Permit - ---------'-----' -------'-- -----
CITY OF TIGARD
DEVELOPMENT SERVICES
AA, u�m�� m�n���n omoo�n� n ~�u�om�m��w�w� ELECTRICAL PERMIT -
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1�5 SW � Blvd., �� (503)639-4171 RESTRICTED ENERGY
PERMIT #: ELR97-0208
DATE ISSUED: 07/25/97
PARCEL: 2S113AA-00900
SITE ADDRESS...:16520 SW 72ND AVE #B-07
SUBDIVISION :ROSEWOOD ACRE TRACTS ZONING:I-L
BLOCK • LOT •D JURISDICTN: TIG
Project Description: Add burglar alarm.
A. RESIDENTIAL B. COMMERCIAL -
AUDIO & STEREO...: AUDIO & STEREO..: INTERCOM & PAGING..:
BURGLAR ALARM ^X BOILER • LANDSCAPE/IRRIGAT..:
GARAGE OPENER ^ CLOCK • MEDICAL
HVAC • DATA/TELE COMM..: NURSE CALLS........:
VACUUM SYSTEM • FIRE ALARM ^ OUTDOOR LANDSC LITE:
OTHER: :: HVAC • PROTECTIVE SIGNAL..:
INSTRUMENTATION.: OTHER..:
TOTAL # OF SYSTEMS: 0
Owner: ---- FEES ----
ADT SECURITY SYSTEMS INC type amount by date recpt
703 NE HANCOCK PRMT $ 40.00 GEO 07/25/97 97-297566
PORTLAND OR 97212 5PCT $ 2.00 GEO 07/25/97 97-297566
Phone #: 284-3265
Contractor:
ADT SECURITY ALARMS $ 42.00 TOTAL
703 NE HANCOCK
REQUIRED INSPECTIONS
PORTLAND OR 97212 Ceiling Cover Elect'l Final
Phone #: 284-3265 Wall Cover
Reg #..: 000599
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. 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 you to follow rule adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through 0A8 952-1-0000. You may obtain copies of
these rules or direc OUNC (503)246
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'N: DATE: zr " 4776
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Call 639-4175 by 6:00 P.M. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
@
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by:
13125 SW HALL BLVD Date Rec'd: 7— a
TIGARD OR 97223 PRINT OR TYPE
"V - 503 - 639 -4171 X304 Permit #: tL O
F - 503 -684 -7297 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Cali'd:
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL
Restricted Energy Fee $40.00
(FOR ALL SYSTEMS)
JOB Street Address Ste #
ADDRESS /, 5 V) 51,1 7 du
-e_ P d _ Check Type of Work Involved:
Ci State Z' Pone Audio and Stereo Systems
,r nom /`)/' 7 cs o3 b.1a 69
Nam p Burglar Alarm
OWNER Mai ing Add
Oct' �J: ❑ Garage Door Opener*
City/State Zip I Phone # ❑ Heating, Ventilation and Air Conditioning System*
Name ❑ Vacuum Systems*
ADT SECURt1Y SYSTEMS. INC. 103 HANCOCK ❑ Other
CONTRACTOR Mailing Address PUNILANU• UN 9i•ZIZ
(503) 284-3265 TYPE OF WORK INVOLVED - COMMERCIAL
(Prior to issuance a City /State I Zip Phone # Fee for each system $40.00
copy of all licenses (SEE OAR 918 - 260 -260)
are required if Oregon Contr. Brd Lic. # / Exp. Date
expired in C.O.T. 599 Check Type of Work Involved:
7L4
data base). Electrical Contr. Lic. # Exp. Date
"c7-0.? ❑ Audio and Stereo Systems
C.O.T. or Metro Lic. # Exp. Date
❑ Boiler Controls
Owner's Name
❑ Clock Systems
OWNER - Mailing Address
APPLICANT p Data Telecommunication Installation
City/State I Zip I 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:
❑ Instrumentation
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;
❑ Landscape Irrigation Control'
2. CaII for inspections when installation under this permit are ready for
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; ❑
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. Number of Systems
The person signi - for is permit must be the applicant or a person • No licenses are required. Licenses are required for all other installations
authorized to bid th - = pplicant.
FEES: 1/10-
�L�%l
— ENTER FEES $
ignature
5% SURCHARGE (.05 X TOTAL ABOVE) $
Authority if other than Applicant TOTAL $ q oz
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