Permit CITYOFTIGARD V ��� ���-� y , �w�+
DEVELOPMENT `�-
���~��~m~��n n�om~v� n ��m~uw�w��m~��
c/ FC`'�lC' PERMIT -
.^-- - 13125 SW Hall BAv���u�������� (503)639-4171 -- ' -
- PF97R.ICTED ENERGY
[
P�71,}f1 EL997-0101
I�S||FD: 03/31/97
pF19CE 3 D 9;.
SIT? ADDRESS...:16 SV 72ND AVE 41:B-05
SUBDIlISTGN. . . . : 9CSEyOOD ACRE TRACTS ZONIMG l-L
7.LO17! :9 JURISDICTw G
cct Descript ion in»tl protective dgna\inc
- --'---------'-- ---'---------'------------------------'-----------------------
O. TDE NIT IPL --------- P.. cow ERCTAL-------- -----------------
AUDI� & STEREO. . . : C!JpTO & STEREO. . : INTERCOM & PoGING .
DURGLAC: ALARM.... : BOILER.. .. .. . ... : LANDSCAPE/I9RIGAT. . :
�ARPSE OPENER.. . . . . . .
. . .. .. ... .. .. : DATA/TELE COMM.. : NURSE CALLS,--.1
VoCU��
SYSTEM—. . , FIRE ALARM. . . . . . ' OUTDOO LANDSC r �E�
OTHER: HVAC. . . . . . . . . . , . : nRGTECTIVE STGNAL. . :X
INSTRUMENTATION.: Oryy:R
TOTAL # OF SYSTEMS
Owne~: ------------------- ------------------------- FEE5 --------------'
WIC-TRUST type amount by data recpt
15350 5W SEQUOIA oKNY PRMT $ 40.00 TAT 03/31/97 97-9?49
STE 300 5PCT $ 2.08 TAT 03/31/97 97-292449
P OF'Ti.ANT) OR 972:
r�nnc +f;
Cuntr --------------- ----------------------------------------------
SOHITROL PACIFIC $ 42.00 TOTAL
197/, 5W 6TH AVE
REOUTRED INSPECTIONS -----
__
PORTLAND OR 97201 Elect'] Final Wali Cover
7 503-223-5822 fleilinn Cover Elect'l Service
000535
Thi: pErcit is issced subject to the mwIlations ccrtaired in the ./ v/ ______
Yo.trici;:aU [,de State of Or�. Specialty [ode and all other Permit'' • Si. gnaturp
applicable laws. P11 work will be done in accordance with
E"pp�ved plans. This pe~nit will expire if (AK( is not started
uit 1EG days o; isemz ompended for rorc
thEi.r IBD E'ays. 1ssu�� �
- '----------------------' - OWNER INSTALLPTTON ONLY-----
rhs ��stal�ztion �s �eing rade on ?ropsrty I on which is not intended for
•
sale, lease or rent,
91i,HF? 7 5 IG��T�/R�: DATE ________
------- ----------------C[MTPACTOR INSTqL!-ATION OKLY----------------------- --
9TFiNATURE OF SUPR. ELEC' N: _______________
! !ff.;`
. _ _—________ ___��_____
C3)ll for inspection - 639-i(!7.7
Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
., - A 13125 SW Hall Blvd. ` i Cil — b O J )
Tigard, OR 97223 PERMIT # (� /` j v/
/�i�n:� . ' I ; \ Phone (503) 639 4171 DATE ISSUED ... / 7
. l �I�P�� I FAX (503) 684 -7297
^� - _.. TDD No. (503) 684 -2772 �
CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BY ! ,
PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTALLATION 4. TYPE OF WORK
((1) 1 1' 3W 73_4 Avg.,
A dr ss �y j L� RESIDENTIAL — Restricted Energy 0
y Fee $.00
I 1 V g7a3 / (FOR ALL SYSTEMS)
City State Zip Check Type of Work Involved:
PERMITS ARE NON - TRANSFERABLE AND NON - REFUNDABLE AND EXPIRE IF WORK ❑ Audio and Stereo Systems
15 NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR
180 DAYS. ❑ Burglar Alarm
2. CONTRACTOR APPLICATION ❑ Garage Door Opener*
y� ❑ Heating, Ventilation and Air Conditioning System*
Contractorc'l f (y Ili._ Type Ll ka 1' ❑ Vacuum Systems*
Address 0 n W CQ*- � it , `17 ❑ Other
Date Mu-. a 1 Lq / COMMERCIAL — Fee for each system 540.00
�� � F � (SEE OAR 918 - 260 -260)
Property Owner X I Check Type of Work Involved:
Contractor's Board Reg. No. 53,535 ❑ Audio and Stereo Systems
❑ Boiler Controls
Phone # aa3 -5'633 ❑ 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 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.
X 1 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. W
The person signing for this permit must be the applicant or a person a. Enter Fees $ I 0
authorized to bind the applicant.
b. 5% Surcharge (05 x total above) $ 3.
Signature TOTAL $ l O
Authority if other than applicant
ENERGAP.CHP