Permit - PERMIT
C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #: ELR9S -0236
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171 DATE ISSUED: 1 c / 19 / 9 5
PARCEL: 2S102BD-
SITE ADDRESS...: 12760 SW PACIFIC HWY
SUBDIVISION • ZONING:
BLOCK LOT..... ........ :
Project Description: Fire alarm installtion.
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 •k OUTDOOR LANDSC LITE:
OTHER: .. HVAC • PROTECTIVE SIGNAL..:
INSTRUMENTATION.: OTHER..: ..
TOTAL # OF SYSTEMS: 1
Applicant: --- - - - -•- - -- FEES
HONEYWELL type amount by date recpt
15495 SW SEQUOIA PKWY PRMT $ 40.00 CJS 12/19/95 95- -274050
5PCT $ 2.00 CJS 12/19/95 95- 274050
PORTLAND OR 97224
Phone #:
Contractor: - - - - --
CONTRACTOR NOT ON FILE $ 42.00 TOTAL
REQUIRED INSPECTIONS - -•
Ceiling Cover Elect' 1 Service
Phone #: Wall Cover Elect' 1 Final
Reg #.. .
This permit is issued subject to the regulations contained in the _ _^
Tigard Municipal Code, State of Ore. Specialty Codes and all other Perm i t e e Signature
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 _ �11�1— SG_hm��
than 180 days. Issued 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: _ /7Gt ile0/ __ DATE: _/
LICENSE NO:
Call for inspection - 639 -4175
Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd.
.. Tigard, OR 97223 PERMIT # I - 0a3 6
��Ann j 1 h l A P FAX (503) 6847 297 DATE ISSUED /9 - /8 95
TDD No. (503) 684 -2772
CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BY (he /eS S,i n 4,;:,/7"
/ k THE T CC / rr� PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTALLATION 4. TYPE OF WORK
/ (P40 5/Ai AgCIC /Ci hiaiy
A ess / RESIDENTIAL — Restricted Energy Fee $40.00
/ AleD OR._. q .7 azz (FOR ALL SYSTEMS)
City State Zip Check Type of Work Involved:
PERMITS ARE IS NOT STARTED W THIN DAYS OF ISSUANCE ORDF WORK AND
SUSPENDED OOR ❑ Audio and Stereo Systems
180 DAYS. ❑ Burglar Alarm
2. CONTRACTOR APPLICATION ❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
Contractorrnde ! •in ❑ Vacuum Systems*
/ S45 5 ) 5OEQ O/R P, , #A00 ❑ Other
Address P I : I R : T M / t / D , 4 - 6 2 _ q 7 L -
Date /..- -- /.3- - 4f COMMERCIAL — Fee for each system $40.00
(SEE OAR 918 - 260 -260)
Property Owner —7 Check Type of Work Involved:
Contractor's Board Reg. No. 57 9) Z4- 74249 ❑ Audio and Stereo Systems*
❑ Boiler Controls
Y Phone # g& d ' 3 3 .3,_ ❑ Clock Systems
❑ Data Telecommunication Installations
3. OWNER APPLICATION 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.
❑ I 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. CO The person signing for this permit must be the applicant or a person a. Enter Fees $ 46/ C
authorized to bind the plicant.
ii�� _ b. 5% Surcharge (.05 x total above) $
Signature
TOTAL $ J �/ J
41, `•v
Authority if other than applicant
ENERGAP.CHP
4/19/00 Activities for Case #: ELR95 -00236
5:52:24 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRC001 Application Received 12/19/95 CJS RECD TMP 12/19/95
ELRC003 Permit Created 12/19/95 CJS PEND TMP 12/19/95
ELRC700 Ceiling Cover 12/19/95 TMP 12/19/95
ELRC720 Wall Cover 12/19/95 TMP 12/19/95
ELRC730 Elect'I Service 12/19/95 TMP 12/19/95
ELRC799 Elect'l Final 12/19/95 TMP 12/19/95
ELRC500 (F) Issue permit 12/19/95 CJS PASS TMP 12/19/95
ELRC799 Elect'I Final 1/29/96 MJR PASS MJR 1/29/96
ELRC800 Case finaled 1/29/96 MJR YES MJR 1/29/96
•
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