11174 SW SUMMER LAKE DRIVE-1 ADDRESS. •
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i:\records\microflm\targets\building.doc
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DEPARTMENT 1F LAND USE&TRANSPORTATION
LAND DEVELO6'MENT SERVICES DIVISION
WASHINGTON
155 NORTH FIRST,HILLSBORO,OR 91124
COUNTY, INSPECTION REOI.IESTS: 503/540-3561/693.4415
UF OREGONXXXXXXXXX---> 64U-3470
Page 1 of 1
Urate 03/13/95
Time 16 : 05
Permit 'Type Residential Electrical Permit Permit # 05064999 d
Applied 03/13/95
Permit Status APPROVEDlssu`d : 03/13/95
Situs Address 111'/4 SW SUMMERLARM L. V.'1'I completed
+1I�
Permit 'Title SFK - 8URVLAK ALARM L. To Expire 09/09/95
Permit Uescr. P0048243L43
Pr03ect 'Title St'K - BURGLAR ALARM L.V. Project #* EROSION
#
Project Uescr.
Marcel Number : 251'1'1 - Land Use District
Valuation 0
Legal Uescr . : Construction 01'H
Owner s INSPECTION - TIGARD
Applicant Name PHILLIPS ELECTRIC, INC;. Classification : 900
Applicant Addr. s 1110 NW FLANDERS Occupancy K3
PORTLAND, OR 9'/209 Validated by LU
Applicant Phone : 227-0571 inspector Area
Fee descriptionUnits Fee/Unit Ext fee Data
- -----------------
LimitedEnergy/Alter /Extension --^- 1 40. 01) 40 . 00
Subtotal Electrical Fees : 40 ' 00
State Surcharge of 5% 2. 00
'1'otal Electrical Fees : 42 . 00
***
Fees Required ***
** Fees Collected a Credits ***
---------------- ------------------------------
--
Method Check 0 Receipt No. Date Payment
CK 3'/77 03/13/95 42 . 00
'T'O'TAL 'PHLS DA'Z'E ********* 42 . 00
Fees - 42 . 00
Adjustments : . 00 Total Credits: . 1)
'Total Fees : 42 . 00 'Total Payments : 4'L . 0U
T
balance Due: . 00
MOTILE 7 his permit becomes null and void If the work or constriction for which H Is Issued Is not commenced within 100 days. once construction has started,
the permit becomes null and void it construction Is Interrupted for a period of 180 days. I certify that the information presented by the applicant and
his agent or agents In support of this permit Is true and correct to the best of ovr knowledge. 1 acknowledge that the Building Departmont's reliance
upon false and misleading Informatlon may Invalidate this penult. All provisions of applicable laws and ordinances governing the construction and use
of this building or structure will be complied with whether or not specified on the plans or noted on the plane correction sheets. I acknowledge that
the granting of a permit does not gran:authority to access private property or to use easements. I further ack,;owledge that the use or occupancy of
the struetuie or building permitted depends upon my calling for Inspections at various tlmss during the process of construction and then building
inspection staff verifying compliance with the varloiaa codes. Use or occupancy of the building or structure permitted prior to approval by the
Building Department Is solely at the risk of the applicant And such use or occupancy Is revocable until ell inapuctlon requirements are ustistled and
approval Is given by the Building Official I further acknowledge that a lien may be placed on the title of the properly upon which the permit Is Issued
specifying that the use or occupancy of the building or structure In provisional and revocable until the satisfaction of all inspection requlroments.
APPLICANT'S SIGNATURE
S
i
WASHINGTON COUNTY
ENERGY�IG'`"'�'��
Department of Land Use & `1 ransportation R E v T
��� Electrical inspection Section
155 North First �iveiir:e, 113.,0-12 ELECTRICAL,� 4
Hillsboro Oregon 97124 APPLICATION
-
Information: (503)640.34i'0 Fox. (503)683-4412
PLEASE PRINT
Permit No.Olon
i(r,�
1. Lacatlon of Installation / Date 3t
Ador ccs t l ( `7 `f _WJ �-):A 0-4 P t2�f'fl
city TI Y A-A U k'- Zip Code__'_1-- 4. Type of work-
Map N;,. ,3� 1I ,Tac Lot �� I
RESIDENTIAL Restricted Energy Fee 540.011
Thomas Map Book: Page Section tier all systems)
ClirLctions Check type of work involved:
_ -�__ ---- Audio and Stereo Systems*
Commercial �_� Residential Burglar Alarm
Tenant Name �^/��� N �/U Telephone Systems*
(if commercial) V` ��/111 --- Garage Door Opener*
This permit becomes null and void If the work authorized by the Fire Alarm
permit Is not commenced within 180 days from dais of Issuance Heating,Ventilation and Air Conditioning Systems"
of such permit or If the work authorized Is suspended or abandoned
at any time after work Is commenced for a period of 180 days. Vacuum Systems"
Electrical Permits srs non-refundable and non-transferable. Other
2. Contractor ap ic�tion:
1 COMMERCIAL Fee for each system $40.00
Electrical Contractor ,_ ( (( ( rS tsee OAR 918-260.260)
Address /t/ v W /k 0 >Q S'ST'
Date _ Job Number Check type of work involved:
Property Owner 7��11�ti- t4�--
Contractor's Ltcensn No. _ 2• L(3 �-L Boiler controls
Contractor's Board Reg. No. •� _ clock Systems
Phone No.i_ .] --><<� _�� Data Telecommunications installations
Fire Alarm Installation
3. Owner application: HVAC
Instrumentation
Print Owner's Name Phone No. Intercom and Paging System
Landscape Irrigation Control*
Address �T� —� _ Medical
Nurse Calls
Outdoor Landscape Llghting•
This permit Is Issued under OAR 918-320-370. The applicant agrees Protective Signaling i
to make only restricted energy Installations(100 volt amps or less) Other
under this permit and to do the following:
1. Only uta sl+ctrical licensed persons to do lnstallaNu is where i
required. (Certain residential and other transactions are exempt Number of Systems
from licensing. These have asterisks('). All others need Ncens. `—
ing.) `No licenses are required Licenses are required for all other installations.
2. Call for an Inspection when all the Installations under this permit e4 mQ j
ars ready for Inspection.
3. Purchase separate permits for ad irstalle tions that are not ready 5. Fees
for inspection when the inspector is out to Inspect under this
permit. Enter fees $
4. Assume responsibility for assuming that off corrections required
by the inspector are done,and 'L.0-C. 1
S. Assume responsibility for calling for a final inspection when sit of 5% Surcharge (.05 X total above) $ t
the corrections are completed.
The parson signing this permit must be the applicant ore person
Total
authorized to bind the applicant
Signature Space below reserved for validation.
Authority if other than applicant _ �!
For inspections call
644-3561 or 69:1-4415
24-hour recorder,one working dal dvance of need 4p4
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