Permit crry oF TIGARD RESTRICTED ENERGY
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #: EL R96 -01 14
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171 DATE ISSUED: 04/ 10/96
SITE ADDRESS...: 11981 SW PACIFIC HWY EXPIFI CEL: 1S135DD -05000
SUBDIVISION ZONING:C -G
BLOCK • LOT
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
RAINBOW PLAY STRUCTURES type amount by date recpt
11981 SW PACIFIC HWY PRMT $ 40.00 CJS 04/10/96 96- 278001
5PCT $ 2.00 CJS 04/10/96 96- 278001
TIGARD OR 97223
Phone #: 503- 620 -2653
Contractor:
fggiVicRAOK NWT' -%1 FdisE $ 42.00 TOTAL
ADT Secur
703 NE AIancc REQUIRED INSPECTIONS
PO 'i" /c' ^'a,, Pe. 4 '7a/ Z Ceiling Cover Elect' 1 Final
Phone #: &89 - 3165 Elect' 1 Service
Re g #. .
Sq¢yy
This permit 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 permit will expire if work is not started
within 180 days of issuance, or if work is suspended for more r 4 „ 4..
t 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 SIGNATURE: D/1 ci /icc, ,/inter DATE: ti-/0- 9F,
LICENSE NO:
Call for inspection - 639 -4175
. - „ Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
• 13125 SW Hall Blvd.
Tigard, OR 97223 PERMIT # ELA 96- DIN
/
Aanrit ' { II FAX (503) 684 -7297 ,;' Phone (503) 639 -4171 DATE ISSUED 4 /- /D 96- _- TDD No. (503) 684 -2772 /
CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BY CAa r /Pf A m e t4
PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTAL ION 4. TYPE OF WORK
/192/ � (i) ,,
Addre . RESIDENTIAL Restricted Energy Fee "0.00
/ / ` A 97W4; Or 5 (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 Opener*
❑ Heating, Ventilation and Air Conditioning Systems
Contractor AM SECURITY SYSTEMS. INC- T 'I 4 'L acuum Systems*
703 NE HANCUCK /
Address PORTLAND, OR 97212 ❑ Other
(503) 284 -A265
Date O %-6 COMMERCIAL — Fee for each system $40.00
/' ) (SEE OAR 918- 260 -260)
Property Owner _ �� / ("L 1- _ , 1/ ,i■ apoc Type of Work Involved:
Contractor's Board Reg. No. i C / ❑ Audio and Stereo Systems
❑ Boiler Controls
Phone # ❑ Clock Systems
3. OWNER APPLICATION ❑ Data Telecommunication Installations
\ �}.- 6.:z - h/ ❑ Fire Alarm Installation
,t
l -®'1f ( • P 1 tar? c1 � ❑ 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 ca lin', or a final inspection when all of the 5. FEES
corrections are complet f
The person signing .• ), s / permit must be the applicant or a person a. Enter Fees $ 1 6 ' ‘ U( )
autho i 's bin applicant. //ll
At/ b. 5% Surcharge (.05 x total above) $ a � C./
Sig :ture
TOTAL $ �
Authority if other than applicant
ENERGAP.CHP
4/24/00 Activities for Case #: ELR96 -00114
4:54:23 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRC001 Application Received • 4/10/96 CJS RECD CJS 4/10/96
ELRC003 Permit Created 4/10/96 CJS PEND CJS 4/10/96 •
ELRC700 Ceiling Cover 4/10/96 CJS 4/10/96
ELRC730 Elect'I Service 4/10/96 CJS 4/10/96
ELRC799 Elect'I Final 4/10/96 CJS 4/10/96
ELRC500 (F) Issue permit 4/10/96 CJS PASS CJS 4/10/96
ELRA510 (F) Reprint permit 4/10/96 CJS .4/10/96
ELRC580 Expired by limitation 3/28/00 HAP DONE No Hold AKJ 3/28/00
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