Permit jciebi
8
erti, CITY OF TIGARD ELECT ICTED NE -
RESTRICTED ENERGY
�ra DEVELOPMENT SERVICES PERMIT #: ELR2000 -00104
' I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/9/00
SITE ADDRESS: 16342 SW 72ND AVE B -04 PARCEL: 2S113AA-00100
SUBDIVISION: ROSEWOOD ACRE TRACTS ZONING: I -L
BLOCK: LOT: OOA JURISDICTION: TIG
Proiect Description: Installation of protective signaling.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES PHILLIPS ELECTRONICS
15350 SW SEQUOIA PKWY #300 -WMI (DBA FOR MASTER ALARM L.L.C�����
PORTLAND, OR 97224 1110 NW FLANDERS
PORTLAND, OR 97209
Phone: Phone: 222 -5083
Reg #: LIC 00125364
SUP 329JLE
ELE 26213CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT DEB 5/9/00 $60.00 0002017 Elect'I Final
5PCT DEB 5/9/00 $4.80 0002017
Total $64.80 ORIGINAL
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other 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. ATTENTION: Oregon law
requires y• • follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 -0010 th ugh OAR 952 - 001 -0080. You may obtain copies of these rules or direct quest ns to OUNC at (503)
246 -1 87.
Issue. by Permittee Signature 6 p
OWNER INSTALLATION ONLY
The installation is being made on property 1 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 639 -4175 by 7:00 P.M. for an inspection needed the next business day
P
CITY OF TIGARD U ECORTRICTED ENERGY ELECTRICAL APPLICATION Recd by: cak)410-d 1
I3VD ® off Date Recd: 5—k DU
TIGARD OR 972a. PRINT OR TYPE
V
C.-:
- 503 -639 -4171 X304 %.- v 1614 ' Permit #: /eAac29 —OD Io V
F - 503 - 598 -1960 Ai DE TI'dCOMPL E OR IL E IBL ACCEPTED PPLICATI Cust.Call'd:
c � MMU ��
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
kaq n, � ,,, � , � Restricted E nergy Fee $60.00
` ' �glli r�G<� t`oJ r $'^' L (FOR ALL SYSTEMS) , ,
JO , - . StrePt Address . • : . . ; Ste #: .{ ' ' v
ADDRESS 1.'6 342 S � '7z r25� .. CFieek Typ + —
it e i -- --- Phone-#- ❑ A
•
- -- - -- ._ ... - - kio and Stereo Systems -- - -- - --
�r. V - g722
Name ❑ Burglar Alarm
O
❑ Garage Door Opener'
OWNER Mailing Address
/6$20 S W 72 e, 7
17 Heating, Ventilation and Air Conditioning System*
Ci /State Zip Phone #
� _ 77 62o -6 9'77
Name El Vacuum Systems'
- 11 efe.Cirsq ❑ Other
CONTRACTOR Mailing Address
/((O N, Go' �caw�P s TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a D City/ d�a D �te,,, n Zip Phone # Fee for each system $60.00
copy of all licenses 1 "'",'l & _ 7 2207 222501'..3 (SEE OAR 918 - 260 -260)
are required if Oregon Contr. Brd Lic. # Exp. Date
expired in C.O.T. / ).....S`-3 6f. Check Type of Work Involved:
data base). Electrical Contr. Lic. # Exp. Date
21b-2 /3— GI—C ❑ Audio and Stereo Systems
C.O.T. or Metro Lic. # Exp. Date
❑ Boiler Controls
Owner's Name
❑ Clock Systems
OWNER - Mailing Address
APPLICANT ❑ Data Telecommunication Installation
City/State Zip Phone # ❑
Fire Alarm Installation
This permit is issued under OAE 918 - 320 -370. This applicant agrees to .
make only restricted energy installations (100 volt amps or less) under this ❑ HVAC
permit and to do the following: ❑
I nstrumentation EXPIRED
1. Only use electrical licensed persons to do installations where required.
Certain residential and other transactions are exempt from licensing. ❑ Intercom and Paging Systems
These have asterisks('). All others need licensing;
2. Call for inspections when installation under this permit are ready for
❑ Landscape Irrigation Control'
inspection at 503 - 639 -4175; ❑ Medical
3. Purchase separate permits for all installations that are not ready for an ❑ Nurse Calls
inspection when the inspector is out to inspect under this permit;
4. Assume responsibility for assuring that all corrections required by the ❑ Outdoor Landscape Lighting'
inspector are done, and;
4 Protective Signaling
5. Assume responsibility for calling for a final inspection when all of the
corrections are completed. ❑ Other
Permits are non - transferable and non - refundable and expire if work is not
started within 180 days of issuance or if work is suspended for 180 days. 0 ,� /
t� Number of Systems
The person signing for this permit must be the applicant or a person * No licenses are required. Licenses are required for all other installations
authorized to bind the applicant.
FEES:
Signature _ENTER R FEES _D8 $ 6
W. SURCHARGE (,68 X TOTAL ABOVE) $ 4, YP-
Authority if other than Applicant TOTAL $ 6 i f' .1)C1
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