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CI-TY OF TIGARD ELECTRICAL PERMIT
'COMMUNITY I"►=VELOPMENT DEPARTMENT RESTRICTED ENERGY
13125 SW Hall Blvd.Tigard,Oregon 07223.0190 (503)839-4171 PERMIT #: EL.R96--0006
DATE' ISSUED: 01/03,/96
PARGF=.I_. : 1 S 135DB--0 :500
I TE ADDRESS . . 1 t 315 SW 915-1 CT
SUBDIVISION. ,. . . . HAZEL HILL e%rZONING: R-4. 5
131_OCK. . . . . . . .. . . . LOT. . . . . . . . . . . . . J
fir^oject Description:
----------------------------------------
�. RESIDENTIAL—------- B.
AUDIO & STEREO. . . - AUDIO tt STEREO. . : INTERCOM & F-PG I NG. .
BURGLAR AI._.ARM. . . . : Y BOILER. . . . . . . . . . .. I..ANDSCAPE/TRRIGAT. .
GARAGE. OPENER. . . . . CLUCK. . . . . . . . . . . . MEDICAL. . . . . . . . . . . . .
HVAC. . . . . . . . . . . . . . DATA./TELE COMM. . . NURSE CAL-1.5. . . . . . . .
VACUUM SYSTEM. . . . : FIRE ALARM. . . . . . : OUTDOOR LANDSC LITE: �
OTHER: : : HVAC. . . . . . . . . . . . : PROTECTIVE SIGNAL. .
INSTPUMENTATION. : OTHER. . : . .
'TOTAL # OF SYSTEMS: Vi
Opplicant ; _.____._._...___._.______._.__--.— ----------_._____—__—•-- FFFS
BRAIN HOUSTON type amoLint by date rer.pt
11315 SW 91ST r-,RMT $ 40. 00 CJS 01/03/96 96- 274',J_-b
;PCT $ 2. 121121 CJS 01/03/96 96-27453S
TIGARD OR 97'.2'23-6473
r-'hone #: 503-598-8925
C'un•tractor-
i'ONTRACTOR NOT ON FII__E s1 4.71. 00 TOTAL
------- REQUIRED INSPECTIONS
Ceilinq rover 1.1ect' iGet-vice
i" hone # Wall Cover- Elect' l Final
F?en #.
'his pewit is issued sut.)ect to the regulations .ontained in the
igard Municipal Code, State of Ore. Specialty Codes and all other Perm i t ee Sii gnat Lire
applicable laws. All work will be dine in accordance with
approved plans. This nersit will expire if work is not started
:ithin lib days of issuance, or if work is suspended for rove sc_/
Shan 18( days. I s F Lied By
_ . _- -OWNER INSTALLATION
Itne installation ic; heing made on property I own which is not intended for-
ale. l eAse, (,r r•eni:.
f)WNER' S S I 173NATURF: DATE'--
__. ONT9ACTOR TNrTALI_.ATION ONLY-___...
;IGNATURE OF SUPR. ELEC' N: /tea,%off DATE: -
J
ICENGG NO:
yr
J Call fir- inspection - 639-4175
I
L�
Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd.
Tigard,OR 97223 PERMIT# X') 00C 6
Phone(503)639-4171
FAX(503)684-7297 DATE ISSUED
TDD No. (503)684-2772
CITY OF TIOARD Inspection (503)639-4175 ISSUED BY f
�/,�.
?LEASE COMPLETE ALL SECTIONS
'I. LOCATION OF INSTALLATION 4. TYPE OF WORK
Addess p/ n RESIDENTIAL— Restricted Energy Fee. . . . . . . . . $40.00
/ `�J CJr T�J 7 (FOR ALL SYSTEMS)
City eq, State Zip Speck 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. lb—Burglai Alarm
El Garage Door Opener*
1 CONTRACTOR APP KATION
ElFleating,Ventilation and Air Conditioning System`
-Cuntra�4/Awry— �L Typ Al:,C 4i ❑ Vacuum Systems*
Add ess L7 01her
Date COMMERCIAL—Fee for each system . . . . . . . . .
�`-- (SEE OAR 918-260-260)
[
Property Owner 77? V.
S:1lg�k Type of Work Involygd;
Contractor's Board Reg. No. ❑ Audio and Stereo Systems*
t
Phone# ,/ �S O Boiler Controls
y Ciuck 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 918.320-37J,This applicant agrees to make only ❑ Nurse Calls
restricted energy Installations(1o0 volt amps or less)under this permit and to do the ❑ Outdoor L and:cape Lightirg*
following:
1. Only use electrical licensed persons to do installations where required.(Certain ❑ Protective Signa'Ing
residential and other transactions are exempt form licensing.These have ❑ Other
t1 asterisksM.All others need licensing).
K 2. Call for an inspet tion when all of the installations under this permit are ready
N for inspection at 503.639-4175.
❑
3. Purchase separate permits for all installations that are Number of Systems not ready for inspection —
> when the Inspector is out to inspect under this permit.
F— •No licenses are required, licenses are required for eg other Installations,
4 Assume responsibility for assuring that all corrections required by the fnspectnr
.. are done,and
co
5. Assume responsibility for calling for a final inspection when all of the corrections 5. FEES
ware completed.
J The person signing for this permit must be the applicant or a person a. Enter Fees $ /VU
authorized to bind the applicant.
b. 5% Surcharge(.05 x total above) $_ 11
Signature (�7
*640 + TOTAL $ ( G�
Authority if other than applicant
ENERGAP.CHP