Permit A CITY OF TIGARD
% DEVELOPMENT SERVICES � S ELECTRICAL PERMIT —
RESTRICTED ENERGY
PERMIT #: ELR98 -0279
DATE ISSUED: 10/05/98
PARCEL: 2S102CB -02300
SITE ADDRESS...:13200 SW PACIFIC HWY
SUBDIVISION °FREWINGS ORCHARD TRACTS ZONING:C —G
BLOCK LOT °008 JURISDICTN: TIG
Pro.j ect Description : Installation of data telecommunication systems.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO...: AUDIO & STEREO..: INTERCOM & PAGING..:
BURGLAR ALARM • BOILER LANDSCAPE/ IRRI GAT. .:
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
MILLIKAN MEDICAL CENTER type amount by date recpt
13200 SW PACIFIC HWY PRMT $ 40.00 DEB 10/05/98 98- 309698
TIGARD OR 97223 SPCT $ 2.00 DEB 10/05/98 98- 309698
Phone #:
Contractor:
RIEKS COMMUNICATIONS $ 42.00 TOTAL
1704 N MERIDIAN
REQUIRED INSPECTIONS
NEWBERG OR 97132 Low Voltage Insp
Phone #: 538 -8852 Elect'l Final
Reg #..: 74386
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. 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 rule 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 ' '' -ct questions to OUNC at (503)246 -1987. ,Q
Issued L►__i ! L 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 : DATE:
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: 0.
13125 SW HALL BLVD pd„l -0 Date Rec'd: /0 -- -,'g
TIGARD OR 97223 PRINT OR TYPE '
V - 503 - 639 -4171 X304 Permit #: -EC-2 r cf -O.2-Z9
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
/Y 7'vL L / Y "49 /wide_ (FOR ALL SYSTEMS)
JOB Street Address Ste #
ADDRESS /J ..54.149C/A/C Check Type of Work Involved:
Cjy /State Zip ' Phone # ❑ Audio and Stereo Systems
/ /Gi sZ 7 -ori f
Name ❑ Burglar Alarm
OWNER Mailing Address ❑ Garage Door Opener'
City /State Zip Phone # ❑ Heating, Ventilation and Air Conditioning System'
Name ❑ Vacuum Systems'
eIY d'40//'?U// /ei9l/ wj ❑ Other
CONTRACTOR Mailing Address
y, / t9Ee / /, //
/Tp e/ /y, TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a C /State Zip Phone # Fee for each system $40.00
copy of all licenses /��//'" /�(� Q , � . 8-r8lSe-- (SEE OAR 918 - 260 -260)
are required if Orey Cpntr. Brd ic. Exp. Date
expired in C.O.T. l3 /Q' Pr Check Type of Work Involved:
data base). Electrical C tr. Lic. Exp. Date
v3 - r � e- /P -Ai ? ❑ Audio and Stereo Systems
C. . or Metro Lic. # Exp. Dat
❑ 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 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:
J�ature ENTER FEES $ .'
/ 5% SURCHARGE (.05 X TOTAL ABOVE) $
Authority if other than Applicant TOTAL $ o9
i:tdsts\resele.doc 7/97 —
Page No. 1 CASE HISTORY FOR CASE NO.: ELR98 -0279
MILLIKAN MEDICAL CENTER
13200 SW PACIFIC HWY
03/04/99
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
-- -- - -- -- - - - --- ---
ELRC001 Application Received / / / / 10/05/98 RECD DEB 10/05/98 DST
ELRC003 Permit Created / / / / 10/05/98 DONE DEB 10/05/98 DST
ELRC500 (F) Issue permit / / / / 10/05/98 DONE DEB 10/05/98 DST
ELRC725 Low Voltage Inspection / / / / 10/23/98 Limited energy cables above ceiling - PASS BRP 10/23/98 J *H
pass.
ELRC799 Elect'1 Final / / / / 10/23/98 PASS BRP 10/26/98 J *H
ELRC800 Case finaled / / / / 10/26/98 PASS BRP 10/26/98 J *H
•
•