Permit =CITY OF TIGARD •
ELECTRIGAL PERMIT —
COMMUNITY DEVELOPMENT DEPARTMENT RESTRICTED ENERGY
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171 PERMIT #: EL R96 -0180
DATE ISSUED: 06/03/96
iS134DD -00101
SITE ADDRESS...: ' 10525 SW TIGARD ST EXPI L:
'SUBDIVISION ZONING:R -12
BLOCK LOT
Project Description:
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
SHANNON SMITH type amount by date recpt
10525 SW TIGARD ST PRMT $ 40.00 CJS 06/03/96 96- 280111
SPCT $ 2.00 CJS 06/03/96 96- 280111
TIGARD OR 97223
Phone #:
•
Contractor:
ADT SECURITY ALARMS $ 42.00 TOTAL
703 NE HANCOCK
REG.UIRED INSPECTIONS
PORTLAND 'OR 97212 Wall Cover Elect'1 Final
Phone #: 503 -284 -3265 Elect'1 Service
Reg #..: 59944
This permit is issued subject to the regulations contained in the
'Tigard Municipal Code, State of Ore. Specialty Codes and all other Pe rm i t e e Signature
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 �rr��✓f —� i�
than 180 days. Issued 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: Qn off, i r 7� rn/1 DATE: - 3- ( (
LICENSE NO: /
Call for inspection — 639 -4175
Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 PERMIT # Q /e0
� l Phone (503) 639 -4171
,III FAX (503) 684 -7297 DATE ISSUED F —.3 — 96
_ - TDD No. (503) 684 -2772
CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BY C /t cc r /e r 5c-11 m ' df
PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTALLATION 4. TYPE OF WORK
//etAl
AdcJre RESIDENTIAL — Restricted Energy Fee $40.00
/ / ;A ( ' 7c 73d (FOR ALL SYSTEMS)
City 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 El Garage Door Opener*
�— ❑ Heating, Ventilation and Air Conditioning System*
Contractor ADT SECURITY SYSTEMS. IFOfype Vacuum Systems*
703 NE HANCOCK
Address PORTLAND, OR 97212 ❑ Other
{503) 28432265
Date v6 4/-96 COMMERCIAL — Fee for eac
c ste 260) $40.00
(SEE Property Owner � Check Type of Work Involved:
Contractor's Board Reg. No. ad / / y ❑ Audio and Stereo Systems
❑ Boiler Controls
Phone # ❑ Clock Systems
3. OWNER APPLICATION ' ❑ Data Telecommunication Installations
❑ Fire Alarm Installation
❑ HVAC
Print Owner's Name Phone No
❑ Instrumentation
Address ❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
City State Zip ❑ Medical
This permit is issued under OAR 918- 320 -370 This applicant agrees to make only ❑ 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.
The person signing for this permit A e the applicant or a person a. Enter Fees $ 44
authorized to bind the appli .nt. r
d _
b. 5% Surcharge (.05 x total above) $ � - Q U
• Signature �� 0
TOTAL $
Authority if other than applicant
ENERGAP.CHP
3/30/00 Activities for Case #: ELR96 -00180
5:37:25 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRA003 Application received 6/3/96 CJS RECD CJS 6/3/96
ELRA010 Permit created 6/3/96 CJS PEND CJS 6/3/96
ELRA720 Wall Cover 6/3/96 CJS 6/3/96
ELRA730 Elect'I Service 6/3/96 CJS 6/3/96
ELRA799 Elect'I Final 6/3/96 CJS 6/3/96
ELRA500 (F) Issue permit 6/3/96 CJS PASS CJS 6/3/96
ELRA580 Expired by limitation 3/28/00 HAP DONE No Hold AKJ 3/28/00
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