Permit CITY OF TIGARD
^ .��,� i: �,� l � l ��, DEVW LOPMEN�T SERVICES ELECTRICAL PERMIT —
_ g , ( 03) 639 7 RESTRICTED ENERGY
PERMIT #: ELR98 -10Q��
DATE ISSUED: 08/18/98
PARCEL : �S 1 Q� 1 AD— Q��600
SITE ADDRESS...:12625 SW 69TH AVE
SUPDIVISION :WEST PORTLAND HEIGHTS ZONING:MUE
FLOCK LOT •031 JURISDICTN: TIG
F'ro,j ect Description : Rdd data teleco�sunication.
A. RESIDENTIAL B. COMMERCIAL
AUDI O 8 STEREO...: AUDI O R STEREO..: I NTERCOM t� F'AG I NG.. :
BURGLAR ALARM BOILER LANDSCAPE /IRRIGAT..:
GARAGE OPENER CLOCK MEDICAL
HVAC DATA /TELE COMM..:X NURSE CALLS
VACUUM SYSTEM FIRE ALARM OUTDOOR LANDSC LITE:
OTHER: .. HVAC RROTECTIVE SIGNAL..:
INSTRUMENTATION.: OTHER..: ..
TOTAL # OF SYSTEMS: 1
Owner: FEES
JOHN MCCROSKEY type amount by date recpt
14125 SW FARMINGTON I�RMT $ 40. Q�0 GEO 08/17/98 98- 3�D834Q1
PEAVERTON OR 97Q�Q�5 5p'CT � �. 0Q� GEO Q�8/ 17/98 98- 3Q�834Q�
Rhone #: 646 -9157
Contractor:
AMERICAN TELECOM INC � 4.00 TOTAL
1��5 SE WATER AVE
REQUIRED INSPECTIONS
F�ORTLAND OR 97214 Low Voltage Insp
Phone #: X36 -8991 Elect'1 Final
Reg #..: 0 @773
This per�it is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All pork will be done in accordance with approved plans. This per�it pill expire if work is not started within 180
days of issuance, or if work is suspended for yore than 188 days. ATTENTION: Dregon laM requires you to follow rule adopted by the
Oregon Utility Notification Center. Those rules are set forth in QAR 95��1 -0®10 through OAR 952- 001 -0080. You way obtain copies of
these rules or direct questions to ��i a 15@3)246 -1987. .�
Issued by / `� /���� permittee Signature �����
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 SUF'R. ELEC' N: /v � DATE: � �T (/�
LICENSE N0:
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + ++ + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 P. M. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITX OF TiGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Recd by:
13125 SW HALL BLVD Date Recd: $�
TIGARD OR 97223 PRINT OR TYPE �'G,Q y�' — /1�0�
V - 503 -639 -4171 X304 Permit #:.� ,
F - 503 -684 -7297 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL
Restricted Energy Fee $40.00
� �2 � �� �� -��r�y (FOR ALL SYSTEMS)
.IOB! Street Address � Ste #
ADDRE� S -w �j 9 Check Type of Work Involved:
Cry ���� a � Zip ��o�e�� ❑ Audio and Stereo Systems
Name 6 J ❑ Burglar Alarm
��L�� � ����° —' ❑ Garage Door Opener'
OWNER Mailing Address
City /State Zip Phone # ❑ Heating, Ventilation and Air Conditioning System'
Name ❑ Vacuum Systems'
�Al6j� /� � G �G�dmay( ��r/ �. ® Other P�tol7 e, �G�Gt ' ' r l e
CONTRACTOR �ailing y
Z L� TYPE OF WORK INVOLVED - COMMERCIAL
(Prior to issuance a City /State i . P , �o / ne # Fee for each system $40.00
copy of all licenses �CrlGne� �I � ��o� � �7V "�19� (SEE OAR 918 -260 -260)
are required if re n tr r Lic. # Exp. Da
expired in C.O.T. ����� ���� Check Type of Work Involved:
data base). ical Contr. Lic # xp. D to
� �6 �' � �� � °�� ❑ Audio and Stereo Systems
C.O.T. or Metro�ic. # Exp. Date
❑ Boiler Controls
Owner's Name
i� � �p�, ,,� /"l � C�� F� ❑ Clock Systems
OWNER - Mailing Address
APPLICANT / y /,� ��✓, �r�.,; � ?� � /�� Data Telecommunication Installation
Ci /State Zi Phone Fire Alarm Installation
This permit is issued under OAE 918 - 320 -370. This applicant agrees to HVAC �-' �
make only restricted energy installations (100 volt amps or less) under this ❑
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 - 639175; ❑ 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. Number of Systems
The person signi for this permit must be the - � pl' � - nt or a person No licenses are required. Licenses are required for all other installations
authorized to d the applicant.
�/ ��, �—
� ENTER FEES $ �®
Signature
5 %SURCHARGE (.05 X TOTAL ABOVE) $
Authority if other than Applicant TOTAL $ G�j� —r
i:tresele.doc 12/96 –
Page No. 1 CASE HISTORY FOR CASE NO.: ELR98 -1002
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 / / / / 08/17/98 RECD GEO 08/18/98 GEO
ELRC003 Permit Created / / / / 08/17/98 DONE GEO 08/18/98 GEO
ELRC500 (F) Issue permit / / / / 08/18/98 PASS GEO 08/18/98 GEO
ELRC725 Low Voltage Inspection • / / / / 08/26/98 voice & data PASS CD 08/26/98 CD
ELRC799 Elect'1 Final / / / / 11/17/98 PASS CD 11/17/98 co
ELRC800 Case finaled / / / / 11/18/98 PASS CD 11/18/98 J *H