Permit CITY OF TIGARD
4 j ��i DEVE SERVICES ELECTRICAL PERMIT -
RESTRICTED ENERGY
PERMIT #: ELR99- -0065
DATE ISSUED: 03/24/99
PARCEL: 25114AD -00100
SITE ADDRESS...: 16575 SW 85TH AVE
SUBDIVISION ZONING:R -4.5
BLOCK • LOT JURISDICTN: URB
Pro ect Descri pt ion : Install burglar alarm in existing residence.
A. RESIDENTIAL B. COMMERCIAL -----
AUDIO & STEREO...: AUDIO & STEREO..: INTERCOM & PAGING..:
BURGLAR ALARM •X BOILER • LANDSCAPE/ IRRI GAT. .:
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
UNIFIED SEWERAGE AGENCY type amount by date recpt
2132 SE RIVER RD PRMT $ 40.00 BED 03 /24/99 99- 313956
HILLSBORO OR 97 123 SPCT $ 2.00 GEO 03/24/99 99- 313956
Phone #: 681 -5224
Contract or:
HONEYWELL INC $ 42.00 TOTAL
15495 SW SEQUOIA
STE 100 REQUIRED INSPECTIONS -- - - -- - --
PORTLAND OR 97224 Low Voltage Insp
Phone #: 968 -3333 Elect'1 Final
Reg #..: 000578 ._
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 I80
days of issuance, or if work is suspended for more than 1:', 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 OAR 952 -001 -0080. You may obtain copies of
these rules or direct estions t t (5033)246 -1987.
Issued by. �� Permittee Signature
OWNER INSTALLATION ONLY
The installation is being made on property I on which is not intended for
sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY r�
SIGNATURE OF SUPR. ELEC' N : 4//9 DATE: 3 - a T�
LICENSE NO: _
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD RECEIVEIIESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by:
13125 SW-HALL BLVD Date Rec'd:
TIGARD OR 97223 MAR 2 4 1999 PRINT OR TYPE
V - 503 - 639 -4171 X304 Permit #: ,GGeg9-o 5"
F - 503 - 684 -7297 COMMUNITY DEVELOPMENNCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee $40.00
lih ;l P. d , Se h i ed-n e- Agency (FOR ALL SYSTEMS)
JOB Street ddress / St J
ADDRESS `(,,5 7S so 8,5d Ave . Check Type of Work Involved:
City / State Zip Phone # ❑ Audio and Stereo Systems
Ti q ,,,-.1 n 9 72 2'/
Nagle < ^ ix Burglar Alarm
(i L t 1 1 �e.4JCra, e. AQ en P ❑ Garage Door Opener*
OWNER 1a s J /
Mailing ddre
155 " Yh li ye. S d ❑ Heating, Ventilation and Air Conditioning System*
City, /Sate Zip I Phone #
Hills b o rg OR 9T 1.9.y I ❑ Vacuum Systems*
Name
Hon s h r / /, ❑ Other
CONTRACTOR Mailing Addre �
/5 q 9 S Id Se �aicv p /et,, #lDa TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a /S to Phon Fee for each system $40.00
copy of all licenses or f land OE J2 468 .33 ( SEE OAR 918-260-260)
are required if Oregon Contr. Brd # Exp. Da e
expired in C.O.T. ()5 7 9.2_5/ /27 00 Check Type of Work Involved:
data base). Electrical Contr. Lic. # Exp. ate
L - d 7CL-E 16/1/49 ❑ Audio and Stereo Systems
C.O.T. or Metro Lic. # Exp.fDate
oo g y V 0D ❑ Boiler Controls
Owner's Name f
❑ 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 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. Call 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. I Number of Systems
The person signing for this permit must be the applicant or a person * No licenses are required. Licenses are required for all other installations
authorized to bind the applicant.
FEES:
J// A //h - C • ENTER FEES $ { u
o, 0 a
'• nature
5% SURCHARGE (.05 X TOTAL ABOVE) $ .2- 00
Authority if other than Applicant TOTAL $ I - 00
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