Permit 'A Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 PERMIT # J L!Z 9.5 - 00q f
//� /1 ;\ Phone (503) 639 4171 /,�
� g i i DATE IS SUED I FAX (503) 684 -7297 i 95 ' TDD No. (503) 684 -2772
CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BY c'5,
PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTALLATION 4. TYPE OF WORK
421/70 cs": l -
Address RESIDENTIAL — Restricted Energy Fee $40.00
a art54.1A Y7.2-2-3 (FOR ALL SYSTEMS)
City V State Zip Check Type of Work Involved:
PERMITS ARE NON - 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. X Burglar Alarm
2. CONTRACTOR APPLICATION ❑ Garage Door Opener*
// ( / � t/ e , /� ❑ Heating, Ventilation and Air Conditioning System*
Contracto k (j !'� 0 Ty (.�2 ❑ Vacuum Systems*
/ �/ „" ❑ Other
Address ,5(�� r Y. �'tJ 6:1 C, .
Date C �`)—/ 76 COMMERCIAL — Fee for each system $40.00
6 / (SEE OAR 918 - 260 -260)
Property Owner - /- --r Q-- cJ #C__ Check Type of Work Involved
Contractor's Boar Reg. No. 7o ❑ Audio and Stereo Systems*
❑ Boiler Controls
Phone . Vi 0 5" 7c7 ❑ Clock Systems
3. WNER APPLICATION ❑ Data Telecommunication Installations
�j�0 / ,, ❑ Fire Alarm Installation
9A-t/1 e i 7 ��OcGIL ��/ �� {� ❑ HVAC
P Owner's Name l Phone No
El 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 ❑ Nurse Calls
restricted energy installations (100 volt amps or less) under this permit and to do the ❑ Outdoor Landscape Lighting*
following:
1. Only use electrical licensed persons to do installations where required. (Certain ❑ Protective Signaling
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 a. Enter Fees $
authorized to bind the applicant.
b. 5% Surcharge (.05 x total above) $ oz
Signatu e
. TOTAL $� —
Authority if other than applicant
ENERGAP.CHP
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: /� A.M. P.M. MST:
Location: / c9-, / 9 p / 7 O (o < ' ' ` A - BUP:
Tenant: Suite: Bldg: MEC:
( Contractor: , 1(4-6--) Phone: (04/— Q c 7/ PLM:
r
Owner: Phone: ELC:
0 v c? I ' A1,.,K ELR: oo "
•
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFI/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Approved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved Not Approved Not Approved
FINAL FINAL FINAL --- FINAL FINAL
i
. ././(60.4 0 ,,_ Ceti, 1 ,....O.A4_c__a.,____,,a..,
All
--
O Call for reinspec '• i 11 Reinspection fee of $ required before next inspection Unable to inspect
Inspector: l/ Date: S i�CJ 9" Page of