Permit CITY OF TIGARD RESTRICTED ENERGY
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #: ELR96 -0108
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839-4171 DATE ISSUED: 04/04/96
PARCEL: 2S110DC -00100
•
SITE ADDRESS...: 15570 SW PACIFIC HWY
SUBDIVISION • WILLOW BROOK FARM ZONING:C —G
BLOCK • LOT •11
Project Description: Commercial Intercom and paging system
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO...: AUDIO & STEREO..: INTERCOM & PAGING..:X
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..:
INSTRUMENTATION.: OTHER..: ..
TOTAL # OF SYSTEMS: 1
Applicant: FEES
AMERICAN TELCOM INC. type amount by date recpt
1225 SE WATER AVE. PRMT $ 40.00 JDA 04/04/96 96 -277831
5PCT $ 2.00 JDA 04/04/96 96- 277831
PORTLAND OR 97214
Phone #:
Contractor:
AMERICAN TELCOM INC. $ 42.00 TOTAL
1225 SW WATER AVE
REQUIRED INSPECTIONS
PORTLAND OR 97214 Ceiling Cover Elect' 1 Service
Phone #: Wall Cover Elect' 1 Final
Reg #..: 26763
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permi ee 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 sore G�
than 180 days. Issued
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: DATE:
LICENSE NO:
Call for inspection — 639 -4175
- -
Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
131255W Hall Blvd.
PERMIT # 0 e1�t eq( O s/
Tigard, OR 97223
4 (;, Phone (503) 639 -4171 a /„
� il,r\ FAX (503) 684 -7297 Iv
- TDD No. (503) 684 -2772 DATE ISSUED
CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BY
PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTALLATION 4. TYPE OF WORK
1 -o 1.4w
Address RESIDENTIAL — Restricted Energy Fee $40.00
176. 9722_3 (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 477/6x_/c'iu ILL/ Type ❑ Vacuum Systems*
❑ Other
Address �/ /225 5,6 . Gv 7L , PaaQiZr � Gie f ?ifY
Date l 4 1 - 16 COMMERCIAL — Fee for each system L40.00
(SEE OAR 918 - 260 -260)
Property Owner Check Type of Work Involved:
Contractor's Board Reg. No. F9 7'7,x- o , 7b3CL G ? ❑ Audio and Stereo Systems
)0///0 ❑ Boiler Controls
Phone # 5o3 -2,.3� - 877/ ❑ Clock Systems
3. OWNER APPLICATION ❑ Data Telecommunication Installations
❑ Fire Alarm Installation
❑ 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:
0
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
S. Assume responsibility for calling for a final inspection when all of the 5. FEES
corrections are completed.
The person signing for this permit must be the applicant or a person a. Enter Fees $ O
authorized to bind the applicant
b. 5% Surcharge (.05 x total above) $ OZ . 00
Sig ature ( "ti 6
TOTAL $ /1
Authority if other than applicant
ENERGAP.CHP
1/21/00 Activities • for Case #: ELR96 -00108
4:27:10 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRC001 Application Received 4/4/96 JDA RECD JDA 4/4/96
ELRC003 Permit Created 4/4/96 JDA PASS JDA 4/4/96
ELRC700 Ceiling Cover 4/4/96 JDA 4/4/96
ELRC730 Elect'I Service 4/4/96 JDA 4/4/96
ELRC799 Elect'I Final 4/4/96 JDA 4/4/96
ELRC720 Wall Cover 4/4/96 JDA 4/4/96
ELRC500 (F) Issue permit .4/4/96 JDA PASS JDA 4/4/96
ELRC800 Case finaled 4/15/96 MJR YES MJR 4/15/96
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