Permit CITY OF TIGARD
; DEVELOPMET SERVICES ELECTRICAL PERMIT -
Tigard, 13125 SW Hall Blvd., RESTRICTED ENERGY
PERMIT #: ELR97 -0029
DATE ISSUED: 01/28/97
PARCEL: 2511ODB -00700
SITE ADDRESS...: 15520 SW PACIFIC HWY #D
SUBDIVISION WILLOW BROOK /TIGARD PROMENADE ZONING:C -G
BLOCK LOT -10
Project Description: DATA TELECOMMUNICATION INSTALLATIONS
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: FEES
CARL KARCHER ENTERPRISES type amount by date recpt
800 MELLON AVE PRMT $ 40.00 TAT 01/28/97 97- 289551
5PCT $ 2.00 TAT 01/28/97 97- 289551
MANTECA CA 95337
Phone #: 209 - 823 -9251
Contractor:
ST JOHNS ELECTRIC INC $ 42.00 TOTAL
3202 NE 65TH ST
REQUI RED INSPECTIONS
VANCOUVER WA 98663 Ceiling Cover Elect'1 Service
Phone #: 360 - 693 -5100 Wall Cover Elect' 1 Final
Reg #..: 000431 ,,ff
This perait is issued subject to the regulations contained in the "�1,1( .11-/J
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permitee Signature
applicable laws. All work will be done in accordance with 7
approved plans. This permit will expire if work is not started
within 180 days of issuance, or if work is suspended for more )2,/ /}�B 1
than 180 days. I s u e d 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
Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd. � Lk? 7_ Z)27
/4�r
Tigard, OR 97223 PERMIT #
^ n :> 0 , 1 � ; Phone (503) 639 -4171
- �'�'°� A I I FAX (503) 684-7297 DATE ISSUED Off
/9'
TDD No. (503) 684 -2772
CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BY rr
PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTALLATION 4. TYPE OF WORK
Address RESIDENTIAL — Restricted Energy Fee $40.00
779 4 r C / Ole (FOR ALL SYSTEMS)
City State Zip Check Type of Work involved:
PERMITS ARE NON - TRANSFERABLE AND NON - REFUNDABLE AND EXPIRE IF WORK ❑ Audio and Stereo Systems
IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR
180 DAYS. ❑ Burglar Alarm
2. CONTRACTOR APPLICATION ❑ Garage Door opener*
❑ Heating, Ventilation and Air Conditioning System*
Contractor .SJ _7c/int ar:7r, Type a, / / ❑ Vacuum Systems*
.Y/S A lf /' -iron. /2� A4 r ❑ Other
Address
y � Vi lr/� 9�GG�l
Date /. -a 7 - 9 7 COMMERCIAL — Fee for each system $40.00
(SEE OAR 918 - 260 -260)
Property Owner �Or�s- :TT- Check Type of Work Involved:
Contractor's Board Reg. No. 3 /, Cj ❑ Audio and Stereo Systems
❑ Boiler Controls
Phone # ,-?g,()— 6 5 ,.5-6/0,r) ❑ Clock Systems
pir
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 5. FEES
corrections are completed.
The erson signing for this permit must be the applicant or a person 0
p g g p pp p a. Enter Fees $ �n °
authorized to bind %•'•plicant.
� b. 5% Surcharge (.05 x total above) $ o
Signature
I p 0
TOTAL $ Y�
Authority if other than applicant
ENERGAP.CHP
Page No. . 1 CASE HISTORY FOR CASE .NO.: ELR97 -0029
CARL'S JUNIORS
15520 SW PACIFIC HWY Unit: D
09/16/97
Action Description Reg /. Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
- --- - -- -- - -- --- ---
ELRC001 Application Received 01/28/97 / / 01/28/97 01/28/97 TAT
ELRC003 Permit Created 01/28/97 / / 01/28/97 01/28/97 TAT
ELRC500 (F) Issue permit / / / / 01/28/97 PASS TAT 01/28/97 TAT
ELRC700 Ceiling Cover 01/28/97 / / / / 01/28/97 TAT
ELRC720 Wall Cover 01/28/97 / / / / 01/28/97 TAT
ELRC731 Elect'l Service 01/28/97 / / / / 01/28/97 TAT
ELRC799 Elect'l Final 01/28/97 / / 02/11/97 PASS MJR 02/12/97 MJR
ELRC800 Case finaaled / / / / 02/11/97 PASS MJR 02/12/97 MJR
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