Permit CITY OF TIGARDp ELECT ENERGY
r;` DEVELOPMENT SERVICES 1 / G RESTRICK TED CAL PERMIT #: ELR2000 -00004
� 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -417I DATE ISSUED: 1/6/00
SITE ADDRESS: 12705 SW PACI FI C W HY 1 4 PARCEL: 2S102BD -00500
SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. ZONING: C -G
BLOCK: LOT: 050 JURISDICTION: TIG
Project Description: Installation of protective signaling.
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: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
FUNK, JAMES H PROTECTION ONE ALARM MONITORIN
do BERGMANN, FLOYD H + MARINE 3900 SW MURRAY BLVD
11600 SW 90TH BEAVERTON, OR 97005
TIGARD, OR 97223
Phone: Phone: 520 -6000
Reg #: ELE 34- 428CCLE
LIC 116325
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT DEB 1/6/00 $60.00 00- 320963 Elect'I Final
5PCT DEB 1/6/00 $4.80 00- 320963
Total $64.80
•
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 -00 i i • ough OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246- • 87.
'1'7
Issu • • by : I l ✓i � Permittee Signature /j,� ,�Q E � ,�, ,
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 639 -4175 by 7:00 P.M. for an inspection needed the next business day
•
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd b `
Y
13125 SW HALL BLVD Date Rec'd: / -5110
YIGARD OR 97223 PRINT OR TYPE
V - 503 - 639 -4171 X304 Permit #:11,,A220 -C�__
F - 503 - 598 -1960 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee $60.00
1A (11 ,/ 1A/ 1-J (FOR ALL SYSTEMS)
JOB treet Addr ss Ste #
9� /� `�G/ C(1 /b Check Type of Work Involved:
/
ADDRESS // 1 p
ity State It, 0 Phone # . Audio and Stereo Systems
N4n/e9-7 4 Kg : urglar Alarm
L)-'f f " ` / ` Garage Door Opener*
OWNER Mailing, e G 0 r2 ,
City /State Zip /u Phone # El Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
me A[.�QM
Molte77D J d t1e Made //J . ❑ Other
CONTRACTOR Mailing Address
960 A HUkieit y &IAD TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a ¢ityX tg 7 7 0 /2 / ,l �5 Si�O (1 Phone # Fee for each system $60.00
copy of all licenses /a V 00 (SEE OAR 918- 260 -260)
are required if Ore on Contr. Brd Lic. # VI . Date
expired in C.O.T. ////61:596 a DO Check Type of Work Involved:
data base). F ricV Contr. L i L Exp. Date
�� C: io / oU ❑ Audio and Stereo Systems
C.O.T. or Metro Lic. # Exp. Date ❑
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;
❑ 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. [ 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.
% ''t ie 6 • FEES:
Si ture , ��ER FEES $ V
4% SURCHARGE (.95 X TOTAL ABOVE) $
Authority if other than Applicant TOTAL $ 6 5'
iAdsts\forms\resele.doc 3/98