Permit CITY OF TIGARD
// DEVELOPMENT LOPMEN R 6
'11. 13125 OR ELECTTRICAL ENERGY
RESTRICTED
PERMIT #: ELR97 -0033
DATE ISSUED: 01/31/97
PARCEL: 2511ODB -00700
SITE ADDRESS...: 15520 SW PACIFIC HWY #D
SUBDIVISION • WILLOW BROOK /TIGARD PROMENADE ZONING:C —G
BLOCK • LOT •10
Project Description: Install restricted energy intercom and paging
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO...: AUDIO & STEREO..: INTERCOM & PAGING..:X
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..:
INSTRUMENTATION.: OTHER..: ..
TOTAL # OF SYSTEMS: 1
Owner: FEES
CARL KARCHER ENTERPRISES type amount by date recpt
800 MELLON AVENUE PRMT $ 40.00 DST 01/31/97 97- 289771
SPCT $ 2.00 DST 01/31/97 97- 289771
MANTECA CA 95337
Phone #: 823 -9251
Contractor: --
CONSOLIDATED BUSINESS MACHINES $ 42.00 TOTAL
831 SE MARTIN LUTHER KING JR BLVD
REQUI RED INSPECTIONS
PORTLAND OR 97214 -2188 Wall Cover Elect'1 Final
Phone #: 239 -5910 Elect' 1 Service
Reg #..: 104590
This permit is issued subject to the regulations contained in the � /1i/i 410-
T igard Municipal Code, State of Ore. Specialty Codes and all other Dermitee 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 mare ,
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 : see a D p DATE: //3///7
LICENSE NO:
Call for inspection — 639 -4175
CITY O TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by: , •
13125 SW HALL BLVD Date Rec'd: / ' Eil
TIGARD OR 97223 PRINT OR TYPE
V - 503 - 639 -4171 X304 Permit #: CL 0 7-0033
F - 503 -684 -7297 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL
CA gL S J R Restricted Energy Fee $40.00
(FOR ALL SYSTEMS)
JOB Street Address ��((�� �f Ste#
ADDRESS 155 Su.) VrS IW Check Type of Work Involved:
City/State �� Zi -1 l' Phone # I:=1 Audio and Stereo Systems GR I
Name G � T ❑ Burglar Alarm
c A a c Ki f +E FN T.
OWNER Mailing Address ❑ Garage Door Opener*
City /State Zip I Phone # ❑ Heating, Ventilation and Air Conditioning System*
Name El Vacuum Systems*
Go /J501, I O "ThO BJ5. t1 PIC 14' • ❑ Other
CONTRACTOR Mailin Address
�jf 3 $F M LK TYPE OF WORK INVOLVED - COMMERCIAL
(Prior to issuance a /State Zip Phone # Fee for each system $40.00
copy of all licenses O gTt,f�n 1 O a R 1-72I9 2Yt:5510 (SEE OAR 918-260-260)
are required if Oregon Contr. Brd Lic. # Exp. Date
expired in C.O.T. Check Type of Work Involved:
data base). Electrical Contr. Lic. # Exp. Date
❑ 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 I Zip I 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; ''77``��
❑ 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 a licant.
FEES: �J l
ga
P(P ------
ENTER FEES $ /-70. 6v
Signature v
5% SURCHARGE (.05 X TOTAL ABOVE) $ 2. 0
•
Authority if other than Applicant TOTAL $ i i .Z 0 0
i:\resele.doc 12/96 —
Page No. 1 CASE HISTORY FOR CASE NO.: ELR97 -0033
CARL KARCHER ENTERPRISES
15520 SW PACIFIC HWY Unit: D
09/16/97
Action Description Reg/ Schd/ End/ Action Notes Diep By Update Upd
Code Sent Done Done Date By
ELRC001 Application Received / / / / 01/31/97 PASS JDA 01/31/97 DST
ELRC003 Permit Created / / / / 01/31/97 PASS JDA 01/31/97 DST
ELRC500 (F) Issue permit / / / / 01/31/97' PASS JDA 01/31/97 DST
ELRC720 Wall Cover 01/31/97 / / / / 01/31/97 DST
ELRC731 Elect'l Service 01/31/97 / / / / 01/31/97 DST
ELRC799 Elect'l Final 01/31/97 / / 02/11/97 PASS MJR 02/12/97 MJR
ELRC800 Case finaled / / / / 02/11/97 PASS MJR 02/12/97 MJR
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