Permit ELECTRICAL PERMIT -
CITY TIGARD RESTRICTED ENERGY
4 "g l tilIe DEVELOPMENT SERVICES PERMIT #: ELR1999 - 00249
a 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/25/1999
SITE ADDRESS: 11705 SW PACIFIC HWY B PARCEL: 1S136CD - 00100
SUBDIVISION: ZONING: C -
BLOCK: LOT: JURISDICTION: TIG
Project Description: Data telecommunication installation for a tenant improvement.
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: Contractor:
PACIFIC CROSSROADS PROPERTIES BACHOFNER DATACOM INC
BY WYSE INVESTMENT SERVICES 55SE MAIN ST
200 SW MARKET ST STE 345 PORTLAND, OR 97214 -3346
PORTLAND, OR 97201
Phone: Phone: 233 - 7873
Reg #: LIC 0111978
ELE 26 -953CL
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT DST 10/25/1990 $60.00 99- 319299 Elect'I Final
5PCT DST 10/25/199C. $4.80 99- 319299
Total $64.80 r" r !NAL
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. 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 started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 1987. Ate _ 4 1
Issued by �� Permittee Signature e%
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: ./i////9"- DATE: /Q - v ' 4 9
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by:
13125SW HALL BLVD Date Recd:
TIGiRD OR 97223 PRINT OR TYPE
V x'503- 639 -4171 X304 Permit #: t (99f CS0ay�
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 $40.00
Radio Shack (FOR ALL SYSTEMS)
JOB Street Address Ste #
ADDRESS 11705 SW Pacific Hwy Check Type of Work Involved:
City /State Zip Phone # ❑ Audio and Stereo Systems
Tigard 97223 620 -9530
Name n Burglar Alarm
Bachofner Datacom
OWNER Mailing Address
El
Door Opener*
City /State I Zip Phone # _ n Heating, Ventilation and Air Conditioning System*
-- ' ❑ Vacuum Systems*
Name
Bachofner Datacom ❑ Other
CONTRACTOR Mailing Address
55 SE Main TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a City /State Zip Phone # Fee for each system
copy of all licenses Portland 97223 233 -2016 (SEE OAR 918-260-260) ���
are required if Oregon Contr. Brd Lic. # Exp. Date � e
expired in C.O.T. 44569 3/ 6/ n n Check Type of Work Involved:
data base). Electrical Contr. Lic. # Exp. Date
26-451c 7/1 / 0 0 ❑ Audio and Stereo Systems
C.O.T. or Metro Lic. # Exp. Date
❑ Boiler Controls
Owner's Name
❑ Clock Systems
OWNER - Mailing Address
APPLICANT in 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 ❑ Nurse Calls
inspection when the inspector is out to inspect under this permit;
4. Assume responsibility for assuring that all corrections required by the I I 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 must be the applicant or a person * No licenses are required. Licenses are required for all other installations
authorized to bind the applicant.
FEES: C
Signature ENTER FEES $
y/% SURCHARGE (.05 X TOTAL ABOVE) $ 67r U ZD
Authority if other than Applicant TOTAL $- a3 2,(;
i: \dsts \resele.doc 7/97 — /, q
11/09/1999 Activities for Case #: ELR1999 -00249
10:52:24 AM
. Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRC003 Permit Created 10/25/1999 GEO DONE No Hold DST 10/25/1999
ELRC001 Application Received 10/25/1999 GEO RECD No Hold DST 10/25/1999
ELRC725 Low Voltage Inspection No Hold DST 10/25/1999
ELRC799 Elect'l Final 10/26/1999 BP PASS No Hold JS 10/26/1999
ELRC500 (F) Issue permit 10/25/1999 GEO DONE No Hold DST 10/25/1999
ELRA700 Ceiling Cover 10/26/1999 10/26/1999 10/26/1999 BP PASS No Hold JS 10/26/1999 Ceiling limited energy cables.
ELRA800 Case finaled 10/29/1999 JMT DONE No Hold JMT 10/29/1999
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