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i:\records\microfim\targets\buiIding.doc
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line Ceiling -Plumb.
Post/Beam Mach. SI sear/Sheath Framing -Mach.
Plbg.Und/Fir/Slab Plbg. Top Out Insulation -Elect.
Post/Beam Struct, Mech. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other:
Date: A.M. P.M. Entry:
Address: L�
Tenant: 1� a�.. 13-q-Lk-rf-- St : ^ MST
'2�L Gs� __ BUF: _
Con/Own: t _ MEC:
PLM: _
THE F LOWING CORRECT IONS ARE REQUIRED: ELR:
Inspector: r" Date: CS ,
APPROVED —DISAPPROVED/CALL FOR REINSP. CF CO
�Ar7r�'-jC_{J�
Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION`S
13125 SW Hall Blvd.
Tigard,OR 97223 PFRMff #
Phone(503)639-4171
FAX(503)684-7297 DAPI ISSUED
TDD No.(503)684-2772
CITY OF TIOARD Inspection (503)639-4175 ISSUED BY _ p,Ie-c
PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTALLATION 4. TYPE OF WORK
Address �p RESIDENTIAL--Restricted Energy Fee. . . . . . . . . 140.00
jKAIeQ 02
1•� (IORAI1, SYS TTM,)
Ily State 1 Zip Check Tyne of Work Inyolmd:
PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND EXPIRE IF WORK El Audit and Stereo Systems'
IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR
180 DAYS, ❑ Burglar Alarm
El Garage Door Opener*
2. CONTRACTOR APPLICATION ❑ Heating,Ventilation and Air Conditioning System*
Contractor �7L zrG (� ��.._Type e� El Vacuum Systems'
L
;19__�� �I.LO/ �JU /� ❑ Other
Addressfw17R_/�/ -
---.
Date /r0y& ' S __-_ COMMERCIAL—fee for each system . . . . . . . . . X40.00
(SEE OAR 918-260-260)
Property Owner Check Tyne of Work Involved:
Contractor's Board Reg. No. G7192+ ❑ Audio and Stereo Systems'
❑ Boller Controls
Phone# tT � � _ ❑ Clock Systems
3. OWNER APPLICATION n Data Telecommunication Installa.ions
❑ Fire Alarm Installation
❑ hIVAC
(Tint Owner's Name Phone No ❑ ,
,nstrumentatfon
Adchr,� — ❑ 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 a nps or less)under this permit and to do the ❑ Outdoor Landscape Lighting'
fnllr»ving:
❑ 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 ,f"7 .
asterisks(•).All others need licensing).
2. Call for an inspection when all of the installations under this permit are ready
for inspection at 503.539-4175.
❑ Number of Systems
3. Purchase separate permits for all installations that am not Irady for inspection
when the innpector is out to inspect under this permit. •No licenses are required. Licenses are required for all n-her 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 corrections S. FEES
are completed.
The person signing for this permit must he the applicant or a person a. Enter Fees $ 40,
authorized to hind the applicant.
b. 5%Surcharge(.05 x total above) $ • ��
TOTAL $_ ,7 c30
Authority if other than applicant
ENERGAP.CHP
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t.'I.I Y OF 1'I l3NF(L1 OF 4.1NYMEN 1 F L+: 1 P 1 Ntl. 195 -C"/l /10
C;HE:L;K HMOUNI t �w. 4'0
Nilly:. a HONE:YM1U.L. CASH AMUUN1' a r,l, 00
FW1)RL,ri6 a 15495 BW SUOU01A PkKY #J00 PAYMFN-t g041"E:. r I
PORTLAND AND ON SUk3171 V TSL C1N
'URPOS[: OF FlAYMEN1 AMU1.1N'T PA 11) PURPOSE Of- PAYMVNI AMOUNT V41Ib
E1»FC7'RIL:N1w�PERMIT� 40. 00 R;I'. BUILD PF:R .-t. 00
ELR955 r11171A
8900 SW SURNH1401
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UYTAL AMOUNT VIAIU
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