Permit I
CITY OF TIGARD A v4 ,,, M . DEVELOPMENT SERVICES ELECTRICAL PERMIT - '
' 13125 SW Hall Blvd., Tigard, OR 97223 503 639.4171 RESTRICTED ENERGY
ROY
PERMIT # : ELR97- -022 9 '
DATE ISSUED:. 8/07/97
PARCEL: 2S 1 1 0DC- -0EE00
SITE PDDRESS. . . 15570 SW PACIFIC HWY
SUBD I V I S I ON....: W I LLOW BROOK FARM Z ON I fNG e C -G
BLOCK..........: LOT. . . . . .. . — .. ;11 JURISDICTN; TIC
Pro.j ect De scr ipt ion : Installing data telecommunications system
A. RESIDENTIAL-- ---- - - - - - --
J3. COt+lh1E RC I AI_ -- - - -- ____--- _.--- •__ - __ __.._-----•
AUDIO & STEREO...: AUDIO & STEREO..: INTERCOM & Pl7CING..:
BURGLAR 'ALARM.... : BOILER..........: LANDSCAPE/ I RR I GAT. . :
GARAGE OPENER. CLOCK..... , . _ n .. s ME'DICAL .. . . ...... . . .
HVAC .............. DATA /TELE COM1.= :X NURSE CALLS.._......
VACUUM SYSTEM....: FIRE ALARM.... r .: OUTDOOR L.ANDSC LITE:
OTHER: - HVAC ............. PROTECTIVE SIGNAL...
INSTRUMENTATION.: OTHER..: : .
_
TOTAL # OF SYSTEMS :1
Owner: - -------- •---- - -• - -- - - - - - -- - - - - -• - • .--- - - - - -- - -- ------ •- - -• - - FEES -- - -- - - - - -- - - - -- - - _
SAFEWAY STORES INC type amount by date recpt
16300 SE EVELYN ST PRIM ' 40.00 B 08/07/97 97.- 298060
CLACKAMAS OR 97015 5PCT 2.00 B 08/07/97 97-298060
Phone af: 656-1461 .
MOORE COMMUNICATIONS INC qi 42. 'Do TOTAL
20811 NW CORNELL RD •
STE 700 -- • - - - -- REQUIRED INSPECTIONS -- ---- .-- • - - - --
HILLSBORO OR 97124 Ceiling Cover Elect'1 Final
Phone ;f: 617 -9800 Wall Cover
- —
Reg #... 000763
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 1Orc•
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 95270011M through OAR 952-001-0 180. You may obtain copies of
these rules or di a :t questions to UNC -1987.
Issued by ■ "�'� V Per�mittee Signat�_Fre _
...________-- ._.___ ---- - -- OWNER INSTALLATION ONLY - -• -- - . - - --
The installation i,s being made on property I own' which is not intended 'fbr
s lease, or rent. -
OWNFR' S SIGNATURE: ' DATE : .
-----CONTRACTOR INSTALLATION ONLY __._ _--- •-- .-- ____._.. •----- ._._ -
SIGNATURE OF SUPR. ELEC' N : DATE :
LICENSE NO: '
-'-F-F+-F- 5-±-t- F- F -(-+-I -1- i-+± f- 1••- F- F++±±+- F- F- F -F++ ++±-F-F-F- I•-F- F••F-t•-F -FA -F-F-F •- F- F- F± -F- F±-1- i- -F-FA-i- i-+-i- -I--F-I +-1--F-I- ±- -F-F -F4 ±±
Call 639 -4175 by 6 :00 P.M. for an inspection needed the next business day
- F- t-- F••F 4-1-- F-- I-A- t- F- F- Fi-- F•- F- F- F -F-F- F- F- F-F- Fi-•- F-F-Fi- ++ -1- - 4- F- F-F-F•-- ++-F1- -- 1-- 4- F-F- P- 14- 1 °-F•-F$•-t-#-1-44• - F- F- F:- F±' ••- F-[- -F•F-F--F-F•i- -t••±••Fi-
4'4a, CO elk)
C -ITYOF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by: ek)
13125 SW HALL BLVD Date Rec'd:
TIGARD OR 97223 PRINT OR TYPE ,� p/�
V - 503 - 639 -4171 X304 Permit #: I - I -1 - 07 Z /
F - 503 - 684 -7297 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL
Restricted Energy Fee $40.00
SaFewa 1 (FOR ALL SYSTEMS)
JOB Street Address Ste
ADDRESS /5570 5 aJ• fr; 4 Ni ,,t/ ( /,Check Type of Work Involved:
City/ tat ip , Phone " # 3 ❑ Audio and Stereo Systems
r/ ( r2 z if 61?-98
Nam ❑ Burglar Alarm
OWNER Mailing Address
El
Door Opener*
City /State Zip I Phone # ❑ Heating, Ventilation and Air Conditioning System*
Name ❑ Vacuum Systems'
moo se Co►-r',mvn/ca7 ons ❑ Other
CONTRACTOR Mailing Address
.2 0 elf 8 to . rnr°c J -
L ,,ao TYPE OF WORK INVOLVED - COMMERCIAL
(Prior to issuance a City /State { Zi Phone # Fee for each system $40.00
copy of all licenses � ► LL ,S h pro or2 °17/2y40-9,60 1 (SEE OAR 918 - 260 -260)
are required if Oregon Contr. Brd Lic. # Exp. Date
expired in C.O.T. 7 to 3 6 7 Check Type of Work Involved:
data base). Electrical Contr. Lic. # 3y— 3s1. Exp. Date
c. E /O -/ -99 ❑ 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 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. I 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.
`.IA/144 Cilri----tevvi-- ENTER FEES $ I/0 U 0
lgnature
5% SURCHARGE (.05 X TOTAL ABOVE) $ 2 • 0
Authority if other than Applicant TOTAL $ 4 /2 . 00
I r.\resele.doc 12/96
1/21/00 Activities for Case #: ELR97 -00229
4:27:28 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRC001 APPlication Received 8/7/97 B RECD DST 8/7/97 _
ELRC003 Permit Created 8/7/97 B PASS DST 8/7/97
ELRC700 Ceiling Cover 8/15/97 MJR PASS MJR 8/20/97
ELRC799 Elect'l Final 1/30/98 RC PASS JT 1/30/98 per conversation with Ron
Church this date, when he
inspected T.I. he saw that
electrical had been signed off
ELRC500 (F) Issue permit 8/7/97 B PASS DST 8/7/97
ELRC800 Case finaled 1/30/98 JT 1/30/98
•
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