Permit •
A ,
CITY OF TIGARD
j � l � DEVELOPMENT SERVICES ELECTRICAL PERMIT —
RESTRICTED ENERGY
PERMIT #: ELR97 -0078
DATE ISSUED: 03 /18/97
PARCEL: 1S136CC -00100
SITE ADDRESS...: 11765 SW PACIFIC HWY
SUBDIVISION ZONING:C —P
•
BLOCK LOT
Project Description: INSTL PROTECTIVE SIGNALING
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO...: AUDIO & STEREO..: INTERCOM & PAGING..:
BURGLAR ALARM • BOILER LANDSCAPE /IRRIGAT..:
GARAGE OPENER • CLOCK MEDICAL
HVAC • DATA /TELE COMM..: NURSE CALLS •
VACUUM SYSTEM • FIRE ALARM OUTDOOR LANDSC LITE:
OTHER: .. HVAC PROTECTIVE SIGNAL..:X
INSTRUMENTATION.: OTHER..: ..
TOTAL # OF SYSTEMS: 1
Owner: FEES
GENERAL MOTORS INC type amount by date recpt
11765 SW PACIFIC HWY PRMT $ 40.00 TAT 03/18/97 97 -291871
SPOT $ 2.00 TAT 03/18/97 97- 291871
TIGARD OR 97223
Phone #: 639 -6191
Contractor:
ADT SECURITY ALARMS $ 42.00 TOTAL
703 NE HANCOCK
REQUIRED INSPECTI
PORTLAND OR 97212 Ceiling Cover Elect'1 Service
Phone #: 503 - 284 -3265 Wall Cover Elect'1 Final
Reg #..: 000599 •
This peroit is issued subject to the regulations contained in the 1 1 /
Tigard Municipal Code, State of Ore. Specialty Codes and all other Perm' e i gnat u e
applicable laws. All work will be done in accordance with
approved plans. This per.it will expire if work is not started
i
within 180 days of issuance, or if work is suspended for more i,.,, �" , / i
than 180 days. I s - ued By / •
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 : DATE:
LICENSE NO:
Call for inspection — 639 -4175
' . . _ 6 :t , a -, 1 /// 5 - 79 7
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by: .
13125 SW HALL BLVD Date Rec'd:
TIGARD OR 97223 PRINT OR TYPE I �
V - 503 -639 -4171 X304 Permit #: r-v!`%17 -Cirna
F - 503 -684 -7297 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL
..3// �// 7 Restricted Energy Fee $40.00
(FOR ALL SYSTEMS)
JOB Street Address
#
ADDRESS // 765 SLl) /9 G H Check Type of Work Involved:
C'
� /State n O � 9 ! r� / // ❑ Audio and Stereo Systems
.),
Na � � ❑ Burglar Alarm
❑ Garage Door Opener'
OWNER M ini/ res� s ,�
/ r ❑ Heating, Ventilation and Air Conditioning System'
Ci State c Ziphone #
`"` � XI ` 7, ,-? 3 I t 3 / ./ ❑ Vacuum Systems'
Na me/ 7 ,C DT SECURITY SYSTEMS,
V 703 HANC0 II ❑ Other
Pr1RTLAND. OP 9
CONTRACTOR Mailing Address /503) 284-3265
TYPE OF WORK INVOLVED - COMMERCIAL
(Prior to issuance a City /State Zip Phone # Fee for each system $40.00
copy of all licenses (SEE OAR 918 - 260 -260)
are required if Oregon Contr. Br�i�. //� Exp. Date
expired in C.O.T. �� `f Check Type of Work Involved:
data base). Electrical Contr. Lic. # p Exp. Date
,P(p X7 ❑ Audio and Stereo Systems
C.O.T. or Metro Lic. # Exp. Date
❑ Boiler Controls
Owner's Name
❑ 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 ❑ 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 pe/mu/the applicant or a person • No licenses are required. Licenses are required for all other installations
authorized to bind the appli . .
EEET
/ 70351_ S ENTER FEES ' / 0
Signature
5% SURCHARGE (.05 X TOTAL ABOVE) $ ,9 ,
Authority if other than Applicant TOTAL $ 4 /Z 2
iAresele.doc 12/96 _
7/26/99 Activities for Case #: ELR97 -00078
1:52:01 PM
•
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRA003 Application received 3/18/97 3/18/97 TAT . 3/18/97
ELRA010 Permit created . 3/18/97 3/18/97 TAT 3/18/97 •
ELRA799 Elect'I Final 3/18/97 9/17/97 • MJR PASS MJR 9/30/97
ELRA500 (F) Issue permit 3/18/97 TAT PASS TAT 3/18/97
ELRC800 Case finaled 9/17/87 MJR PASS MJR 9/30/97
•
•
•
Page 1 of 1
"'"-.---46,6:
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: / 9 -, 6? -97 A.M. P.M. MST:
Location:
:- / �y (L7 �t � 4 �li _1 \- ' BUP:
Tenant: .` %�/ �� _ ii � ` _� , .
A i � '/ /_ Suite: . 1219.: MEC:
Contractor: AD (9 Q/ Phone: — 34 PLM:
Owner: Phone: / / Y ,w t►/' ,% / ;,BI£- , 7 7 (f
fi i ELR:e- t -) 9 / 7 O/33
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL L411 kw r re, v SITE
Site Post/Beam Post/Beam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C U T Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump - I Volt
Approved Approved Approved Approved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved FIN oved Not Approved
FINAL FINAL FINAL FINAL
ii _97- CO 78 P.J],o &C Cir-P .:;.e�� �� _ c: ,
S -f 97- 0183 J� G&" ,g1 ♦,n
d o
4
•
O Call for reinspection - O Reinspection fee of $ required before next inspection O Unable to inspect
Inspector: /y / C 4..et ( Ate -g Date: () ? 2?-?7 Page ( of /
1