Permit (270) ELECTRICAL PERMIT —
'eC�IY OF T I CARD RESTRICTED ENERGY
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #: ELR95 -0241
13126 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171 DATE ISSUED: 12/22/95
PARCEL: 2S102AB -01801
SITE ADDRESS...: 09450 SW TIGARD ST *OLD
SUBDIVISION : NO.TIGARDVILLE ADDITION AMEND. ZONING:I —
BLOCK LOT •56
Project Description:
A. RESIDENTIAL B. COMMERCIAL -- - ------------ •
AUDIO & STEREO...: AUDIO & STEREO..: INTERCOM & RAGING..:
BURGLAR ALARM • X BOILER LANDSCAPE / I RRIGAT.. :
GARAGE OPENER • CLOCK MEDICAL •
HVAC DATA /TELE COMM..: NURSE CALLS
VACUUM SYSTEM • FIRE ALARM • OUTDOOR LANDSC LITE:
OTHER: .. HVAG • PROTECTIVE SIGNAL...
INSTRUMENTATION.: OTHER..: ..
TOTAL # OF SYSTEMS: 0
Applicant: . - -- -- - -- FEES
PHILLIPS ELECTRONICS type amount by date recpt
1110 NW FLANDERS PRMT $ 40.00 CJS 12/22/95 95- 274200
5PCT $ 2.00 CJS 12/22/95 95- 274200
PORTLAND OR 97209
Phone #:
Contractor: •-
CONTRACTOR NOT ON FILE $ 42. 'TOTAL
REQUIRED INSPECTIONS
Ceiling Cover Elect'1 SQrvire
Phone #: Wall Cover Elect' 1 Final
Reg #.. .
This per.it is issued subject to the regulations contained in the
Tigard Municipal Code. State of Ore. Specialty Codes and all other Perm i t e e Signature
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started
within 180 days of issuance, or if work is suspended for ■ore
than 180 days. Issued By
OWNER INSTALLATION ONLY •- --
The installation is being made on property I own which is not intended for
sale, lease. or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY - --
SIGNATURE OF SUPR. ELEL'' N: -- ___,__.- -.�_ - DATE: 4R- as ;— __.- ._____
LICENSE NO:
Call for inspection — 639 -4175
'-If
Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd.
• Tigard, OR 97223 PERMIT # a095 - Oo?
��" i �'41 j� 1'� Phone (503) 639-
FAX (503) 84 297 DATE ISSUED /, - a a - 9.5
- - TDD No. (503) 684 -2772
CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BY C 4 des Sc y,,, ,./f
PLEASE COMPLETE ALL SECTIONS
1. LOCATIO OF INSTALLATION 4. TYPE OF WORK
F C (S —.C) 6 (k) 1 aii ,S7
/� Z L RESIDENTIAL — Restricted Energy Fee $40.00
Addre�
1 — L `� Q
City State Zip Check Type of Work Involved:
PERMITS ARE NO - TRANSFERABLE AND NON - REFUNDABLE AND EXPIRE IF WORK . ❑ Audio and Stereo Systems*
IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR
180 DAYS. gt
Burglar Alarm
Garage Door Opener*
2. CONT C OR APPLICATION
C � ❑ Heating, Ventilation and Air Conditioning System*
Contractor Type a a c� I R_- v ❑ Vacuum Systems*
Address (((0 W
'' ,, `` FL-Du-Los-f-' ❑ Other
Date /v / / 4 COMMERCIAL — Fee for each system $40.00
� Ru/ S : � (SEE OAR 918-260-260)
Property Owner r `/'� Check Type of Work Involved:
Contractor's Board Reg. No. Iii 3 3 c-4- ,3 ❑ Audio and Stereo Systems* X . � � 2 ° �^ 7 / ❑ Boiler Controls
Phone# ` ❑ Clock Systems
3. OWNER APPLICATION ❑ Data Telecommunication Installations
❑ Fire Alarm Installation
❑ HVAC
Print Owner's Name Phone No
❑ Instrumentation
Address ❑ Intercom and Paging Systems
❑ Landscape Irrigation Control *,
City State Zip ❑ Medical
This permit is issued under OAR 918 - 320 -370. This applicant agrees to make only El Nurse Calls
restricted energy installations (100 volt amps or less) under this permit and to do the ❑ Outdoor Landscape Lighting*
following:
❑ Protective Signaling
1. Only use electrical licensed persons to do installations where required. (Certain
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 installations 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.
4. Assume responsibility for assuring that all corrections required by the inspector
are done, and
5. Assume responsibility for calling for a final inspection when all of the corrections 5. FEES .
are completed.
The person signing for this permit must be the applicant or a person �'
P g g P PP P a. Enter Fees $ V U
authorized to bind the applicant. 1
/p b. 5% Surcharge (.05 x total above) $ ?
Signature ! ' c�
TOTAL $
Authority if other than applicant
ENERGAP.CHP
6 /13 /99 Activities for Case #: ELR95 -00241
4:11:06 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRA003 APPlication received 12/22/95 CJS RECD TMP 12/22/95
ELRA010 Permit created 12/22/95 CJS PEND TMP 12/22/95
ELRA700 Ceiling Cover 12/22/95 • TMP 12/22/95
ELRA720 Wall Cover 12/22/95 TMP 12/22/95
ELRA730 Elect! Service 12/22/95 TMP 12/22/95
ELRA799 Elect! Final 12/22/95 12/4/98 BRP PASS B *P 12/4/98
ELRA500 (F) Issue permit 12/22/95 CJS PASS TMP 12/22/95
ELRA510 (F) Reprint permit 12/22/95 TMP 12/22/95 • ELRA800 Case finaled 12/9/98 JT 12/9/98
•
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