Permit CITY OF TIGARD
DEVELOPMENT SERVI ELECTRICAL PERMIT — .!
RESTRICTED ENERGY
PERMIT #: ELR96 -0316
DATE ISSUED: 10/15/96
PARCEL: 2S11ODC -00200
SITE ADDRESS...: 15660 SW PACIFIC HWY #4
SUBDIVISION • WILLOW BROOK FARM ZONING:C —G
BLOCK • LOT :11
Project Description: Data /Telecommunications System
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO...: AUDIO & STEREO..: INTERCOM & PAGING..:
BURGLAR ALARM BOILER • LANDSCAPE /IRRIGAT..:
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
NOAH'S BAGELS type amount by date recpt
14054 CATALINA ST PRMT $ 40.00 DST 10/15/96 96- 285169
5PCT $ 2.00 DST 10/15/96 96- 285169
SAN LEANDRO CA 94577
Phone #: 510 - 352 -6624
Contractor:
APPLIED INFORMATION SERVICES $ 42.00 TOTAL
12950 SW PACIFIC HWY
SUITE #7 REQUIRED INSPECTIONS
TIGARD OR 97223 Wall Cover Elect'1 Final
Phone #: 639 -0777 Elect' 1 Service
Reg #..: 080188
This permit is issued subject to the regulations contained in the l
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permit e e 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
than 180 days. Issued
OWNER INSTALLATION ONL
The installation is being made on property I own which is not intended for
sale, lease, or rent.
OWNER'S SIGNATURE: 4-Qt 0/, , DATE:
1
CONTRACTuR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call for inspection — 639 -4175
Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
PERMIT # g l I
13125 SW Hall Blvd. � - 03 Y
Tigard, OR 97223
�i��tm
Phone
FAX (503) 6847 297 DATE ISSUED - /d/f5# (j
. TDD No. (503) 684 -2772
CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BY r ati/GUI/--
PLEASE COMPLETE ALL SECTIONS P .P4
1. LOCATION OF INSTALLATION f �I ,�QG)GQ 4. TYPE OF WORK
iS6ro u/ /�, ..//:.....,)) W 0
Address RESIDENTIAL — Restricted Energy Fee $40.00
/eA D2 2'722, Y (FOR ALL SYSTEMS)
City u 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 System*
Contractor /liTS Type ❑ Vacuum Systems*
Address / Z 7S0 .5 ■? , ...A. ,/,‘"-- ❑ Other
Date /0�,5,/ COMMERCIAL — Fee for each system $40.00
(SEE OAR 918 - 260 -260)
Property Owner Check Type of Work Involved;
Contractor's Board Reg. No. 7f l 7 5( ❑ Audio and Stereo Systems
❑ Boiler Controls
Phone # 6 31'- 07 7 7 ❑ 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:
❑ Protective Signaling
1. Only use electrical licensed persons to do installations where required. (Certain
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 - pplicant or a person a. Enter Fees $ 7v •0
authorized to bind the applic nt.
� � y� b. 5% Surcharge (.05 x total above) $ c2.0
Signature
TOTAL $ -/- �[ of 7
• Q 6
Authority if other than applicant
ENERGAP.CHP
Page No. 1 CASE HISTORY FOR CASE NO.: ELR96 -0316
NOAH'S BAGELS
15660 SW PACIFIC HWY Unit: 4
09/17/97
Action Description Reg/ Schd/ End/ Action Notes Diep By Update Upd
Code Sent Done Done Date By
- - -- --- -------- ---
ELRC001 Application Received / / / / 10/15/96 RECD JDA 10/15/96 DST
ELRC003 Permit Created / / / / 10/15/96 PASS JDA 10/15/96 DST
ELRC500 (F) Issue permit / / / / 10/15/96 APSS JDA 10/15/96 DST
ELRC720 Wall Cover 10/15/96 / / / / 10/15/96 DST
ELRC731 Elect'l Service 10/15/96 / / / / 10/15/96 DST
ELRC799 Elect'l Final 10/15/96 / / / / 10/15/96 DST
ELRC800 Case finaled / / / / 10/16/96 PASS MJR 10/17/96 MJR
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