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Permit CITYOFTIGARD •i , �? I�Ij DEVELOPMENT M SERVICES ELECTRICAL RESTRICTED ENERGY PERMIT #: ELR96 -0367 DATE ISSUED: 12/11/96 PARCEL: 2S113AA -00900 SITE ADDRESS...: 16520 SW 72ND AVE #7 SUBDIVISION : ROSEWOOD ACRE TRACTS ZONING:I —L BLOCK LOT •D Project Description: ADD 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: FEES JOHN KYUPERS type amount by date recpt BRIDGEPORT DISTRIBUTION INC PRMT $ 40.00 TAT 12/11/96 96- 287541 16520 SW 72ND AVE #7 5PCT $ 2.00 12/11/96 96- 287541 TIGARD OR 97224 Phone #: 620 -6977 Contractor: ADT SECURITY ALARMS $ 42.00 TOTAL 703 NE HANCOCK REQUIRED INSPECTIONS PORTLAND OR 97212 Ceiling Cover Elect'l Service Phone #: 503- 284 -3265 Wall Cover Elect'l Final Reg #..: 59944 rn,, This permit is issued :subject to the regulations contained in the -!% (�(.(11f Tigard Municipal Code, State .of Ore. Specialty 'Codes and all other . Perm i S i gnat applicable laws. All work will be done in accordance with approved plans. This permit will expire'. if work is not started n '� within 188 days of issuance, or if work is suspended for more /G6 /-- than 188 days. I s � sued d B y 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 r Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION ._ ! 13125 SW Hall Blvd. t-!4 N r _� Tigard, OR 97223 PERMIT # G1�11`9 3l(� //��n. &�� (;� Phone (503) 639 -4171 ' �1 I I ( I �I I FAX (503) 684 -7297 DATE ISSUED �- A TDD No. (503) 684 -2772 CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BY PLEASE COMPLETE ALL SECTIONS 1. LOCATION INSTALLATION n 4. TYPE OF WORK /6s) u) 7�'� - #7 Adds. RESIDENTIAL — Restricted Energy Fee $40.00 // L4 / Q © 9 7,:9-.2 (FOR ALL SYSTEMS) City L� State Zip Check Type of Work Involved: PERMITS ARE NON - TRANSFERABLE AND NON - REFUNDABLE AND EXPIRE IF WORK ❑ Audio and Stereo Systems 15 NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. ❑ Burglar Alarm ❑ Garage Door Opener* 2. CONTRACTOR APPLICATION ❑ Heating, Ventilation and Air Conditioning System* Contractor ADT Suunany cyc[ftuc tl pe (,eit. / 4$<_� ❑ Vacuum Systems* 703 NE HANCOCK ❑ Other Address PORTLAND, OR 97212 P3) 284.3265 Date Jr'_ 1 A COMMERCIAL — Fee for each system $40.00 . (SEE OAR 918 - 260 -260) Property Owner %e/ . / /,." _4.,1 i t, ,� /I _, 1, O � Work Involved / r stems L ❑ Audio and Stereo S Contractor's Board Reg. No. �g � T Y ❑ Boiler Controls Phone # ❑ Clock Systems ❑ Data Telecommunication Installations 3. OWNER APPLIC , TION ❑ Fire Alarm Installation j��� . .�_ .4 4 1 1_4 'c �n 9 —b9 7 ❑ HVAC P�� Owner's Nam: / 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: Protective Signaling • 1. Only use electrical licensed persons to do installations where required. (Certain 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 5. FEES corrections are completed. The person signing for this permit must be the applicant or a person a. Enter Fees $ 46 authorize• to bind the applica t. _..4/' / 0 // " , / � /` b. 5% Surcharge (.05 x total above) $ .::: Q 0 Sign" ure _ �t TOTAL $ l d Authority if other than applicant ENERGAP.CHP