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Permit
1,- l.. Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION I, 13125 SW HaII Blvd. -O) Tigard, OR 97223 PERMIT # / S� * Phone (503) 63 FAX (503) 6847 297 DATE ISSUED o9 oC C TDD No. (503) 684 -2772 CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BY ______*--------) PLEASE COMPLETE ALL SECTIONS 1. LOCATION OF INSTALLATION 4. TYPE OF WORK `// / I T X. v • Ac t r c mss✓ • Ass RESIDENTIAL — Restricted Energy Fee $40.00 9∎6 � ©� 9 7 Z Z (FOR ALL SYSTEMS) City • State Zip Check Type of Work Involved: PERMITS ARE NON - TRANSFERABLE AND NON - REFUNDABLE AND EXPIRE IF WORK 0 Audio and Stereo Systems* - IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. ❑ Burglar Alarm ❑ Garage Door Opener* 2. CONTRACTOR APPLICATION .° ❑ Heating, Ventilation and Air Conditioning System* ContractorlfKpu O'Type L ?. Lvc.r x ❑ Vacuum Systems* Address 7,5 f 1 .... /44.4.....v ..e_ ,V ❑ Other Date l/�(.�/ p5- COMMERCIAL — Fee for each system $40.00 �yL 4.10`. (SEE OAR 918- 260 -260) Property Owner /7'1 *-9��i5a∎/ Check Type of Work Involved: Contractor's Board Reg. No. 2 6- 789 GLe -Audio and Stereo Systems* e# C S °3) Z,3/- 'r ❑ Cl S stems Phon ❑ Clock Systems 3. OWNER APPLICATION ❑ Data Telecommunication Installations ❑ Fire Alarm Installation ❑ HVAC Print Owner's Name Phone No ❑ Instrumentation Address ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* City State Zip ❑ Medical This permit is issued under OAR 918 - 320 -370. This applicant agrees to make only ❑ Nurse Calls restricted energy installations (100 volt amps or less) under this permit and to do the ❑ Outdoor Landscape Lighting* following: 1. Only use electrical licensed persons to do installations where required. (Certain ❑ Protective Signaling residential and other transactions are exempt from licensing. These have ❑ Other asterisks('). All others need licensing). 2. Call for an inspection when all of the installations under this permit are ready for inspection at 503- 639 -4175. ❑ Number of Systems 3. Purchase separate permits for all installations that are not ready for inspection when the inspector is out to inspect under this permit. • No licenses are required. Licenses are required for all other installations. 4. Assume responsibility for assuring that all corrections required by the inspector are done, and 5. Assume responsibility for calling for a final inspection when all of the corrections 5. FEES are completed. The person signing for this permit must be the applicant or a person a. Enter Fees $ ' Z-- / ------------ authorized to bind the plicant. J . b. 5% Surcharge (.05 x total above) $ ( Signature .----- TOTAL $ Authority if other than applicant ENERGAP.CHP • DEPARTMENT OF LAND USE & TRANSPORTATION ii " WASHINGTON LAND DEVELOPMENT SERVICES DIVISION 155 NORTH FIRST, HILLSBORO, OR 97124 COUNTY, INSPECTION REQUESTS: 503/640- 3561/693 -4415 Illp XXXXXXXXX - -> 640 -3470 OREGON Page : 1 of 1 Date : 02/22/95 Time : 14:49 Permit Type • Commercial Electrical Permit Permit # : 05064288 Permit Status : APPROVED Applied : 02/22/95 Situs Address : 11619 SW PACIFIC HW TI Issued : 02/22/95 Permit Title : MAZATLAN RESTAURANT LOW VOLT Completed : Permit Descr. : HVAC LOW VOLTAGE To Expire : 08/21/95 Project Title : MAZATLAN RESTAURANT LOW VOLT Project # : P0047773 Project Descr. : HVAC LOW VOLTAGE * EROSION * Parcel Number : 2S1'TI - Land Use District : Valuation 0 • Legal Descr. • Owner : INSPECTION - TIGARD Construction : OTH Applicant Name : MARKMAN INC Classification : 900 Applicant Addr.: 9955 SE ASH Occupancy . PORTLAND OR 97216 Validated by • : EB Applicant Phone: 255 -9923 Inspector Area : Fee description Units Fee /Unit Ext fee Data Limited Energy /Alter. /Extension 1 40.00 40.00 Subtotal Electrical Fees: 40.00 State Surcharge of 5% 2.00 Total Electrical Fees: 42.00 * ** Fees Required * ** * ** Fees Collected & Credits * ** Method Check # Receipt No. Date Payment CK 18284 02/22/95 42.00 TOTAL THIS DATE * * * * * * * ** 42.00 Fees: 42.00 Adjustments: .00 Total Credits: .00 Total Fees: 42.00 Total Payments: 42.00 Balance Due: .00 NOTICE: This permit becomes null and void If the work or construction for which It Is Issued Is not commenced within 180 days. Once construction has started, the permit becomes null and void If 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 our knowledge. I acknowledge that the Building Department's reliance upon false and misleading Information may Invalidate this permit. 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 plans correction sheets. I acknowledge that the granting of a permit does not grant authority to access private property or to use easements. I further acknowledge that the use or occupancy of the structure or building permitted depends upon my calling for Inspections at various times during the process of construction and the building Inspection staff verifying compliance with the various 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 all Inspection requirements are satisfied and approval Is given by the Building Official. I further acknowledge that a lien may be placed on the title of the property upon which the permit Is Issued 00 specifying that the use or occupancy of the building or structure Is provisional and revocable until the satisfaction of a requirements. r . _..,.4.... CANT'S SIG ATURE WASHINGTON COUNTY RESTRICTED ...4 ^ Department of Land-Use & Transportation 155 North First Avenue, #35 0 -12 ELECTRICAL ENERGY #350-12 (503 Hillsboro, 640 -3 eon 97124 APPLICATION Information: (503) 640 -3470 0 Fax: (503) 693-4412 PLEASE PRINT Please complete all sections, 1 through 5. Permit No. S_ &q e 1. Location of installation Date Z-I ge7g ' j1019.______ Address S ) (Jl P([, KW y cit -T-16t Zip Code 4. Type of work: ' Map No. Tax Lot RESIDENTIAL Restricted Energy Fee $40.00 Thomas Map Book: Page Section (for all systems) Check type of work involved: Directions Audio and Stereo Systems* Commercial or Residential 0 = Burglar Alarm Telephone Systems* Tenant Name — Garage Door Opener* (if commercial) MP7 AP L I=A a .� .(1' = Fire Alarm Heating, Ventilation and Air Conditioning Systems* 2. Contractor application: = Vacuum Systems* M 4 v ` , , 1 L.. _ Other Electrical Contractor �1�1, t nJ�, Address 99 SS St: At# COMMERCIAL Fee for each system $40.00 City n State Zip Tn." 60 (see OAR 918 - 280-280) Date 7.....1 paZ) 9 Job Number Check type of work involved: Property Owner Contractor's License No. 1 - S 26,- SISC.EE_ Boiler Controls Contractors Board Reg. No. c1957 Clock Systems Phone No. 2-55.--q97-3 Data Telecommunications Installations ire Alarm Installation 3. Owner application: HVAC Instrumentation Print Owner's Name Phone No. Intercom and Paging System Landscape Irrigation Control* Address Medical Nurse Calls City State Zip . Outdoor Landscape Lighting* This permit is issued under OAR 918- 320 -370. The applicant agrees Protective Signaling to make only restricted energy installations (100 volt amps or less) Other under this permit and to do the following: 1. Only use elecbical licensed persons to do installations where required. (Certain residential and other transactions are exempt 1 Number of Systems from licensing. These have asterisks ("). All others need licens- ing.) 2. Call for an Inspection when all the installations under this permit * No licenses are required. Licenses are required for all other installations. are ready for Inspection. 3. Purchase separate permits for all installations that are not ready 5* Fees for Inspection when the inspector Is out to Inspect under this 0 permit. Enter fees $ q / 4. Assume responsibility for assuming that all corrections required by the Inspector are done, and 5. Assume responsibility for calling for a final Inspection when all of 5% Surcharge (.05 X total above) $ 2 the corrections are completed. The person signing this perm u he applicant or a person Trust Account $ authorized to bind th ppl a t. Signature Total $ 1 12. — Authority if other than applicant This permit becomes null and void If the work authorized by the permit is not commenced within 180 days from date of issuance For inspections call of such permit or If the work authorized is suspended or abandoned 640 -3561 or 693 -4415 at any time after work is commenced for a period of 180 days. Electrical Permits are non - refundable and non - transferable. 24 -hour recorder, one working day in advance of need BL24 - 114 6/16/99 Activities for Case #: ELR95 -00133 2:06:05 PM Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes ELRC001 Application Received 9/2/95 JIM RECD TMP 12/29/95 ELRC003 Permit Created . 9/20/95 JIM PEND" TMP 12/29/95 ELRC700 Ceiling Cover 12/29/95 TMP 12/29/95 ELRC720 Wall Cover 12/29/95 TMP 12/29/95 ELRC730 Elect'I Service 12/29/95 TMP 12/29/95 ELRC799 Elect'l Final 12/29/95 TMP 12/29/95 ELRC500 (F) Issue permit 9/20/95 JIM . PASS TMP 12/29/95 ELRC800 Case finaled 1/30/96 MJR YES MJR 3/4/96 • Page 1 of 1