Permit 4 CITY OF TIGARD
%l � � i t f � l DEVELOPMENT SERVICES RESTRICTED ENERGY
PERMIT #: ELR97 -0007
DATE ISSUED: 01/09/97
PARCEL: 28110AA- 00300
SITE ADDRESS...: 14145 SW 105TH AVE
SUBDIVISION • ZONING:R -12
BLOCK • LOT -
Project Description: Installing data telecommunications system
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO...: AUDIO & STEREO..: INTERCOM & PAGING..:
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........._...: PROTECTIVE SIGNAL..:
INSTRUMENTATION.: OTHER..: ..
TOTAL # OF SYSTEMS: 1
Owner: FEES
TIGARD MEDICAL & REHAB type amount by date recpt
SUNRISE HEALTHCARE PRMT $ 40.00 B 01/09/97 97- 288690
14145 SW 105TH AVE 5PCT $ 2.00 B. 01/09/97 97- 288690 .
TIGARD OR 97224
Phone #:
Contractor:
MOORE COMMUNICATIONS INC $ 42.00 TOTAL
20811 NW CORNELL. RD
STE 700 REQUIRED INSPECTIONS
HILLSBORO OR 97124 Ceiling Cover Elect'l Service
Phone #: 617 -9800 Wall Cover Elect'l Final
Reg #..: 007636
This permit is issued subject to the regulations containedin:the ,,,.
Tigard Municipal Code, S t a t e o f O r e . Specialty Cedes��and all. o t h e r P e r m i t ee �S i gnat u
applicable laws. All work will be done in accordance with
approved plans. This peruit will expire if work is not -started
i
within 188 days of issuance, or if work is suspended for tore 6-----2,.A.,://
than 188 days. s sued B y
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 :4'OVf DATE:
LICENSE NO: 01 p,GQ
Call for inspection — 639 -4175
. . -
01/09/97 09:37 72503 684 7297 CITY OF TIGARD
410 0 2/0 0 2
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by: "��b - _ -
13125 SW HALL BLVD Date Recd: ( —
TIGARD OR 97223 PRINT OR TYPE
V - 503 - 639.4171 X304 Permit #- Cc q 7- G 7
F - 503 - 684 - 7297 INCOMPLETE OR ILLEGIBLE APPLICATIONS CusLCali'd:
WILL. NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL
Restricted Energy Fee $40.00
(FOR ALL SYSTEMS)
JOB S Address ` , t Ste #
ADDRESS ii41HS SW l uS 1/\ Check Type of Work Involved:
Stain Zi Phone* ❑ Audio and Stereo Systems
t -- G3c1 -flay
Name
❑ Burglar Alarm
- 1 - 16inp ' \Cg,,` Ce- (AsAu
OWNER Mailing Address ❑ Garage Door Opener
I g1 "lc 10s-►I Heating, entilation and Air Conditioning S stem'
Cite/State I Zip one # ❑ g 9 Y
i 1It 0 l tc— I fr,Ph3°I - Il4+.4 r �-�
Name r _ —`,_ L i l Vacuum Systems'
0k_ Vste 'A\mA(.ikkviNS ❑ Other
CONTRACTOR Mailing Adgi
'aZAA\ [ J (arht)u\ 8 lk 10■ TYPE OF WORK INVOLVED - COMMERCIAL
(Prior to issuance a city/state Zip Phone* Fee for each system 540.00
copy of all licenses A��9...t, 4'11 IV (10 (SEE OAR 918-260 -260)
are required if Oregon Contr. Brd Lic. # Ell bate
expired in C.O.T. , ( p1)t.yy C%Jl Check Type of Work Involved:
data base). Electrical Contr. Lic. # Ezp. D to
3L - . SStoCI 1011 � Al ❑ Audio and Stereo Systems
C.O.T. or Metro Lic.* L\ 5 , 0 Exp. D,ate
y , All lgri ❑ Boiler Controls
Owner's Name
❑ Clock Systems
OWNER - Mailing Address
APPLICANT 14 Data Telecommunication Installation
City /State Zip Phone # ���� ❑ "``
Fire Alarm Installation
This permit is issued under OAF 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 asterlsks( - ). All others need licensing;
❑ Landscape Irrigation Control"
2. Call for inspections when installation under this permit are ready for
inspection at 503 - 839 -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 n Outdogr 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 Ikenses are required. Licenses are required for al other inatalk one
authorized to bind the applicant.
�^ � Fees.
/ /�iii1,P ENTER FEES ````
Signatur S '1� ��
5% SURCHARGE (.06 X TOTAL ABOVE) $
a°
Authority if other than Applicant TOTAL S 0 4. .
i:vesele.doc 12/96
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /Flr /Slab Plbg. Top Out Insulation a_4L
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other:
Date: 3 / / 6 / A.M. P.M. Y--r �s / S S
Address: / I ' b Tv` 1
Tenant: Ste: MST:
U
Con /Own: � � / r MEC :
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR: r,
-� ctr � /
$;/
Inspector: // C _ , ∎ Dater : 7,7
APPROVED DISAPPROVED /CALL FOR REINSP. CF CO
. Lc 77 --cDo
Page No. 1 CASE HISTORY FOR CASE NO.: ELR97 -0007
TIGARD MEDICAL & REHAB
14145 SW 105TH AVE
06/04/97
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
---- --- -- - - - - -- ---
ELRC001 Application Received 01/09/97 / / 01/09/97 RECD B 01/09/97 DST
ELRC003 Permit Created 01/09/97 / / 01/09/97 PEND B 01/09/97 DST
ELRC500 (F) Issue permit / / / / 01/09/97 PASS B 01/09/97 DST
ELRC700 Ceiling Cover 01/09/97 / / / / 01/09/97 DST
ELRC720 Wall Cover 01/09/97 / / / / 01/09/97 DST
ELRC731 Elect'l Service 01/09/97 / / / / 01/09/97 DST
ELRC799 Elect'l Final 01/09/97 / / / / 01/09/97 DST