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Permit X7/0/ ov cj C 8 c rc(' / t CITY OF TIGi4R® ELECTRICAL PERMIT 1„. 6 we V COMMUNITY DEVELOPMENT Permit #: ELC2010 -00284 TEGAAD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/11/2010 Parcel: 2S114BCO3000 Jurisdiction: Tigard Site address: 16657 SW RIVERWOOD PL Subdivision: Lot: 0 Project: Bradley Project Description: Feeder installation. 6/11/10 added (1) branch circuit. 6/18/10 added (2) branch circuits B.T. Owner: FEES BRADLEY, TODD Quantity Description Date Amount 16657 RIVERWOOD PL TIGARD, OR 97224 1 ea Services or Feeders - 200 06/11/2010 $100.70 amps or less PHONE: 1 ea 12% State Surcharge - 06/11/2010 $12.08 Electrical 7 da Electrical Permit 06/11/2010 $7.42 Contractor: 1 da 12% State Surcharge - 06/11/2010 $0.89 OWNER Electrical 15 da Electrical Permit 06/18/2010 $14.84 2 da 12% State Surcharge - 06(18/2010 $1.78 PHONE: Electrical FAX: Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $137.71 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 more the 180 days. ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth 'n OAR 952 - 001 -0010 through OAR •52- 001 -0100. You -may 'htai a of the ru es ect questions to OUNC by calling 503. 99 or 1.800.332.2344. Issued By: Permittee Signature: 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. ELEC' Date: LICENSE NO. CaII 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. b /8%v oc a irc-cA CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2010 -00284 Date Issued: 06/11/2010 TEGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 �.,. Parcel: 2S114BCO3000 Jurisdiction: Tigard Site address: 16657 SW RIVERWOOD PL Subdivision: Lot: 0 Project: Bradley Project Description: Feeder installation. Owner: FEES BRADLEY, TODD Quantity Description Date Amount 16657 RIVERWOOD PL TIGARD, OR 97224 1 ea Services or Feeders - 200 06/11/2010 $100.70 amps or less PHONE: 1 ea 12% State Surcharge - 06/11/2010 $12.08 Electrical 7 da Electrical Permit 06/11/2010 $7.42 Contractor: 1 da 12% State Surcharge - 06/11/2010 $0.89 OWNER Electrical PHONE: FAX: Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $121.09 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0100. You may obtain a •r direct questions to OUNC by calling 503. 9 or 1.800..(/33J- 2 2344. Issued By: ft—... �= Permittee Signature: G - 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. ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. '' ELECTRICAL PERMIT CITY OF TIGARD 6. COMMUNITY DEVELOPMENT Permit #: ELC2010 -00284 TEGAAD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/11/2010 Parcel: 2S114BCO3000 Jurisdiction: Tigard Site address: 16657 SW RIVERWOOD PL Subdivision: Lot: 0 Project: Bradley Project Description: Feeder installation. Owner: FEES BRADLEY, TODD Quantity Description Date Amount 16657 RIVERWOOD PL TIGARD, OR 97224 1 ea Services or Feeders - 200 06/11/2010 $100.70 amps or less PHONE: 1 ea 12% State Surcharge - 06/11/2010 $12.08 Electrical Contractor: OWNER PHONE: FAX: Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $112.78 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. At 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 more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0100. You ma es or direct questions to OUNC by calling 50 . •.• •9• 1.800.332.2344 Issued By: ■ Perm ittee Signature: L /A 4 - 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. ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. ,r s44rw (k ; rrIt'v ? e} �N a7 iN .=!0 7 ri ut igm w7 I� r t , Electrical Permit Application r1�� , ,, � , , 1 t WOW 1 1(, ,LS1 OWNI 1 �ls 14 �� 11 . � 7' City of Tigard RDeceived I Permit No.: -��9 1 U -- � '' ° 13125 SW Hall Blvd., Tigard, OR 97223 ED Plan Review ;� ; C .'r Phone: 503.639.4171 Fax: 503.598.1 * 11 ECE Date/B : Other Permit: I IC NIL D, Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for ),,a Internet: www.tigard- or.gov tl3 1 Q "L1�1il Notified/Method: Supplemental Information TYPE OF WORK d ` ^^ PRp PLAN REVIEW ❑ New construction ❑ Addition /alteration/�g�rd 6= �� ` 1 1 P lease check all that apply (submit 2 sets of plans w /items checked below): l @ ► O IN �� ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: BU�L.D where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ (� /, S ' �, rf / ' I or more. occupancy. ( Job no.: Job site address: "` , " � vim/ • (r (. , ❑ Six Six or or more a residential units. ❑ R ecreational vehicle parks. City/State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. • FEE SCHEDULE Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1 * New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 67.84 2 Limited energy, multi- family . �/nC � M br C1 c � ci : I� residential (with above sq. ft.) 67.84 2 �/i Y lJt / Services or feeders installation, alteration, and/or relocation Pi /x 1 S - e rr) ( 200 amps or less 100.70 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and /or City/State /ZIP: relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Branch circuits – new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT . 1 ❑ CONTACT PERSON above service or feeder fee, 7 42 2 each branch circuit Business name: C..A (�/ `� !TI" B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: branch circuit Each add'I branch circuit ed.... 7.42 i1j c8...ii 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular 67.84 2 Y dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited - energy Business name: 8rad l , ` — — a,,, K. panel, alteration, or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: Additional inspection (1 hr min) 66.25/ hr City/State /ZIP: Investigation (1 hr min) 66.25/ hr Industrial plant (I hr min) 78.18/ hr Phone: ( ) Fax: ( Inspections for which no fee is 90.00 / hr specifically listed (%3 hr min) CCB Lic.: Electrical / ate: uprv ELECTRICAL PE FEES Subtotal: ( - L Plan review (25% of pe Suprv. Electrician signature, required: rmit fee): Print name: State surcharge (12°/a ofpermit fee): TOTAL PERMIT FEE: 1(p 60 if Authorized signature: This permit applicaon expires it a permit is not obtained within 180 days after it has been accepted as complete. Print name: ate: * Number of inspections allowed per permit. I:t Building \Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(1 l /05 /COM/WEB �� °ri4 N Electrical Permit Application ,i ' 4. , 1 ( 1 1 Osi hi , , , > ., ., 7 ' : % City of Tigard Received , p erm i t No.: �' . `, g .. 9 d Date/ : / 1 11 11111 k v 13125 SW Hall Blvd. T igar d, OR 97223 t E t t ' ' j •,'I i ' - "' Plan Review 1 Phone: 503.639.4171 Fax: 503.598.19 4 Date/B : Other Permit: c ^' Ai:l) " Inspection Line: 503.639.4175 D ate Ready/By: uns: ® See Page 2 for k i '+i � "�' 1 �a� Internet: www.tigard-or.gov 3 `\ ;; ± Notified/Method: � Supplemental Information • TYPE OF WORK r F�.(; ,Cl�g PLAN REVIEW . 4 ° C.: 9 , t`'Ia .. v.i Please check all that apply (submit 2 sets of plans w /items checked below): ❑ New construction ❑ Addition/alterat atet et?t1 �„ 1.,):.� .. . �{ n ) ; I t :'e..• ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: r where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "l -3 ", Job no.: Job site address: IL, / t ,,,/ n _ 100HP or more. occupancy. ! !O J � •V lit A V.iv V l �/� r /, ❑ Six or more residen units 0 Recreational vehicle parks. City/State /ZIP: ;, d , � , V . e ,I a a L . 0 Health-care faciliti ❑ Supply voltage for more than V L / ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: r _d ' y ❑ Service or feeder 600 amps or more. FEE SCHEDULE Description Cross street/directions to job site: J I Qty. 1 Fee. 1 Total 1 • , New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot 1,000 sq. ft. or Tess 168.54 14 7 Ea. add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: ` Limited energy, residential 67 84 2 DESCRIPTION OF WORK ( 1 (with above sq. ft.) t i Limited energy, multi - family residential (with above sq. ft.) 67.84 2 - Services or feeders installation, alteration, and/or relocation n - 1 '4 ,- 1)S ( fit, C ) � C, 200 amps or less 1 100.70 !U) '7v 2 0 PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 Name 1 b A 1/V- j2 n t e. 401 amps to 600 amps 200.34 2 (( t t 1, 601 amps to 1,000 amps 301.04 2 Address: /b / L 1 L5 l Li tt,. w 0 o �� P / ace Over 1,000 amps or volts 552.26 2 ✓ v n Temporary services or feeders installation, alteration, and /or City/State /ZIP: 1 i v y 6l' e /� 1) � ,t ' a 2 Li relocation Phone: ( ) /7 F 9' 3 Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125,08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended for sale, le. a t. sr ex hange, . lording tI ORS 447, 449, 670, and 701. r i /� _ I`\ Branch circuits — new, alteration, or extension, per panel Owner signature: /j p[/ji r' r �( / ), L. Date: ( 0 A. Fee f or branch circuits with • Cl APPLICANT 1 • CONTACT PERSON above service or feeder fee, 7 42 2 each branch circuit Business name: c ` I 13. Fee for branch circuits without J Q > 'J I(f U ()i� 1 service or feeder fee, first Contact name: branch circuit 56.18 2 Each add'l branch circuit 1 7.42 7, 1 - () -- 2 Address: Miscellaneous (service or feeder not included) City /State /Z1P: Each manufactured or modular 67.84 2 dwelling, service and/or feeder Phone: ( ) Fax: ; ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited- energy Business name: J A ri,.t 1` el S 46b 0.„ Clr Ll)ATZrJ) � panel, alteration, or extension. Page 2 2 V Each additional inspection over allowable in any of the above Address: Additional inspection (1 hr min) . 66.25/ hr City /State /ZIP: Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr min) 78.18 / hr Phone: ( ) Fax: ( ) Inspections for which no fee is specifically listed (%2 hr min) 90.00 / hr CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES _ Suprv. Electrician signature, required: Subtotal: �. i-i �} Plan review (25% of permit fee): _ Print name: Date: State surcharge (12% of permit fee): 43,-CL , . 1 TOTAL PERMIT FEE: g 3 Authorized signature: rill"! !. This permit application P ermit a Itcation ex Tres if a permit is not obtained within 180 ll" _../ 1 days after it has been accepted as complete. Print name: J `J V . � ((c / ate: t_,— I I _ 0 I d * Number of inspections allowed per permit. \ 1:\ Building \PermitsELC- PermitApp.doc 10/01/09 440- 4615T(I1/05 /COM/WEB Electrical Permit Application c' � �, i -,� � ,, Received City of Tigard l�t DateB : / )� d Permit No. Ca 1 3125 SW Hall Blvd., Tigard, OR 97223 y CEA ' Plan Review Phone: 503.639.4171 Fax: 503.598.19611'. ' Date : Other Permit: I I ( i A4.1). Inspection Line: 503.639.4175 ; Date Ready /By uns: ® See Page 2 for It.' Internet: www.tigard- or.gov July Notifie Supplemental Information TYPE OF WORK Ti(' lk.D `_` PLAN REVIEW M ®V w �1.V Please check all that apply (submit 2 sets of plans w /items checked below): ❑ ❑ New construction Addition/alteratio e� o L 1 11`1 El Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "l -3 ", S , r .. , 100HoP or more. occupancy. Job no.: Job site address: ( n (f17 r (f�/ wO Da Pi, ❑S or more residential units. ❑ Recreational vehicle parks. Ci /State /ZIP: j ■ /[ ll l ( Ti 7 ,(a ❑ Health -care facilities. 0 Supply voltage for more than r' g f t' ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: Project name: 2 L( ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qtv. I Fee. 1 Total 1 " New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential 67.84 2 DESCRIPTION -OF.-WORKf (with above sq. ft.) t Limited energy, multi - family 67.84 2 VtQ , X Cm 1 oil residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation . it - S t IQ - ),k 200 amps or less 1 100.70 j(fv - w 2 0 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: I b f A _ '2 V i9 l e'/ 601 amps to 1,000 amps 301.04 2 Address: L / S � tit/. t l " \ 1 V e 1 ,0 j U 6 d P/ Q ( Over 1,000 amps or volts 552.26 2 ( ✓ 7 ` L Temporary services or feeders installation, alteration, and /or City /State /ZIP: l tip k iri ()Yelp h -/-) a tt relocation Phone: (5 t)5 ° 1 r , - L�) 9.3 Fax: / ( ) 200 amps or Tess 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not intended for sale, lea e t ex hange, ording t ORS 447, 449, 670, and 401 amps to 599 amps 168.54 2 r sr , d 70 6 _ 4 A Branch circuits — new, alteration, or extension, per panel Owner signature: � 1km _ , Date: A. Fee for branch circuits with C O APPLICANT CONTACT PERSON above service or feeder fee 7.42 2 each branch circuit Business name: 341 kink AS &bo i' 0- G, /NP�� B. Fee for branch circuits without eJ V service or feeder fee, first 56.18 2 Contact name: branch circuit Each add'I branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: /State /ZIP: Each manufactured or modular 67.84 2 tY dwelling, service and/or feeder Phone: ( ) Fax :: ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: Sign or outline lighting 67.84 2 CONTRACTOR - Signal circuit(s) or limited- energy panel, alteration, or extension. Page 2 2 Business name: SA 0 ,, L , i 0 b / 4ti - Each additional inspection over allowable in any of the above Address: Additional inspection (1 hr min) 66.25/ hr Clty /State /ZIP: Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: ( ) I Fax: ( ) Inspections for which no fee is 90.00 / hr specifically listed (%I hr min) CCB Lic.: I Electrical Lic.: I Suprv. Lic.: • ' ,ELECTRICAL PERMIT FEES . Suprv. Electrician signature, required: Subtotal: 1(30 .70 Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee): 1 �- t v —' TOTAL PERMIT FEE: 1( )-. 7 t Authorized signature: � 4/ e This permit application expires if a permit is not obtained within 180 f / ���111 days after it has been accepted as complete. Print name: J I jQ '-� V� ( ( C y ate: t_,-- I — Z:\)) b * Number of inspections allowed per permit. 1:\Building \Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(11/05 /COM/WEB • lt )-1 3, sz .'i Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.055 (4)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. 1 -214/ I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and 1 hereby certify that the information on this homeowner statement is true and accurate. l_rJ( Gil- GVi919Ie Print � e of Permit Applicant 4v, 6--/I-)1610 Signature of Permit Applicant Date Permit #: Address Issued by: Date: [ This Copy for Permit Offices Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK "ONLY: : • - • Fee for all residential systems combined ... $67.84 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* 0 Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: . • - Fee for each commercial $67.84 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems n Boiler Controls n Clock Systems ❑ Data Telecommunication Installation n Fire Alarm Installation n HVAC n Instrumentation ❑ Intercom and Paging Systems n Landscape Irrigation Control* n Medical n Nurse Calls n Outdoor Landscape Lighting* ❑ Protective Signaling n Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I: \BuildingWermits\ELC- PermitApp.doc 10/01/09