Permit CITY OF TIG4RD ELECTRICAL
ENERGY
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #: EL.R96 -0102
13125 SW Hall Blvd. Tigard, Oregon 97223.6199 (503) 639 -4171 DATE ISSUED: 03/26/96
PARCEL: 25110DC -00100
SITE ADDRESS...: 15570 SW PACIFIC HWY
SUBDIVISION • WILLOW BROOK FARM ZONING:C -G
BLOCK • LOT :11
Project Description: Install 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
Applicant: -------- -- - - FEES - - - - - -- - - -- _..
SAFEWAY type amount by date recpt
15570 SW PACIFIC HWY PRMT $ 40.00 CJS 03/26/96 96- 277449
BLDG B 5PCT $ • 2.00 CJS 03/26/96 96-- 277449
TIGARD OR 97223
Phone #:
Contractor: - - -- - _ _ ------------------ -
PHILLIPS ELECTRONICS $ 42.00 TOTAL
1110 NW FLANDERS
REQUIRED INSPECTIONS ---
PORTLAND OR 97209 Ceiling Cover E_lect'1 Service
Phone #: 503 -227 -0571 Wall Cover Elect' 1 Final
Reg #..: 43.343
This peruit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permitee Signature
applicable laws. All work will be done in accordance with
approved plans. This perait will expire if work is not started //
within 180 days of issuance, or if work is suspended for sore 'r/j'
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
AUTHORIZED -- -- - - - --
AUTHORIZED SIGNATURE: On of / DhCcchon DATE: 3- a6- 46
LICENSE NO: /
Call for inspection - 639- -4175
•
i -
Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 PERMIT # FLRg6 0/0 a
/4 4 Phone (503) 639 4171
.II
- I FAX (503) 684 -7297 DATE ISSUED 3 - a6 - 96
- TDD No. (503) 684 -2772
CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BY 1/A r /es Sch n /,‘
PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTALLATION 4. TYPE OF WORK
Address RESIDENTIAL — Restricted Energy Fee $40.00
- 7 - 76 g4 0 p- y w (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 Openers
❑ Heating, Ventilation and Air Conditioning System*
Contracto ///u / /-S Type ❑ Vacuum Systems*
Address / 1/0 4/-4/ /-4400/ct ❑ Other
Date 3/J, L/ 9& COMMERCIAL — Fee for each system $40.00
((( (SEE OAR 918 - 260 -260)
Property Owner 5i l_LrJ Check Type of Work Involved:
Contractor's Board Reg. No. '.JJ €.7 ❑ Audio and Stereo Systems
❑ Boiler Controls
Phone # .2--„2 7 7/ ❑ Clock Systems
3. OWNER APPLICATION ❑ Data Telecommunication Installations
❑ Fire Alarm Installation
❑ HVAC
Print Owner's Name Phone No
❑ Instrumentation
Address El 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 person signing for this permit must be the applicant or a person a. Enter Fees $ i'61 e-
.---
authorized to bind the applicant.
b. 5% Surcharge (.05 x total above) $ ,2.-----w
Signature TOTAL $ , `---
Authority if other than applicant
ENERGAP.CHP
r Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
' 13125 SW Hall Blvd. p
Tigard, OR 97223 PERMIT # RP : M . - CO/
- CO /
Av Nif l h ;�4p Phone (503) 639 -4171
I I
- FAX ( 503) 684 -7297
TDD No. (503) 684-2772 DATE ISSUED _,?- d6
-
CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BY _/ �ja,- /es' SCA4.7, /7L
PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTALLATION 4. TYPE OF WORK
k il / 4/
Address RESIDENTIAL — Restricted Energy Fee 540.00
_ (FOR ALL SYSTEMS)
City 7z- State Zip Check Type of Work Involved:
PERMITS ARE IS NOT STARTED WITHIN NON-TRANSFERABLE 8 DAYS OF D ISSUANCE OR IF WORK I US END DOFOR ❑ Audio and Stereo Systems
180 DAYS. ❑ Burglar Alarm
❑ Garage Door Opener*
2. CONTRACTOR PLICATION
Q / ' �� ❑ Heating, Ventilation and Air Conditioning System*
Contractor / Type LV / C L'" _ ❑ Vacuum Systems*
Address /1/0 A/W ❑ Other
Date COMMERCIAL — Fee for each system . . . . . . $40.00
(SEE OAR 918- 260 260)
Property Owner Check Type of Work Involved;
Contractor's Board Reg. No. 9 3 �� ❑ Audio and Stereo Systems*
�s 7/ ❑ Boiler Controls
Phone# 3- ' � ❑ Clock Systems
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 corrections 5. FEES
are completed.
The person signing for this permit must be the applicant or a person a. Enter Fees $ SO
authorized to bind the applicant.
...... b. 5% Surcharge (.05 x total above) $ Z
Signature
( t
TOTAL $ v
Authority if other than applicant
ENERGAP.CHP
/
� �w.:� : Q� 10" S.E. 3RD AVENUE • PORTLAND, OREGON 97214 • (503) 238 -5700
850 CONGER • EUGENE, OREGON 97402 • (503) 683 -9333
11/11}Y if 2600 AIRPORT WAY, SOUTH • SEATTLE, WASHINGTON 98134 • (206) 340 -4300
CERTIFICATION STAL LATION /INSPECTION
_f/
Customer Name ( fr f � �
Address ICS 74 . l v' gl7/
�
SYSTEM
Model(s) and serial numbers /!fraI/ 1(72 - - ./:,11/14e/
Number of nozzles and Part No. ° e// de/.(/6.ta 2 ,i/ 1Mii`
Number of detector(s) and degree rating 7 ed "i6r
Energy shut -off devices — type and size A 4/ /1 /f %�,0i,L ';•/;/7 ,Y' ,. ///
Other accessory equipment provided (pull station, electric switches, etc.) fr./ /f//
COOKING /VENTILATING EQUIPMENT
Number of duct(s) and size 9 n't^ /61D A e ;Qw"
Hood size and plenum size �' / 1 c 7 '� 2•7 � i
Cooking Appliances and size of cooking surface. (NOTE: List appliances from left to right and indicate those
being protected.)
1. ° f fl/0 17/ - 1. 1 / 11 41;/ 4.
2 t ?fierieei- r /(f. - 1 6f1 5.
TO BE COMPLETED BY INSTALLER
S ❑ NO
The fire suppression system is installed in accordance TO BE COMPLETED BY CUSTOMER
with the manufacturer's instructions, NFPA Standard
96 and 17 (current issue), and all applicable state and
local codes. Exceptions to other provisions of NFPA 96 ifrVYES ❑ NO
that were observed are noted below. I understand that it is the recommendation of ANSUL
Exceptions: and of the National Fire Protection Association
Standard 96 and 17 that the fire suppression system be
inspected and maintained every 6 months to ensure
continued efficiency and reliability and that failure to
do so may result in failure of the system to operate
properly.
CUSTOMER NAME AND TITLE
,YES ❑ NO
All) electrical work or work provided by others to SIGNATURE
complete this system installation has been completed. DATE
INSTALLER NAME a f / l� - fink/ �f
SIGNATURE i` �/�� (% /
DISTRIBUTOR , / ��._ �_ l / ``'
/ /e C
ADDRESS
AW/ . 9?21'/
DATE / 7'■ .96
11111 NW/RS& /
m /yet 117 3RD AVENUE • PORTLAND, OREGON 97214 • (503) 238-5700
ioura granws 1/ 850 CONGER • EUGENE, OREGON 97402 • (503) 683-9333
MIVEMSAFETY COMPANY 2600 AIRPORT WAY, SOUTH • SEATTLE, WASHINGTON 98134 • (206) 340-4300
CERTIFICATION -411
A
Customer Name . ../frft t/./..q/ Mier /24>i Address /55 .... 2 i4/777(
77/1 A (J
■
SYSTEM
Model(s) and serial numbers
Number of nozzles and Part No./ Ake
Number of detector(s) and degree rating
Energy shut-off devices — type and size riyird cf/re
Other accessory equipment provided (pull station, electric switches, etc.) Aq /04/,
P.MT .71— 441
COOKING/VENTILATING EQUIPMENT
Number of duct(s) and size /
Hood size and plenum size /AV)
Cooking Appliances and size of cooking surface. (NOTE: List appliances from left to right and indicate those
being protected.)
1. 695 e / 41 4.
5.
3. 6.
TO BE COMPLETED BY INSTALLER
CLI4E 0 NO
The fire suppression system is installed in accordance TO BE COMPLETED BY CUSTOMER
with the manufacturer's instructions, NFPA Standard
96 and 17 (current issue), and all applicable state and
local codes. Exceptions to other provisions of NFPA 96 NO
that were observed are noted below.
I understand that it is the recommendation of ANSUL
Exceptions: and of the National Fire Protection Association
Standard 96 and 17 that the fire suppression system be
inspected and maintained every 6 months to ensure
continued efficiency and reliability and that failure to
do so may result in failure of the system to operate
properly.
CUSTOMER NAME AND TITLE
(nc YES 0 NO
SIGNATURE
All electrical work or work provided by others to
complete this system installation has been completed. DATE
INSTALLER NAME
SIGNATURE 41..e-
DISTRIBUTOR
ADDRESS .././ TI
Air/A/C. 6.k
DATE
1/21/00 Activities for Case #: ELR96 -00102
4:26:51 PM
Assigned Hold Updated •
Activity Description Date 1 Date 2 Date 3 To Done By. Disp. Level By Updated Notes
ELRC001 Application Received 3/26/96 CJS RECD TMP 3/26/96
ELRC003 Permit Created 3/26/96 CJS PEND TMP 3/26/96 •
ELRC700 Ceiling Cover 3/26/96 TMP 3/26/96
ELRC720 Wall Cover 3/26/96 TMP 3/26/96
ELRC730 Elect'I Service 3/26/96 TMP 3/26/96
ELRC799 Elect'l Final 3/26/96 TMP 3/26/96
ELRC500 (F) Issue permit 3/26/96 CJS PASS TMP 3/26/96
' ELRC800 Case finaled 9/5/96 MJR NOTE MJR 9/5/96
•
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