Permit •
•
r � CITY OF TIGARD ` RESTRICTEDE ERG
RESTRICTED ENERGY
Az,i, r�. DEVELOPMENT SERVICES PERMIT #: ELR1999 -00291
� I- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/06/1999
SITE ADDRESS: 12388 SW SCHOLLS FERRY RD PARCEL: 1S134BC-00500
SUBDIVISION: PP1993 -057 ZONING: C -G
•
BLOCK: LOT: 001 JURISDICTION: TIG
Project Description: 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
Owner: Contractor:
MCDONALD'S CORPORATION HONEYWELL INC •
036/0002 15495 SW SEQUOIA
PO BOX 66207 STE 100
CHICAGO, IL 60666 PORTLAND, OR 97224 •
• Phone: Phone: 968 -3300
Reg #: SUP 941 -JLE
LIC 00057824
ELE 26207CLE
• FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT BON 12/06/1995 $60.00 99- 320200 Elect'I Service
5PCT BON 12/06/199E $4.80 99- 320200 Elect'I Final
Total $64.80
• ORIGIN4L
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. 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 rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987. /� n
f
•
Issued by ,v /AA �1' L Permittee Signature l t ((G (U7'\ - 0/1
•
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: )\_3A- .DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
i t. v. RECEIVED
• DEC 0 6 1999
£0 ' d 0961 965 £05 07:9T 6i —TO -lrif
Ail
COMMUNITY DEVELOPMENT ,r(
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Date Rec'd: /� —
13125 SW HALL BLVD PRINT OR TYPE
TIGARD OR 97223 Permit #: `L —ooze, (
V - 503 - 639 -4 X304 Cust.Call'd:
F - 503 - 598 -1960 INCOMPLETE OR ILLEGIBLE APPLICATIONS
WILL NOT BE ACCEPTED
Name of Develenrnent Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee
' V I fi A1 (FOR ALL SYSTEMS)
JOB Street Address Check Type of Work Involved:
ADDRESS /. _ ' :. S.. - _ rerr ■��
City/Stat • '
CRY/S8;7 Ph-
one # 0 Audio and Stereo Systems
`
Na.•e 0 Burglar Alarm • . P§0m L Os CZb o V � ❑ Garage Door Opener'
OWNER Ma11m9 nuwase ❑
Heating. Ventilation and Air Conditioning System
City/State ® Phone #
0 vacuum Systems'
Name ❑
Other
HONEYWELL
CONTRACTOR Mailing Address L VED - COMME RCIAL ONLY
-•1 ••. •.•.• #100 TYPE OF WORK INVO $60.
15 95 SW Phone # Fee f or each system
(Prior of issuance s City/State 9 3300 (SEE OAR 918 - 260 -260)
copy of all licenses Portl. • • ► WWII •
are required If Oregon Contr. Brd Lic. # 1 Ex.. Date Check Type of Work Involved:
expired in C.O.T. 0 Exp. Date ❑
data base). Electrical Contr. lie. >t r Audio and Stereo Systems •
• 2 6 — 2 0.7 _
G.O.T. or Metro Lio Exp. Data # 0.0 ❑ Boiler Controls
Owner's Name ❑ Clock Systems •
OWNER - U . ❑ 0 Data Telecommunication Installation
APPLICANT Phone #
City/State 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(1. All others need licensing; Landscape irrigation Control'
2. Call for inspections when Installation under this permit. are ready for 1:2 Medical
inspection at 503- 6394175;
3. inspection when the inspector Is out to installations Inspect under this permit; tr an Nurse Calls
Outdoor Landscape Lighting
4. Assume responsibility for assuring that all corrections required by the
Inspector are done, and; isi Protective Signaling
5. Assume responsibility for calling for a final inspection when all of the Other
corrections are completed.
Permits are non - transferable and non- refundable and expire if work is not __Number of Systems
started within 180 days of issuance or if work is suspended for 180 days. Ired Licenses are requred for all other Installations
The person signing for this permit must be the applicant of a person • No licenses are required.
authorized to bind the applicant.
60.00
1 +: .11 PNTER FEES $
'R "ature tO S URCHARGE (.05 X TOTAL ABOVE) $ 4 80
Authority if other than Applicant TOTAL $ 64 i
i•w..•w.yeAresele.doe 9/98