Permit - :.A CITY OF TIGARD
1 'v „Ili DEVELOPMENT SERVICES RESTRICTED ENERGY
PERMIT #: ELR98 -0104
DATE ISSUED: 04/10/98
PARCEL: 19136DA -00100
SITE ADDRESS...:113O8 SW 68TH PKWY
SUBDIVISION . ZONING:MUE
BLOCK • LOT • JURISDICTN: TIG
Pro.j ect Description : Restricted energy permit for CO2 sensors.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO...: AUDIO & STEREO..: INTERCOM & PAGING..:
BURGLAR ALARM • BOILER • LANDSCAPE/ IRRI GAT. .:
GARAGE OPENER • CLOCK • MEDICAL -
HVAC • DATA /TELE COMM...: NURSE CALLS
VACUUM SYSTEM • FIRE ALARM • OUTDOOR LANDSC LITE:
OTHER: :: HVAC • PROTECTIVE SIGNAL..:
INSTRUMENTATION.: OTHER..: ::X
TOTAL # OF SYSTEMS: 1
Owner: FEES
PROVIDENCE type amount by date recpt
4805 NE GLISAN PRMT $ 40.00 DEB 04/10/98 98- 304850
PORTLAND OR 5PCT $ 2.00 DEB 04/10/98 98- 304850
Phone #:
Contractor:
FULLMAN SERVICE CO LLC $ 42.00 TOTAL
5805 SW HOOD AVE
REQUIRED INSPECTIONS
PORTLAND OR 97201 -3716 Low Voltage Insp
Phone #: 224 -5221 Elect'1 Final
Reg #..: 001223
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 180
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 DAR 9524814810 through OAR 952-081-8888. You may obtain copies of
these rules direct estionst OUNC at (503)246 -1987.
AA
Issued y I� P ermittee Signatures kilt/ L )/14,4/4.)
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:
CON CTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' N : A DATE: //er—PO �/
LICENSE NO:
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
l
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by: 4 '
13125 SW HALL BLVD Date Rec'd: 1
TIGARD OR 97223 PRINT OR TYPE
V - 503 - 639 -4171 X304 Permit #:
F - 503 -684 -7297 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL
egN /"t 4;44 P7 S Wri
Restricted Energy Fee $40.00
1' (FOR ALL SYSTEMS)
JOB Street Address �- Ste #
ADDRESS J /36 S6 v Check Type of Work Involved:
Citv/Sta � V I Zip aa Phone # 0 Audio and Stereo Systems
N ame Yt �` ❑ Burglar Alarm
Pea ncitee A/4e IN
OWNER Mailing Address �- Garage Door Opener*
�� 3v� SCiJ ❑ Heating, Ventilation and Air Conditioning System*
` Na
Cites tale p, Zip I Phone #
me ❑ Vacuum Systems*
FeeLe —A 1-A) ❑ Other
CONTRACTOR Mail Address
- 7 5 ,?/ J TYPE OF WORK INVOLVED - COMMERCIAL
(Prior to issuance a UM" ipa,., / Ph -# Fee for each system $40.00
copy of all licenses �� (� X 70� p`�7 j5 (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 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 C �a2 � 5 ��
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 •ind the applicant.
FEES:
tU B s` ENTER FEES $ ace
5% SURCHARGE (.05 X TOTAL ABOVE) $
Authority if other than Applicant TOTAL $ � OZ
i:Vesele.doc 12/96 \_ —
3/6/00 Activities for Case #: ELR98 -00104
7:52:01 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRC001 Application Received 4/10/98 GEO RECD KJP 4/10/98
ELRC003 Permit Created 4/10/98. GEO DONE KJP 4/10/98
ELRC725 Low Voltage Inspection 5/4/98 CD PASS J'H 5/5/98
ELRC799 Elect! Final 5/4/98 CD PASS J *H 5/5/98
ELRC500 (F) Issue permit 4/10/98 DEB DONE DST 4/10/98
ELRC800 .Case finaled 5/4/98 CD PASS J *H 5/5/98
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