Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
4I1' DEVELOPMENT SERVICES PERMIT #: ELR1999 -00185
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/30/99
SITE ADDRESS: 15660 SW PACIFIC HWY A -1 PARCEL: 2S110DC -02200
SUBDIVISION: WILLOW BROOK FARM ZONING: C -G
BLOCK: LOT: 011 JURISDICTION: TIG
Project Description: Restricted engergy for two new wall signs.
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:
INSTRUMENTATION: OTHER: WALL SIGNS X
TOTAL # OF SYSTEMS:
Owner: Contractor:
HOLLYWOOD VIDEO • NEW IMAGE NEON
15660 SW PACIFIC HWY 619 S ALASKA ST
SUITE 100 SEATTLE, WA 98108
TIGARD, OR 97223
Phone: Phone: 206- 292 -9440
Reg #: LIC 90550
SUP 592SIG
ELE 37 -608CL
FEES Required Inspections
•
Type By Date Amount Receipt Low Voltage Inspection
MENU GEO 7/30/99 $120.00 99- 317296 Elect'I Final
5PCT GEO 7/30/99 $8.40 99- 317296
Total $128.40 ORAGNAL
This Permit is issued subject to the regulations contained in the Tigard Muniapal 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 OA' 952 -' :1 -0080. You may obtain copies of these rules or direct qu- lions to OUNC at (503)
246 -1987. /
Issued by A „ / �/�/f 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: "'// DATE: .0
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
RECEIVED .,1 A, ., 11uARD
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION 1,0 ooz
13125 SW HALL BLVD
TIGAR[?r OR 97223 JUL 1 6 199 Rec'd by:
17 - 503-639-4171 � PRINT OR TYPE D Recd
F - 503 - 598 -1960 C�MINUNITY DEVELOPMF � NC OMPlETE OR ILLEGIBLE CATIONS Permit #: � / l � ' Q Q - 00 / $'5- WILL NOT BE ACCEPTED
Cust. Calla:
Name of Development Project
TYP OF WORK Ene INVOLVED - RESIDENTIA
RA ; '� ��� stricted r F L ONLY
JOB Street Addre (FOR ALL SYS " " " "" $60.00
ADDRESS Ste #
9 _ SC� ` 4 Check Type of Work Involved:
Pone# EVEMerwl, d ❑ Audio and Stereo Systems
Name
n ` d ❑ BurglarAlann
OWNER `7, ailin ddress a c ❑ Garage Door Opener' sk
`� r ziR a Phone # ❑ Heating, Ventilation and Air Conditioning System'
ame `t 3(0', �. -0 3�1
❑ Vacuum Systems*
CONTRACTOR Win. Address v r , CU ' ��'� ❑ Other
• " {t et S, TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a City /States,
• ,� ' � t ' Phone #.
copy of all licenses / 1 tQ ' 1- l ._ , 9 Fee for each system $60.00
-are required if • y - (SEE OAR 918-260-260)
expired in C.O.T. - P• Date
data base). Gl
Exp.. Dat� Check Type of Work Involved:
.5 w .1 • ❑ Audio and Stereo Systems
C.O.T. or Metro Uc. # Exp. Date
Owner's Name ❑ Boller Controls
• ,f4D ( - �- IA"
OWNER - Mailing Address E=1 Clock Systems
4 .' s..)
• iiLiii f / ❑ Data Telecommunication Installation
`� t a ..„\, us- le „`Ir ❑ 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;
2. Call for inspections when installation under this permit are ready for ❑ Landscape Irrigation Control*
inspection at 603 - 639-4175; ❑
Medical
3. Purchase separate permits for all installations that are not ready for an
inspection when the inspector is out to inspect under this permit; El Nurse Calls
4. Assume responsibility for assuring that all 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 t e !� 1
corrections are completed. � b Other el OA C sk. ' ��la!'
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
No licenses are required. Licenses are required for all other installations
The person signing for this permit must be the applicant or a person
authoriz- , bind the applicant.
/ / / /d - / I ,� / FEES:
gnature ENTER FEES $ • .
- "0Th cy
7% SURCHARGE (.06 X TOTAL ABOV $
,..
Authority if other than Applicant TOTAL $ ....4111, P'
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