Permit -_---_-- ��--_-------__--� �� � --- _---� ��--- �� �--____-
� ~~~.
-CITY OF � ELECTRICL PERMIT — � RESTRICTED ENERGY
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #: ELR95-0190
13125 SW Hall Blvd. Tigard, Oregon e7223°8199 (5o3)o39-41r1 DATE ISSUED: 11/02/95 -
PARCEL: 2S104BD—RMO23
SITE ADDRESS...: 127691 SW 138TH AVE
SUBDIVISION....: ROSE MEADOWS ZONING:R-7
BLOCK ^ LOT ^023
Project Description: Install audio and stereo system
A. RESIDENTIAL B. COMMERCIAL —
AUDIO & STEREO :X AUDIO & STEREO..: INTERCOM & PAGING..:
BURGL,AR ALARM.: ^~^ LANDSCAPE/IRRIGAT..:
�� ^
^^^ BOILER
GA'^A`E OPENER....:
CLOCK ^ MEDICAL........ ..^^
HVAC. .. ... . • DATA/TELE COMM..: NURSE CALLG. . ...~. . :
VACUUM SYSTEM....: FIRE ALARM......: OUTDOOR LANDSC LITE:
OTHER: :: HVAC ^ PROTECTIVE SIGNAL..:
INSTRUMENTATION.: OTHER..: ::
TOTAL # OF SYSTEMS: 0
Owner: ------ FEES —
RICHARD KERKERING type amount by date recpt
12701 SW 138TH AVE PRMT $ 40.00 JSD 11/02/95 95-:272452
5PCT $ 2.00 JSD 11/02/95 95-272452
TIGARD OR 97223
Phone #:
Contractor: — — —
OWNER $ 42.00 TOTAL
REQUIRED INSPECTIONS -------
Final inspection
Phone #:
Reg #..: 000000
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. Is .ted By
— — 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
•
•
A Community Development RESTRICTED ENERGY E TRICAL APPLICATION
13125 SW Hall Blvd. C7_ i50
Tigard, OR 97223 PERMIT # /han 9hlryllNl i ,II,' Phone (503) 639 -4171 DATE ISSUED / �
1 1 FAX (503) 684 -7297
- -� TDD No. (503) 684 -2772
CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BY '
PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTALLATION 4. TYPE OF WORK
\ 1 c4 t S1/4.)..1 \3 g ." A- \I
Address RESIDENTIAL — Restricted Energy Fee $40.00
‘ yG d. a c -2-2---S (FOR ALL SYSTEMS)
Ci 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. CONTRACTOR APPLICATION ❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
Con .ctor Type ❑ Vacuum Systems*
❑ Other
Address
Date COMMERCIAL — Fee for each system $40.00
(SEE OAR 918 260 - 260)
Property Owner Check Type of Work Involved:
Contractor's Board Reg. No. ❑ Audio and Stereo Systems
❑ Boiler Controls
Phone # ❑ Clock Systems
3. OWNER APPLICATION ❑ Data Telecommunication Installations
❑ Fire Alarm Installation
V...cN.+aces \LcC\‘'-`–cvN9 Sly` (PO ‘-k ❑ HVAC
Print Owner's Name Phone No
❑ Instrumentation
\I, $ \ S w \ -.2 ""- A V ❑ Intercom and Paging Systems
Address
-- `yck..0 ch O 2_ cl1 ' Z ❑ Landscape Irrigation Control*
City State Zip ❑ Medical
This permit is issued under OAR 918- 320 -370. This applicant agrees to make only El 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. v/r
The person signing for this permit must be the applicant or a person a. Enter Fees $
authorized to bind the applicant.
b. 5% Surcharge (.05 x total above) $
Signature %��
TOTAL $ `7
Authority if other than applicant
ENERGAP.CHP