Permit A CITYOFTIGARD
h ay !;I � l ; l � DEVELOPMENT LOPMEN SERVICES ELECTRICAL PERMIT —
RESTRICTED ENERGY
PERMIT #: ELR98 -0010
DATE ISSUED: 01/20/98
PARCEL: 19136DA -00100
SITE ADDRESS...:113O8 SW 68TH PKWY
SUBDIVISION • ZONING:MUE
BLOCK LOT • JURISDICTN: TIG
Pro.j ect Description : Providence Information Center
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO...: AUDIO & STEREO..: INTERCOM & PAGING..:
BURGLAR ALARM BOILER LANDSCAPE/ IRRI GAT. .:
GARAGE OPENER • CLOCK • MEDICAL
HVAC • DATA /TELE COMM..: NURSE CALLS •
VACUUM SYSTEM - FIRE ALARM • OUTDOOR LANDSC LITE:
OTHER: :: HVAC •X PROTECTIVE SIGNAL..:
INSTRUMENTATION.: OTHER..: ••
TOTAL # OF SYSTEMS: 1
Owner: FEES
PROVIDENCE HEALTH SYSTEMS type amount by date recpt
4805 NE GLISAN ST PRMT $ 40.00 JSD 01/20/98 98- 302619
PORTLAND OR 97213 5PCT $ 2.00 JSD 01/20/98 98- 302619
Phone #:
Contractor:
ENVIRONMENTAL CONTROL CORP. $ 42.00 TOTAL
7606 SW BRIDGEPORT ROAD
f REQUIRED INSPECTIONS
PORTLAND OR 97224 Ceiling Cover Low Voltage Insp
Phone #: 620 -4228 Wall Cover Elect']. Final
Reg #..: 006467
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not/st.rted with
days of issuance, or if work is suspended or more than 188 days. ATTENTION: Oregon law requires you to follow le adopted , , e
Oregon Utility Notification Center. rules are set forth in OAR 952481 -0818 through OAR 952-881 Yo 1. obtain es of
these rules or direct questions t :..'i (503)246 -1987. 1 % / •
Issued by � /� �� Permittee Si.nat e
411 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: DATE:
LICENSE NO:
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
0
CITY. Ot TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by: C
13125 SW HALL BLVD Date Recd: c /
TIGARD OR 97223 PRINT OR TYPE �qn �/ a
V - 503 -639 -4171 X304 Permit #: / Y '
F - 503 -684 -7297 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL
pleat toe.3ce, Restricted Energy Fee $40.00
I IV AA-rIpN1 C D- lee_ (FOR ALL SYSTEMS)
JOB Street Address Ste #
ADDRESS % 1 3 0 8 sui s - ail v j c1Q Check Type of Work Involved:
City/State Zip Phone # ❑ Audio and Stereo Systems
71 ta• 9722.3 .
Name ❑ Burglar Alarm
?gall QIEV- . 41SeL.TI4- .54151t4A4 S ❑ Garage Door Opener*
OWNER Mailing Address _
Ore, _5 1.1c u- "� S - ❑ Heating, Ventilation and Air Conditioning System*
City/State Zip #
�St ZTI'�� c172c172.1 7 3 I ❑ Va Systems*
Nam /�^,,,,,,��
�J .W (lltt`111 U Cl1NMcL. GO f' ❑ Other
CONTRACTOR Mailing Address
741:2a 5W I t _ Ioecco*r ieo . TYPE OF WORK INVOLVED - COMMERCIAL
(Prior to issuance a City/State Zip Phone # Fee for each system $40.00
copy of all licenses ' YtAt.O tf7ZZ4- (20-422 8 (SEE OAR 918 -260 -260)
are required if Oregon Contr. Brd Lic. # Exp. Date
expired in C.O.T. _34- -2.7 TGl..-C_ 1 D -I — Check Type of Work Involved:
data base). Electrical Contr. Lic. # Exp. Date
Oci .6073 ¢ -Ib-9$ ❑ Audio and Stereo Systems
C.O.T. or Metro Lic. # Exp. Date
❑ Boiler Controls
Owner's Name
0 Clock Systems
OWNER - Mailing Address
APPLICANT ❑ Data Telecommunication Installation
City/State Zip I Phone # ❑ Fire Alarm Installation
This permit is issued under OAE 918 - 320 -370. This applicant agrees to
make only restricted energy installations (100 volt amps or less) under this X HVAC
permit and to do the following:
❑ Instrumentation
1. Only use electrical licensed persons to do installations where required.
Certain residential and other transactions are exempt from licensing. ❑ Intercom and Paging Systems
These have asterisks('). All others need licensing;
❑ Landscape Irrigation Control*
2. Call for inspections when installation under this permit are ready for
inspection at 503-639-4175; ❑ Medical
3. Purchase separate permits for all installations that are not ready for an ❑ Nurse Calls
inspection when the inspector is out to inspect under this permit;
4. Assume responsibility for assuring that all corrections required by the ❑ Outdoor Landscape Lighting'
inspector are done, and;
❑ Protective Signaling
5. Assume responsibility for calling for a final inspection when all of the
corrections are completed. ❑ Other
Permits are non - transferable and non - refundable and expire if work is not
started within 180 days of issuance or if work is suspended for 180 days. 1 Number of Systems
The person signing for this permit mus • e the a • • ' - nt or a person • No licenses are required. Licenses are required for all other installations
auth • v ed bind the applicant.
/ / FEES:
Signature - ENTER FEES $ 49 ia,
5% SURCHARGE (.05 X TOTAL ABOVE) $ Z. 1 CO
•
Authority if other than Applicant TOTAL $ 4-2., 00
i:Vesele.doc 12/96 —
•
3/6/00 Activities for Case #: ELR98 -00010
7:51:25 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRC001 Application Received 1/20/98 JSD PASS JSD 1/20/98
ELRC003 Permit Created 1/20/98 JSD PASS JSD 1/20/98
ELRC720 Wall Cover 4/3/98 BRP PASS DGW 4/8/98 HVAC control roughin by
Fullman approved.
ELRC725 Low Voltage Inspection 4/3/98 BRP PASS B *P 4/6/98
ELRC799 Elect'I Final 4/8/98 BRP PASS B *P 4/8/98
ELRC500 (F) Issue permit 1/20/98 JSD PASS JSD 1/20/98
ELRC800 Case finaled 4/10/98 JT 4/10/98
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