Permit CITY OF TIGARD 5,6
,a „., „7„,,: DEVELOPMENT SERVICES
�� 13125 SW Hall Blvd, Tigard, OR 97223 (503) 639.4171 ELECTRICAL PERMIT -
RESTRICTED ENERGY
PERMIT ;L: EL_RS8 -01 J3
DATE ISSUED: 06/18/58
PARCEL: 2 5101 AD- 0c:600
SITE ADDRESS...:1262 5 SW 69TH AVE
SUBDIVISION....: WEST PORTLAND HEIGHTS ZONING : MUE
BLOCK..........: LOT .............: x+31 ?UR I SD I CTN : T I G
Project Description: HVp,C liiited energy for 3 sys +.etas.
A. RESIDENTIAL--------- B. COMMERCIAL.
AUDIO 8• STEREO...: AUDIO R• STEREO..: INTERCOM R• PAGING..:
BURGLAR ALARM..... BOIL.ER........... L_PNDSCAPE/ IRRIGAT.. .
GARAGE OPENER..... CL_CGK.......... , . s'IEDICt==1L. , .......... :
HVAC .............: DATA /TELE COMM..: NURSE CALLS........:
VACUUM SYSTEM....: FIRE ALARM......: OUTDOOR L_PNDSC L I T E :
OTHER.: .. HVAC ............:X PROTECTIVE SIGNAL...
INSTRUMENTATION.: OTHER..: . .
TOTAL 14 OF SYSTEMS: 1
Owner--: ____.-----------____.--- .____.------------ ___-- __ —__. __ FEES
JOHN MCCROSREY type amount by date recpt
1380 MORNING SKY CT PRMT $, 120.00 DEB 06 /18/58 58- 3016655
LAKE OSWEGO OR 97035 • 5PCT $ 2.00 DEB 06/18/98 98- 306655
Phone #: 636-8638
•
Contractor: W I L L A M E T T E HVAC $ 122.00 ToTAL
27655 SW LEPLEY LN
• REQUIRED INSPECTIONS
HIL.LSBORO OR 97123 Ceiling Cover Low Voltage Insp
7-'h one :!*: 628- - 6841 Wall Cover Elect' 1. Final
Reg V.:..: 56951
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 percit will expire if work is not started within 180
days of issuance, or if work is suspended for lore than 180 days. ATTENTION: Oregon law requires you to follow rule adopted by the
Oregon Utility Notification Center. Those rules are set forth in OA.R 352 -001 -0010 through OAR 452 -001 -0080. You Nay obtain copies of
these rules r direr, questions '' OL'NC at (503)246-1987.
Issued b-• Pertnittee Signature
- - OWNER INSTALLATION ONLY — - - - -- //f-
The installation is being made on property I on which is not intended For
sale, lease, or rent.
OWNER'S S'.GNATURE: DATE:
--_-- .-- .- .---- _-- ___--- ___.. - - -. -- CONTRACTOR INSTALLATION ONLY-
SIGNATURE OF SUPR. ELEC'N:
� /IF DATE;
LICENSE NO
+ + +-1- +•i- :-++ ++-9--!•••. + +-1 +++ + + + + + + + ++ + + + + + ++ + ++ + + + + + + ++ + +•i + + + + + + + + ++ ++ ++ ++ + + + + + + +-f ++++++
Call 639 -4175 by 7:00 P.M. for an inspection necd e the next business clay
•;- -I--I- 1-± -'.-°; +- 1-- 1-4-4-}•_r.F• +-!• +-:-+-!--'r•t ;- + + + +•{- •i'•+•i 1-+++++++++++++- i-- 1-4-1-4-++-' r+ + +++ + +++ +.4- •4• + +•4.-f•_ }•4• -1 - F•v+ ++++
CITYF i IGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by: 4 ---
13125 SW HALL BLVD Date Rec'd:
TIGARD OR 97223 PRINT OR TYPE nn
V - 503 - 639 -4171 X304 Permit #: , i(,,K...n .0753
F - 503 - 684 -7297 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee 540.00
"friar foshy (FOR ALL SYSTEMS)
JOB Street Address Ste #
ADDRESS /2 4 CY s c.-? Check Type of Work Involved:
Cites /State Zip Phone # ❑ Audio and Stereo Systems
Name ❑ Burglar Alarm
OWNER Mailing Address ❑ Garage Door Opener'
City /State Zip Phone # ❑ Heating, Ventilation and Air Conditioning System`
Name ❑ Vacuum Systems*
hia /7i *1-0 ❑ Other
CONTRACTOR Mailing Address
,Z 7L .Sts' SwL,i■p2G Z TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a Cit S ate Phone # Fee for each system $40.00
copy of all licenses /� �a /l'3 et' ' (SEE OAR 918-260-260)
are required if Oregon Contr. Brd Lic. # Ex D e
expired in C.O.T. S' 4 9s ,' I Check Type of Work Involved:
data base). lectrical Contr. Lic. # _ e x ate
q
' ?NG .-C.'► P--6 A04 [ O 9 ❑ Audio and Stereo Systems
C.O.II or Metro Lic. # p. to
C/0--.- G /Q -Tr 11:1 Boiler Controls
OOwner's Nam y
❑ Clock Systems
OWNER - Mailing Address
APPLICANT ❑ Data Telecommunication Installation
City /State Zip 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 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 0 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. Number of Systems
The person signing for this permit must be the applicant or a person • No licenses are required. Licenses are required for all other installations
authorized to bind the applicant.
FEES: 0 8
• ature ENTER FEES $
/0
6. 00
5% SURCHARGE (.05 X TOTAL ABOVE) $
Authority if other than Applicant TOTAL $ / o'q' ,00
i:\dststresele.doc 7/97 —
Page No. 1 CASE HISTORY FOR CASE NO.: ELR98 -0153
JOHN MCCROSKEY
12625 SW 69TH AVE
11/20/98
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
ELRC001 Application Received / / / / 06/18/98 RECD DEB 06/18/98 KJP
ELRC003 Permit Created / / / / 06/18/98 DONE DEB 06/18/98 KJP
ELRC500 (F) Issue permit / / / / 06/18/98 DONE DEB 06/18/98 KJP
ELRC799 Elect'1 Final / / / / 11/17/98 PASS CD 11/17/98 CD
ELRC800 Case finaled / / / / 11/17/98 PASS TLP 11/18/98 J *H
•