Permit � ~ CITY OF TIGARD
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=:�p~ —~ 13125 SW Hall Blvd., ELECTRICAL PERMIT -
- Tigard, `--' RESTRICTED ENERGY
PERMIT #: ELR97-0300
DATE ISSUED: 10/20/97
PARCEL: 1S136DB-02600
SITE ADDRESS. . . : 11201 SW 72ND AVE
SUBDIVISION....: ZONING:C-G
BLOCK : LOT ^ JURISDICTN: TIG
Pro ject Description: Installing a data telecommunications system
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO... : AUDIO & STEREO.. : INTERCOM & PAGING..
BURGLAR ALARM • BOILER • LANDSCAPE/ IRRI GAT. .:
GARAGE OPENER • CLOCK • MEDICAL
HVAC • DATA/TELE COMM. : X NURSE CALLS ^
VACUUM SYSTEM • FIRE ALARM...... : OUTDOOR LANDSC LITE:
OTHER:
• HVAC • PROTECTIVE SIGNAL..:
INSTRUMENTATION.: OTHER..:
TOTAL # OF SYSTEMS: 1
Owner: FEES
MCDONALDS CORPORATION type amount by date recpt
5000 SW MEADOWS ROAD, SUITE 230 PRMT $ 40.00 B 10/20/97 97-300223
LAKE OSWEGO OR 07035 5PCT $ 2.00 B 10/20/97 97-300223
Phone #: 684-9334
Contractor: -
APPLIED INFORMATION SERVICES $ 42.00 TOTAL
12950 SW PACIFIC HWY
STE #7 REQUIRED INSPECTIONS
TIGARD OR 97223 Ceiling Cover Low Voltage Insp
Phone #: 639-0777 Wall Cover Elect'l Final
Reg #..: 000801
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 0A8 952-y�1-0010 through OR 952-001-w80. You may obtain copie
these rules or direct questions to OUNCat (5N3)246-1��. ��� ~ =-
&�
Issued by 0/ ���~� Permittee Si Signat/ `OC ~ „^~_-
OWNER INSTALLATION ONLY -
The installation is being made on property I on which is not intended for
sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONT; aCTOR INSTAL TI L
SIGNATURE OF SUPR• ELEC'N:_ ~ �� DATE: o~
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Call 639-4175 by 7:00 P.M. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
i 7
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by: ��i/� (��—�
13125 SW HALL BLVD. Date Rec'd:
TIGARDyOR 97223 PRINT OR TYPE
V -.503 -639 -4171 X304 Permit #: ELR' 7
F - 503 -684 -7297 Incomplete or Illegible will not be accepted Cust.Call'd:
PLEASE COMPLETE ALL SECTIONS
Name of Development Project
��� l TYPE OF WORK INVOLVED - RESIDENTIAL
aA Restricted Energy Fee $40.00
JOB Street Address Ste # (FOR ALL SYSTEMS)
ADDRESS //2a/ Scv 72"
City/State Zip Phone # Check Type of Work Involved:
T, 9 4A 6 c1(
❑ Audio and Stereo Systems
Name
❑ Burglar Alarm
OWNER Mailing Address ❑
Garage Door Opener*
City /State Zip Phone # ❑
Heating, Ventilation and Air Conditioning System*
Name
❑ Vacuum Systems*
42,/e4 Z.d R. S ;.Palk - S
CONTRACTOR Mailing Address ,. Other
/7 96 6a..) t c. - ,Q e. t/u
. (Prior to issuance a City/State Zip • Phone # TYPE OF WORK INVOLVED - COMMERCIAL
copy of all licenses Ti c.A G/Z 635-079 Fee for each system $40.00
are required if Oregon Contr. Brd Lic. # Exp. Date (SEE OAR 918- 260 -260)
expired in C.O.T. pp 5-0 l - "1' S/- / 91(
data base). Electrical Contr. Lic. # Exp. Date Check Type of Work Involved:
34 5t/ ec Y - /6 - 95(
C.O.T. or Metro Lic. # Exp. Date ❑ Audio and Stereo Systems
Owner's Name ❑ Boiler Controls
OWNER - Mailing Address ❑ Clock Systems
APPLICANT
City/State Zip Phone # Er Data Telecommunication Installation
This permit is issued under OAE 918 - 320 -370. This applicant agrees to ❑ Fire Alarm Installation
make only restricted energy installations (100 volt amps or less) under this
permit and to do the following: ❑ HVAC
1. Only use electrical licensed persons to do installations where required. ❑ Instrumentation
(Certain residential and other transactions are exempt from licensing.
These have asterisks(*). All others need licensing). ❑ Intercom and Paging Systems
2. Call for inspections when all of the installations under this permit are ❑ Landscape Irrigation Control'
ready for inspection at 503 -639 -4175.
3. Purchase separate permits for all installations that are not ready for an ❑ Medical
inspection when the inspector is out to inspect under this permit. ❑
Nurse Calls
4. Assume responsibility for assuring that all corrections required by the
inspector are done, and ❑ Outdoor Landscape Lighting'
5. Assume responsibility for calling for a final inspection when all of the ❑ Protective Signaling
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
authorized to bind the applicant. • No licenses are required. Licenses are required for all other installations
FEES:
4.0
SI na ure ENTER FEES $
5% SURCHARGE (.05 X TOTAL ABOVE) $ /
Authority if other than Applicant TOTAL $ 1 4 7 - ob
Page No. 1 CASE HISTORY FOR CASE NO.: ELR97 -0300
MCDONALDS CORPORATION
11201 SW 72ND AVE
02/12/98
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
ELRC001 Application Received / / / / 10/20/97 RECD B 10/20/97 DST
ELRC003 Permit Created / / / / 10/20/97 DONE B 10/20/97 DST
ELRC500 (F) Issue permit / / / / 10/20/97 PASS B 10/20/97 DST
ELRC700 Ceiling Cover / / / / 10/22/97 PASS BRP 10/29/97 J *H
ELRC720 Wall Cover / / / / / / 10/20/97 DST
ELRC725 Low Voltage Inspection / / / / / / 10/20/97 DST
ELRC799 Elect'l Final / / / / 11/06/97 PASS MJR 12/03/97 MJR
ELRC800 Case finaled / / / / 11/06/97 PASS MJR 12/03/97 MJR