Permit OF � ELECTRICL PERMIT —
RESTRICTED ENERGY
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #: ELR96-0158
,31owSW Hall Blvd. Tigard, Oregon m72o°w1wm (503)m39-4171 DATE ISSUED: 05/13/96
//5 /5 — ~~ PARCEL 2S112DC 001G@
SITE ADDRESS...: —I-5603 SW 72ND AVE
SUBDIVISION • SP TIGARD INDUSTRIAL PARK ZONING:I—L
BLOCK : LOT ^2
Project Description: Installing data telecommunications.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO...: AUDIO & STEREO..: INTERCOM & PAGING..:
BURGLAR ALARM • BOILER ^ LANDSCAPE/IRRIGAT..:
GARAGE OPENER • CLOCK ~ MEDICAL
HVAC • DATA/TELE COMM..:X NURSE CALLS •
VACUUM SYSTEM • FIRE ALARM ^ OUTDOOR LANDSC LITE:
OTHER: :: HVAC ^ PROTECTIVE SIGNAL..:
INSTRUMENTATION.: OTHER..:
TOTAL # OF SYSTEMS: 1
Owner: FEES
NIKE — TETRA type amount by date recpt
ONE BOWERMAN DRIVE PRMT $ 40.00 CJS 05/13/96 96-279338
5PCT $ 2.00 CJS 05/13/96 96-279338
BEAVERTON OR 97008
Phone #: 503-671-2017
Contractor:
SASCO DATA $ 42.00 TOTAL
3800 SW CEDAR HILLS BLVD STE.152—D
REQUIRED INSPECTIONS
BEAVERTON OR 97005 Wall Cover Elect'l Final
Phone #: 503-526-9297 Elect'l Service
Reg #..: 108174
This permit is issued subject to the regulations contained in the �, �� /Y
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permitee 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 more ^
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. ELEC'N: DATE:
LICENSE NO:
Call for inspection — 639-4175
�.. - Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 PERMIT # CZP96 -0158
ii to:m i�i J , i �\ Phone
FAX (503) 684-7297 1 DATE ISSUED 5 - /3 - 96
- TDD No. (503) 684 -2772
CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BY Ch6r /Pt -c-ti,i,-;;e/7
.7-.e 1N - P\00-\-\ c _5 PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTALLATION/f7,) 4. TYPE OF WORK
Address RESIDENTIAL — Restricted Energy Fee $40.00
' - r - CA p C •�2 D (FOR ALL SYSTEMS)
City 11 `JV` 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 15 SUSPENDED FOR
180 DAYS. ❑ Burglar Alarm
❑ Garage Door Opener*
2. CONTRACTOR APPLICATION -�� ❑ Heating, Ventilation and Air Conditioning System*
Contractor °. (' �L'"' T IY1 r ❑ Vacuum Systems*
❑ Other
Address sYaD S, v-D • -{� -t-tillS ,IVd.
v -Nik.6 t's2.� .2r�V egrts0 or<
Date 5I ' ; 2 NI q r ,, COMMERCIAL — Fee for each system $40.00
Y� A (SEE OAR 918 - 260 -260)
Property Owner N > Check Type of Work Involved:
Contractor's Board Reg. No. 10? 1 94 ❑ Audio and Stereo Systems
❑ Boiler Controls
Phone # „n4___5 - 929.4_ ❑ 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 ❑ Nurse Calls
restricted energy installations (100 volt amps or Tess) 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. ❑ I 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 5. FEES
corrections are completed.
The person signing for this permit must be the applicant or a person a. Enter Fees $ 90.
author' ed to bind the applicant.
b. 5% Surcharge (.05 x total above) $ c . ”
0 4 A e PAPA r 41.
' ture
" � �� /rn TOTAL $ yc� • °p
'1
0 446 - weA
Authority if other than applicant
ENERGAP.CHP