Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
� DEVELOPMENT SERVICES PERMIT #: ELR2004 -00015
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/26/04
SITE ADDRESS: 16875 SW PACIFIC HWY PARCEL: 2S1156D -02600
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: KIN
Project Description: Low voltage for CCTV
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: CCTV X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
SPACE AGE FUEL INC ADVANCE CASTLE TECHNOLOGIES, INC.
PO BOX 607 220 SE 32ND AVE.
GRESHAM, OR 97030 HILLSBORO, OR 97123
•
Phone: 503- 665 -5693 Phone: 503- 869 -4626
Reg #: ELE 34- 579CLE
LIC 149864
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 1/26/04 $75.00 Elect'I Final
[TAX] 8% State Surcharl 1/26/04 $6.00
Total $81.00
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 - 001 -0010 throuc
Issued by 40. a4. 4.dl ^€1 ) Permittee Signature A
7\1:.• _ -'
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