg #. . : _
---_---- REQUIRED INSPECTIONS -- _ ..
-
This Applicant agrees to comply with all the rules and regulations Sewer Inspect ion
of the Unified Sewage Agency. The permit expires 188 days from
the date issued. The total amount paid will be forfeited if the
-
pereit expires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not located at the measurement
given, the installer shall prospect 3 feet in all directions from
the distance given. If not so located, the installer shall purchase i. -
a "Tap and Side Sewer" Permit and the Agency will install a lateral.
Permittee Signature: /( L' 2/t.c- �.wl _ ----.._�— __
Issued B y : _ C .CIIi0." _.__..r__-__.. _—__
i
all for inspection - 639-4175
c2Y /3 /ell
-- . ---
Residential Building_Permit Application
City of Tigard
13125 SW Hal! Blvd.
1 igarcl, UH 91223
(503) 6394171
Jobsite Address: / O 3 / -5-co ,Q 6 h a h 2-q w4- /
Subdivision: ;-uc v t)Vie,J FS�a It Lot l ? b Office Use Only
I
' �y
Valuation: �o Planck/Roc#
„
/
Permit# b'?5t93 " 0 ‘ jr
Owner: /21 c Ci C�( `--- /1� i ,7-0-•C . Reissue of
Address: p. D 1.1-:t X / 7(,,,
/i r it w ��c o �}-?/ Approvals Required
Phone (1,) (:)- Ucl
_ Planning t3 h'S,/tDIohir -eie...,
:Engineering
Contractor: 54 r'- -e other
Address.
Items Required
Subcontractors
Phone:
— S'S//b 3Truss Details
Cortractors License # /1/1c( I(/l I-- It NnP--) .,rrt.c ""-- ---
(attach copy of current Oregon license) Other
Subcontractors:
Plumbing: J-
; 1 5 #1.)A wt.6 i3;
Mechanical: 1) 1 L4 tit e 0'K c,l(f if It ec -te
(attach copy of current OF? Cvntr3ctors License)
Architect/Engineer: ,- ii, i1k.s c ^d !2e J j
Address: / S"VS- ,L/JtJ, ? 3'-cl 4--1..)C.,
(ortia, el 0,k) e 0 -, `17a/ a
f
Phone: ) ) S - 6I/6, I — —
COMMENTS: Lam ' pal: /1.,,,,,,F 1,j4J1 _ ---
1
1 ''1/ to 2n - o, ) \ - 0 ro ?
A plicant Signature & Phone number
Received by: , , mac; Date Received: /c� (-) i c1._3
Permit tt Account Description Amouuit Amt. Pd. Bal. Due
•
h1 5+y3 -040.1 c Bldg. Permit (BUILD) 4-i3.. .50 / ._. '
Plumb. Permit (PLUMB) 155 . (AO _SS,v U
_ Mech. Permit (MECH) 45,00 Vy
State Tax (TAX) 32 , 7 P / -- 3 Z.7Y
Bldg: rae2 `7e
Homo: -T 7 )r
Mech:
/
Plan Check (PLANCK) 1e7•33 ..2,g) Si 33
Bldg: '2%, .vY
Plumb: _
Mech: 1 I 7, ') I
Soig4 j-O S3_ Sewer Connection (SWUSA) ot.2 u 0 g /0
Sewer Inspection (SWINSP) �._ 3)/
Parks Dev Charge (PKSDC) 500 0, �0O'
Storm Drainage Chg (SDSDC) ..Z.[r0'1
Residential TIF (TIF-R) 1 I I V _Ph)
Mass Transit TIF (TIF-MT) 1 I 0 ' 11 0
Commercial TIF (TIF-C) —.
Industrial TIF (TIF-1) - • _—.--
Institutional TIF (TIF-IS)
Office TIF (TIF-0)
Water Quality (WQUAL) —
Water Quantity (WQUANT)
Fire District (FIRE) .
TOTALS: ,5.;)30.6/ .2 %,52YO•Ce 1
- - -
NN -
- ' -
Cli'! � TIGIARD CERTIFICA7E OF
OCCUPANCY
COMMUNITY DEVELOPMENT DEPARTMENT
pERMIT � : MST93-061f
wruuo m�mw (503)
1u1camwxmoowo Tigard,Oregon ° 639-4171PERMIT_ _
� ~~— --' DATE ISSUED: 11/14/94
'
PARCEL: 2S114BC 04900
ATL ADDRESS, , . : 10385 9W BONANZA WY ZONINBxR-7 PD
3JBDIVISION. . . . : RIVERVIEW ESTA--5 NO. 2
8LOCK ^ LOT :086
CLASS OF WORK. :NEW
TYPE OF UGE. . . oSp
OCCUPANCY GRP. :R3
OCCUPANCY LOAD:227 4
TENANT NAME. . . :
Remar,s : PATH I
- ------ ---------------
Owne. : ------------
MC CLELLAN HOMES INC
P O BOX 176
OHEHWOOD OR 97140
Phone #a 625-0507
Cnntr �c�oro -----------------------------
MC CLELLAN HOMES INC
r 0 BOX 176
uHERWUOD OP 97140
Phone *a 625-0507
Reg C , : 55563
Occupancy of the above rmferr..cmd building is hereby given, and certifies
' the compliance with the State Of Oregon Specialty Codes for the group,
— ',pan' *, and use under which the referenced permit was issued.
----- - -'
/ D N,
POST IN CONSPICUOUS PLACE
DEPARTMENT OF LAND USE&TRANSPORTATION
. OWASHINGTON LAND DEVELOPMENT SERVICES DIVISION
155 NORTH FIRST,HILLSBORO,OR 97124
COUNTY INSPECTION REQUESTS: 503/640.3561/693-4415
l PHONE: 503/ �4-v- 3476
6
OREGON Page : 1 of 1.
Date : 03/21/94
Time : 14 : 42
Permit Type : Residential Electrical Permit Permit # : 05051190
Permit Status : APPROVED Applied : 03/21/94
Situs Address : 10395 SW BONANZA WA TI Issued : 03/21/94
Permit Title : SFR - ELEC/NEW HOUSE Competed :
Permit Descr. To Expire : 09/1'7/94
Project Title : SFR - ELEC/NEW HOUSE Project # : P0039021
Project Descr. : * EROSION *
Parcel Number : 251T1 - Land Use District :
Valuation 0
Legal Descr . .•
Owner : INSPECTION - TIGARI) Construction : OTH
Applicant Name : NORTH VALLEY ELECTRIC Classification : 900
Applicant Addr. : PO BOX 222 Occupancy : R3
WOODBURN, UR 9'/071 Validated by : KF
Applicant Phone: 982-5916 Inspector Area :
CONTRACTOR : NORTH VALLEY ELECTRIC, INC Lic, C 24-302C 982-5916
Fee description Units Fee/Unit Ext fee Data
Square Footage [Enter Sq. Ft . ] 2500 185 . 00
Subtotal Electrical Fees : 185 . 00
State Surcharge of 5'%. 9 . 25
Total Electrica._ Fees : 194 . 25
*** Fees Required *** *** Fees Collected & Credits ***
Method Check # Receipt No . Date Payment
CK 2803 03/21/94 194 . 25
TOTAL THIS DATE ********* 194 . 25
Fees : 194 . 25
Adjustments : . 00 Total Credits : . 00
Total Fees : 194 . 25 Total Payments : 194 . 25
Balance Due : . 00
NOTICE: This permit becomes null and void If the work or construction for which 11 Is issued is not commenced within 180 days. Once construction has start^d.
the permit becomes null sod void If construction is Interrupted for a period of 180 days. I certify that the information presented by the applicant and
hit agent or agents In support of this permit Is true and correct to the best of our knowledge I acknowledge that th'Building Department's reliance
upon false and misleading Information may Invalidate this permit. All provisions of applicable laws and ordinances governing the construction and use
o;this building or structure will be complied with whether or not specified on the plans or noted on the plans correction sheets I acknowledge that
the 7i sr n; )f■permit does not grant authority to access private property or to use easements. I further acknowledge that the use or occupancy of
the at•ua..,„ or building permitted depends upon my catling for inspections It various times during the process of construction and the building
inspection staff verifying compliance with the various codes. Use or occupancy of the building or structure permitted prior to approval by the
Building Department Is solely at the risk of the applicant and such use or occupancy Is revocable until all Inspection requirements are satisfied and
approval Is given by the!wilding Official. I further ack.;owtodge that a lien may be placed on the title of the property upon which the permit is Issued
specifying trial the use or occupancy of the bulldino Jr structure Is provisional and revocable until the satisfaction of all Inspection requirements
APPLICANT'S SIGNATURE
- A% WASHINGTON COUNTY
Department of Land Use & Transportation ELECTRICAL PERMIT
Electrical Inspection Section /1�
V,
155 North First Avenue,#350-12 LI COATI�!i ryA�r
Hillsboro, Oregon 97124
Information: (503)640-3470 Fax: (503) 693-4412 ! (_) 2l -.71
Project/Permit 5 l_ 7//9e^
PLEASE PRINT Number Date . y )
Please complete all sections, 1 through 5. , 4. Complete Fee Schedule below
1. Location of installation Number of Inspections per permit allowed
Address.I C' ,-39 5 j•___ iriu n-4 Service included: Items Cost(ea.) Sum
Building A. Residential-per unit
City 1 ( c a el Suite No.
1000 sqft.or less I $110.00 I IC, I , 4
Tenant Naa Each additional 500 sq.ft
(if commercial) _ or portion thereof _s $25.00 7 s.0
Limited Energy -- $25.00 1
Tax Lot. ---- Map No. Each Manuf'd Home or Modular
Dwelling Service or Feeder $68 00 2
Thomas MapBook: Pae: ___415_-__. Section: D- i
Dxp�je"c,t'iyons- Dpu&Italy-��m___ � -._,.x:ui4_..Qx1e alt - B. Services or Feeders
Fapµa 911 et.vvewJO�. '�c g c %'>-�- Wit Installation,alterations or relocation
7 200 amps or less -- $60.00 2
Commercial I_-..-i Residential[X' 201 amps to 400 amps $80.00 2
401 amps to 600 amps X120.00 2
2a. Coniractor installation onlY: 601 amps to amps -__ $180.00 2
Over 1000 amps or volts $340.00 2
Electrical Contractor Kor24{,kVal ks.,4 EjrfIRic- ZNi Reconnect only .-- $50.00 2
Address I' O. c'i AAa. WOCAT7i.W, Ott_ 97c' 71
Date i 1i. 4N Job Number C. Temporary Services or Feeders
Property Owner MA_C Ic_ilfikt 140rl7es Installation,alteration or relocation
200 amps or less $50.00 2
Contractors License No. a�-�;�c- --
Contractor's Board Reg. No. k'8 3c)a _ 201 amps to 400 amps $75.00 2
?�7` 401 amps to 600 amps $100.00 -, . 2
Signature of Supr. Elec'n / '// _ Over 600 amps to 1000 volts see�e�above
License No.5/OO/..S Phone No.(r" :3 3•� 1 D. Branch Circuits
New,alteration or extension per panel
2b. For owner installations! a) The to for branch circuits with
purchase of service or feeder fee.
-.__-___-_-------. Each branch circuit $5.00 2
-
print Owner's Name 51 n ie No.
b) The fee for branch circuits without
Address --' purchase of service or feeder fee.
First branch circuit _______ $35.00 _ 2
City State _-� - Each add'nl branch circuit__ $5 00 _ 2
E. Miscellaneous (Service or Feeder not included)
The installation is being made on property I own Each pump or irrigation circle $40.00 _- 2
which is not intended for sale, lease or rent. Each sign or outline lighting __ $40.00 2
Signal circuit(s)or a limited
Owner's Signature energy panel,alteration
or extension $40.00 2
F. Each additional inspection over the allowable
in any of the abov'-'
3. Plan Review section (if required) Per inspection _ $35.00 _
Please check appropriate Rem and enter fee In section 5B. Per hour ___ $55.00
t In Plant $55.00
4 or inure residential units in one structure
Service over 800 amrs: feeder 800 amps or more 5. Fees
_System over 600 volts nominal A. Enter total of above fees $ IES.ob
_Classified area or structure containing special 5% Surcharge (.05 X total fees) $ 7..2.c-
occupancy
.acoccupancy as described in N.E.C. Chapter 5 Subtotal $ ___Lig 1,5
B. Enter 25% of line A for
Submit 2 sets of plans with application where any of the plan Review if required (Section 3) $
above apply. Not required for temporary construction Subtotal $ 19(1..2,5--
services.
Less Bulk Label Fee -_
Balance Due $ VLAi• s
for inspections call this permit becomes null and void N the work authorized by the permit le not oommenced
640-3561 or 693-4415 within tee days from date of Issuance at such permit or N the work authorized le
suspended or abandoned et any time alter work le commenced lot•period of 100 days
24-hour recorder, one working day in advcnce of need Electrical Permits ere non.refundebMend nonfiansferable.
1/94
DEPARTMENT OF LAND USE & TRANSPORTATION
WASHINGTON LAND DEVELOPMENT SERVICES DIVISION #350-12
155 NORTH FIRST, HILLSBORO, OR 97124
AN
CGUNT'Y, PHONE: 503/640-3470
OREGON INSPECTION REQUESTS (24 hours): 503/640-3561 or 693-4415
(11741.4/
tvet e dit-6
"61) a39
DEPARTMENT OF LAND USE & TRANSPORTATION
4
WASHINGTON LAND DEVELOPMENT SERVICES DIVISION #350-12
155 NORTH FIRST, HILLSBORO, OR 97124
V% COUNTY, PHONE: 503/640-3470
OREGON INSPECTION REQUESTS (24 hours): 503/640-3561 or 693-4415
Nei V A1-t ELtz
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DEPARTMENT OF LAND USE & TRANSPORTATION
Oft WASHINGTON LAND DEVELOPMENT SERVICES DIVISION #350-12
155 NORTH FIRST, HILLSBORO, OR 97124
COUNTY, PHONE: 503/640-3470
OREGON INSPECTION REQUESTS (24 hours): 503/640-3561 or 693-4415
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6:&Li 6/(779y
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DEPARTMENT OF LAND USE&TR4NSPORTATIorl
4009111 WASHINGTON LAND N
155 NORTH FIRST.DEVELOPMENT SERVICES
HILLSBORO,OR 971240
COUNTY INSPECTION RF.OUESTS: 503/640-3.61/'93-4415
4,W
,..., PHONE: 503/648-8761
OREGON edge . 1 :.
Date : 0//U8/94
Time : 13 : 10
Permit 'Type : Residential Electrical Permit Permit # : 05 r,ihbb
Permit btatu:; : APPROVED Applied : (2. //( 8/9
Situs Address : 1U39b SW bUNANGA WA '1'1 Ise ued : 0 - /.i ''-*
Permit Title : St'R - ELEC/1URULAR ALARM Completed. :
Permit Descr . .
1'o Exp,.:_ ' W./04/95
Project Title : bt'R - ELEC/N1;W HOUSE Projec` t., : F00.7i9021
Pru lect Descr . . * EROS1C *
Parcel NumLer , L51'l'1 - Land Use District :
Valuatron : U
Legal Descr . .
owner : IN8PEC'1'1ON - '1'lUAHU Construction : O'1'H
Applicant Name : bRINKb Classification : 900
Applicant Addr . : 80b9 bW CIRRUS DR Occupancy : R3
bEAVER'1'ON, OR 9 /UUb Validated by : Kt'
Applicant Phone : 641-0b'/4 Inspector Area :
Lu[V'1'RAC'1'UR : bRINKS HUME SECURITY Lic . C 34-1b15C b41-019b
tee description Units Fee/Unit Ext tee Date
L,rmite(J Energy/Alter . /Extension: 1 40 . 00 411 . 00
bubtotal Electrical tees : 40 . 00
:Jtal.e burcriaiue (it !...)4. 2 . 00
lutai. Electrical tees : 42 . 00
*** tees Huquited *** *** tees Collected & Credits ***
Method Check # Receipt No . Date Payment
CK 4282 07/08/94 42 . 00
l'U'rAL 'PHIS DATE ********* 42 . 00
i.eei : 42 . 00
/u1 Iustrtents : . 00 'Total Credits : . 00
'total Fees : 42 . 00 'Total Payments : 42 . 00
balance Due: . 00
1
NOTICE: This permit becomes null and void if the work or construction for which h is issued Is not commenced within 180 days. Once construction has started.
the permit becomes null and void if construction is Interrupted fors period of 160 days. I certify that the information presented by tho applicant and
his agent or agents In support of this permit is true and correct to the best of our knowledge. I acknowledge that the Building DeprAment's reliance
upon false and misleading information may Invr r all this permit. All provisions of applicable laws and ordinances governing the construction and use
of this building or structure will be complied with whether or not specified on the plans or noted on the plans correction sheers. I acknowledge that
the granting of a permit does not grant authority to access private property or to use easements. I further acknowledge that the use or occupancy of
the structure or building permitted depends upon my calling for inspections at various times during the process of construction and the building
inspection staff verifying compliance with the various codes Use or occupancy of the building or structure permitted prior to approval by the
Building Department is solely at the risk of the applicant and such use or occupancy is revocable until all insr action requirements are satisfied and
approval is given by the Building Official. I further acknowledge that a lien may be placed on tine title of the properly upon which the permit is issued
specifying that the use or occupancy of the building or structure Is provisional and revocable until the latisfection of all inspection requirements
APPLICANT'S SIONATURF
AO% WASHINGTON COUNTY RESTRICTED
Department of Land Use & Transportation T�
Electrical Inspection Section
155 North First Avenue, #350-12 ELECTRICAL ENERGY
Hillsboro, OregonFax:97124 APPLICATION
Information: (503) 640-3470 (503) 693-4412
t.
PLEASE PRINT
Please complete all sections,, 1 through 5' Permit No j— `, j Lj 5
1. Location of installation Date —g /l.Address I03ciS Si nanza Wal I
City Tisc rd . Zip Code g722.'i 4. Type of work:
Map No._ Tax Lot
RESIDENTIAL Restricted Energy Fee $40.00
Thomas Map Book: Page G 25 Section 01 (for all systems)
Directions Check type of work involved:
Audio and Stereo Systems*
Commercial ❑ Residential .Y] Burglar Alarm
Tenant Name Telephone Systems*
(if commercial) — — — Garage Door Opener*
This permit becomes null and void if the work authorized by the Fire Alarm
permit Is not commenced within 180 days from date of issuance
of such permit or If the work authorized Is suspended or abandoned Heating,Ventilation and Air Conditioning Systems*
at any time after work Is commenced for a period of 180 days. Vacuum Systems*
Electrical Permits are non-refundable and non-transferable. Other _
2. Contractor application:
Electrical Contractor $rlr't NornE SeGur COMMERCIAL Fee for each system $40.00
Address 805q SW Cir rUs Z)r. (see OAR eta-zso-zso►
Date '1-t.- Q`f JobNub¢er 3`i Zq 1 Check type of work involved:
Property Owner P�4fy $oymt1N_L._ _
Contractor's License No. 3't t le E_c Boiler Controls
Contractor's Board Reg. No. 49: 42 I_ Clock Systems
Phone No. Vit-OS1l'i Data Telecommunications Installations
Fire Alarm Installation
3. Owner application: HVAC
L.-0C-C1'{-10n 4 664—Q8toei Instrumentation
Print Owner's Name Phone No. Intercom and Paging System
Landscape Irrigation Control*
Address v Medical
_ Nurse Calls
City State ip Outdoor Landscape Lighting*
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. Only use electrical licensed persons to do Installations where
required. (Certain 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 under this permit *No/WI 11500 lire required. Licenses are required for all other installations.
are ready for inspection.
3. Purchase separate permits for all installations that are not ready 5. Fees
for Inspection when the Inspector Is out to inspect under this
permit. Enter fees $ 40-
4. Assume responsibility for assuming that all corrections required
by the inspector are done,and
5% Surcharge (.05 Xtotal $ _ at
5. Assume responsibility for calling for a final inspection when all of g above)
the corrections arc completed.
The person signing this permit must be the applicant or a person Total $ 44Z 9
authorized to bind the applicant.
Signature _ /{�J Space below reserved for validation.
Authority if other than applicant S• `�
For Inspections call
640-3561 or 693-4415
24-hour recorder,one working day In advance of need
494