Permit • "A
CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
�i�,� • DEVELOPMENT SERVICES PERMIT #: ELR2000 -00103
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 05/09/2000
SITE ADDRESS: 15930 SW 74TH AVE PARCEL: 2S112DC -01300
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -L
BLOCK: LOT: 035. JURISDICTION: TIG
Proiect Description: Data telecommunication installation.
•
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: . LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
LA RUSSO CONCRETE CHRISTENSON ELECTRIC INC
15930 SW 74TH 111 SW COLUMBIA
TIGARD, OR 97224 STE 480
PORTLAND, OR 97201
Phone: Phone: 241 -4812
Reg #: LIC 000458
SUP 3289S
PLM 2468S
ELE 26 -34C
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT GEO 05/09/200C $60.00 0002016 Elect'I Final
5PCT GEO 05/09/200C $4.80 0002016
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 you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952-101-0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
or
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 /lJ //q DATE: 5
d
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
•
,r fY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by:
13125 SW HALL BLVD Date Rec'd:
TIGARD OR 97223 PRINT OR TYPE
V. - 60339 -4171 X304 Permit#: F R365 -6c)/C4---3
F - 503 - 598 -1960 INCOMPLETE OR ILLEGIBLE APPLICATIONS CustCall'd:
JOB: 51 WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
LARUSSO CONCRETE Restricted Energy Fee. »...--- .- . »» »....... » ....... » $80.00
(FOR ALL SYSTEMS)
JOB Street Address Ste #
ADDRESS 15930 SW 74TH Check Type of Work Involved: RECEIVED
TI ARD ,9'224 Phone # ❑ Audio and Stereo Systems
SAY Name ❑
B ?_ ®CM
Burglar Alarm
OWNER Mailing Address
E3 Garage Door Opener* Ota►UtaiN�
City /State ZIP Phone # ❑ Heating, Ventilation and Air Conditioning System*
QUESTIONS? CONTACtlame ❑ Vacuum Systems*
CASEY PONS CHRISTENSON ELECTRIC, INC.— ❑ Other
CONTRACTOR Mailing Address
111 SW COLUMBIA SUITE 480 TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a City /State Z Phone # Fee for each system ...» ....... » » ». .... »... »... $60.00
copy of ail licenses PORTLAND OR 191 241 - 4812 (SEE OAR 918- 260 -260)
are required if Oregon �ntr. Brd Lia # Exp Date
expired in C.O.T. �, 8 5/1/03 Check Type of Work Involved:
data base). Electrical C Lic. # �, t ! /00
L b 3S 44 ((:: ❑ Audio and Stereo Systems
C.O.T. or Metro Lie. # Exp. Date
5246 12/31/0( ❑ 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 Tess) 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;
2. Call for inspections when installation under this permit are ready for El 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 ail corrections required by the El 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 signing for this per u e the applicant or a person • No licenses are required. Licenses are required for alt other installations
authorized to b the appli m cant
4!7;i:e)0( FEES:
•
ENTER FEES $ 60.
Si nature 5/5/00
8 70 3° SURCHARGE ( 6'X TOTAL ABOVE) $ 4.80
Authority if other than Applicant TOTAL $ 64.80:
bdstslforms\resele.doc 3/98
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