Permit CITY OF TIGARD
:--- 'COMMUNITY DEVELOPMENT DEPARTMENT ELECTRICAL PERMIT —
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171 RESTRICTED ENERGY
PERMIT #: ELR96 -0276
DATE ISSUED: 09/05/96
PARCEL: 2S113AD -01700
SITE ADDRESS...: 16920 SW 72ND AVE
SUBDIVISION• • ROSEWOOD ACRE TRACTS ZONING:C —G
BLOCK • LOT •30
Project Description: Tenant Improvement: Low voltage for wiring roof top HVAC
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..:
INSTRUMENTATION.: OTHER.. :HVAC ::X
TOTAL # OF SYSTEMS: 1
Owner: FEES -- - - --
BINGHAM PROPERTIES type amount by date recpt
3939 SW ST. HELENS RD PRMT $ 40.00 DST 09/05/96 96- 283532
SPCT $ 2.00 DST 09/05/96 96-- 283532
PORTLAND OR 97210
Phone #:
Contractor:
TEMP CONTROL $ 42.00 TOTAL
4800 N. CHANNEL AVE
REQUIRED INSPECTIONS
PORTLAND OR 97217 Ceiling Cover Elect' 1 Service
Phone #: 285 -9851 Wall Cover Elect'1 Final
Reg #.. : 004944 6/1C11 This perait is issued subject to the regulations contained in the rlkJ
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permitee ature
applicable laws. All work will be done in accordance with
approved plans. This peruit will expire if work is not started
within 180 days of issuance, or if work is suspended for gore
than 180 days. Issued y
OWNER INSTALLATION ONL
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 : / dee DATE:
LICENSE NO:
Call for inspection — 639 -4175
Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW HaII Blvd. / �Q
Tigard, OR 97223 PERMIT # tie %_ !-
- G rZ 7 +p
/ f ;\ Phone (503) 639 -4171
.I FAX (503) 684 -7297 DATE ISSUED
gl.b alettf.e/f'
TDD No. (503) 684 -2772
CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BY V I { /C /%V
PLEASE COMPLETE ALL SECTIONS
1. LOATION OF INS � O �� � �� 4. TYPE OF WORK
s 1 7 f l , �� , RESIDENTIAL — Restricted Energy Fee
(FOR ALL SYSTEMS) 1.40.011 ��
Ci f 'Jl 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 IS SUSPENDED FOR
180 DAYS. ❑ Burglar Alarm
2. CONS CTOR APPLICATION ❑ Garage Door Opener*
� f ❑ Heating, Ventilation and Air Conditioning System*
Contractor n t • ' _ u I Di T �1 u �" f I ( ❑ Vacuum Systems*
/ 4 ) 1 \I (� ( � • �/v I 0 f � X 0 ve "
l
Address � ❑ Other
Date q y/ 1 q V COMMERCIAL — Fee for each system $40.00
v (SEE OAR 918 - 260 -260)
Property Owner Check Type of Work Involved:
Contractor's Board Reg. No. " () °1-11-1 ❑ Audio and Stereo Systems
Phone # l x `c >
/) ��., �� � r, f2 i ❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installations
3. OWNER APPLICATION
❑ 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). / 6-40/1-7/ i ) � �]
2. Call for an inspection when all of the installations under this permit are ready V J
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 $ 'T /�
0 . O
authorized to bind the applicant.
b. 5% Surcharge (.05 x total above) $ a
Signature
TOTAL $ q v?• O
Authority if other than applicant
ENERGAP.CHP