15042 SW 91ST AVENUE ADDRESS:
91VA
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CITY OF TIGARD r1_UCTRICAL PERMIT
RESTRICTED ENERGY
CCMMUNiTY DEVELOPMENT DEPARTMENT PERMIT #: ELR96-0295
13125 SW Hall Blvd.Tigard,Oregon 9722398199 (503)639-4171 DATE ISSUED: 09/25/96
2SI11AD-16200
SITE ADDRESS. . . : 15042 SW 91ST AVE VARCEL:
SUBDIVISION. . . . : MALLARD LAKES ZONING:R--4. 5
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . :28
[-Dr-oject Descrip-tion :
----------------------------------------------------------------------------------------
A. RESIDENTIAL_-..._.__ -_..__-- La. C',101y1Mr._.RC I Al..........
AUDIO & STEREO. . . : AUDIO & STEREO. . ii INTERCOM & PAGING. . :
BURGLAR ALARM. . . : X BOILER. . . . . . . . . . I LANDSCAPE/ IRRIGAT. . :
GARAGE OPENER. . . . . CLOCK. . . . . . . . . . as MEDICAL. . . . . . . . . . . . .
HVAC. . . . . . . . . . . . . . DATA/TELE COMM. . . NURSE CALLS. . . . . . . . :
VACUUM SYSTEM. . . . : FIRE ALARM. . . . . . : OUTDOOR LANDSC LITE:
OTHER: HVAC. . . . . . : PROTECTIVE SIGNAL. . :,
I N53TRUMENTAT ION. : OTHER. . :
TOTAL # OF SYSTEMS: 0
Owner-: FEES
JOHN GILMAN type amo�.int by date r-ecpt
2
15041-- SW 91ST il'VE. PLRMT $ 40. 00 CJS 09/,::.5/9& 96—C_84358
5PCT $ 2. 00 CJS 09/25/96 96-2_'84356
' TbARD OR 972i'--13
lione #:
!,(Jntr-actor-:
BRINKS 1-40ME SECURITY f 42. 00 TOTAL
8059 SW CIRRUS DR
REQUIRED INc,3P,ECTJIJNF
BEAVERTON OR 970-L"13 Wall Cover- Elect' l FinaJ
Phone #: 503-641-0574 Elect' 1 Set-vice ........
1_2(-g #. . : 44421
T,jis pe:,qllt isb-.zj subject to t�,e regulation5 contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Perm itee Signat ctr-e
applicable laws. All work will be dine in accordance with
approved plans. This pervit will exp re if work is not started
within 180 days of issuance, or if work is suspended for acre
than 180 oays. Issl_ied By
INSTALLATION
The installation is being made on pt-upel'ty I own which is not intended for
kale, lease, or rent.
_
DATE:
OWNER' S SIGNATURE:
Ln _.-----.-_--__--.---_—_—_--_-CONTRACTOR INSTALLATION
43IGNATURE OF SUPIR. ELECI N: _rjijC,�, led D1:11 CCs
I.-ICENSE NO:
Call for inspection 639-4175
Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd.
Tigard,OR 97223 PERMIT#
Phone(503)639-4171
FAX(503)684-7297 DATE ISSUED q_a
TDD No. (503)684-2772
CITY OF TIGARD Inspection (503)639-4175 ISSUED BY Lhc,l e_C .5�c_k rst ,L/14-
PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTALLATION 4. TYPE OF WORK
ttrire's RESIDENTIAL—Restricted Energy Fee. . . . . . . . . $40.00
&r__1
7� (FOR ALL SYSTEMS)
City to Zip Check Type of Work Involved:
PERMITS ARE NON-TR,N5FERABLE AND NON-REFUNDABLE AND EXPIRE IF WORK ElAudio and Stereo Systems*
IS NOT S"ARTED WITHIi 1 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR
180 DAYS. 'Tid—Burglar Alarm
ArT ❑ Garage Door Opener*
4gONT RA r UR APPLICATION
1 ❑ Heating,Ventilation and Air Conditioning System*
�� e _^___ -_ ❑ 'Vacuum systems*
❑ Other
Address
Date f e� � _ COMMERCIAL—Fee for each system . . . . . . . . . $40.00
(SEE OAR 718-260-260)
Property Owner ----___ Check jype of Work Involved:
Contractor's Boa Reg. No. ❑ Audio and Stereo Systems*
G�, El Boller Controls
Phone:# D L1---- — ❑ Clock Systems
El Data Telecommunication Installations
3. OWNER APPLICATION ❑ 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 000 volt amps or less)under this permit and to do the ❑ Outdoor Landscape Lighting*
following:
1. Only usi electrical licensed persons to do installations where required.(Certain El Protective Signaling
residential and other transactions are exempt from licensing.These have ❑ Other
p asterisks(•►.All others need licensing).
R 2. Call for an Inspection when all of the installations under this permit are ready
I`_1 for inspection at 503-639-4175.
❑
J. P:uchase separate pertnif;for all installations that are not ready for Inspection —' Number of Systems
wl len the inspector is out to inspect under this permit •No licenses are required. licenses are required for all other Installations.
4. &sump responsibilih,for assuring that all corrections required by the inspector
.-� are done,and
ca
5. Assume responsibility for calling for a final Inspection when all of the corrections 5. FEES
W are completed.
J
The person signing for this permit must be the applicant or a person a. Enter Fees
$
authorzed to hind the applicant,
b. 5% Surcharge(05 x total above) $
Signature i /���,
TOTAL $--�-_�-
Authority if other thA applicant
FNERGAP.CHP