Permit NI■l/MMINIr
CITY OF TIGARD
DEVELOPMENT o SERO 6 IC ELECTRICAL
ENERGY
PERMIT #: ELR97 -0166
DATE ISSUED: 06/12/97
PARCEL: 28111DD -14800
SITE ADDRESS...:15697 SW 87TH AVE
SUBDIVISION •MILLMONT PARK ZONING:R -7
BLOCK • LOT •25 JURISDICTN: TIG
Project Descr : instl 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
JERRY JOHNSON type amount by date recpt
1.5697 SW 87TH AVE PRMT $ 40.00 TAT 06/12/97 97 -295862
TIGARD OR 97224 5PCT $ 2.00 TAT 06/12/97 97- 295862
Phone #: , �, ,,
IEXI . - D
Contract or:
ADT SECURITY ALARMS $ 42. TOTAL
703 NE HANCOCK
REQUIRED INSPECTIONS -
PORTLAND OR 97212 Ceiling Cover Elect'1 Service
Phone #: 284 -3265 Wall Cover Elect' 1 Final
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 OAR 952 - 001-0080. You may obtain copies of
these rules or direct ` q; tions�1 +- (503)246 -1987.
Issued by /A' �� _____�� - �� Permittee Signature
OWNER INSTALLATION ONLY
The installation is being made on operty I own which is not intended for
sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: 't/Xi/ DATE: r _
LICENSE NO: ,ti
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 6:00 P.M. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
id
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by: I I
13125 SW HALL BLVD Date Rec'd:
TIGARD OR 97223 PRINT OR TYPE SIG
V - 503 - 639 -4171 X304 Permit #: GL IC-► -0 (p
F - 503- 684 -7297 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
Co S f Gh � .# i {/- /2' NOT BE ACCEPTED
ame of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL
Restricted Energy Fee $40.00
(FOR ALL SYSTEMS)
JOB Street Address #
ADDRESS /64! / 589 Check Type of Work Involved:
City ^ , Zip _ I Phone ❑ Audio and Stereo Systems
Name �/ 77 �/ Burglar Alarm
:ehry To�.n Son ❑
OWNER Mailing Address cam/ Garage Door Opener*
City /State Zip Phone # El Heating, Ventilation and Air Conditioning System*
Name ❑ Vacuum Systems*
OK SECURITY VMS, iNg
703 HANCOCK ❑ Other
CONTRACTOR Mailing Address /ONILAAD•un
PA 244325 TYPE OF WORK INVOLVED - COMMERCIAL
(Prior to issuance a City /State Zip Phone # Fee for each system 540.00
copy of all licenses (SEE OAR 918 - 260 -260)
are required if Oregon Contr. Brd Lic. # Exp. at
expired in C.O.T. S'9 4" C/ L( 9 Check Type of Work Involved:
data base). Electri I Contr. Li Exp. ate
/p 97 ❑ Audio and Stereo Systems
C.O.T. or Metro Lic. # E . Da e
❑ 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 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; ,,, 7 I�' r i v
❑ Landscape Irrigation Control* `` „ A y
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 • d n • -ref • le and expire if work is not
started within 180 days of'- suan.: or' • is suspended for 180 days. Number of Systems
The person sig : for is p= it ,I be the applicant or a person * No licenses are required. Licenses are required for all other installations
a thorized - :'• the p• can
FEES: CMG
Ag S f flatur ENTER FEES $
5% SURCHARGE (.05 X TOTAL ABOVE) $
Authority if other than Applicant TOTAL $ d
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