Permit -A. CITY OF TIGARD ELECTRICAL -
ENERGY
RESTRICTED ENERGY
A- r DEVELOPMENT SERVICES PERMIT #: ELR1999 -00215
- ' 13125 SW Hall Blvd.. Tisrard, OR 97223 (503) 639 -4171 DATE ISSUED: 09/14/1999
SITE ADDRESS: 15340 SW ROYALTY PKWY PARCEL: 2S110CD -00102
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT: 002 JURISDICTION: KIN
Project Description: Electrical TI - Burglar alarm
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:
INSTRUMENTATION: OTHER: BURGLAR X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
C V MCCANN ALLIED SAFE + VAULT INC
BY MCCANN'S PHARMACY AKA ALLIED SECURITY
15685 SW 116TH AVE 1609 NE MARTIN LUTHER KING BLV
KING CITY, OR 97224 PORTLAND, OR 97232
Phone: Phone: 281 -1177
Reg #: LAC 0064465
SUP 373JLE
ELE 26 -243CL
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT BON 09/14/199E $60.00 99- 318305 Elect'I Service
Elect'I Final
5PCT BON 09/14/199E $4.20 99- 318305
Total $64.20 ORIGINAL
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. 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 rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct • ('esti• s to OUNC at (503)
246 -1987.
Issued by I / / (/� Permittee Signature , ! �
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
SIGNATURE OF SUPR. ELEC'N JJ" DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by:
13125 SW HALL BLVD Date Rec'd: ► -
TIGARD OR 97223 PRINT OR TYPE
V - 503 - 639 -4171 X304 Permit #: E- LI l / - an-t S
F - 503 - 684 -7297 g INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
Pct — Q 7 -77 WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee $40.00
e4)42 Si C'1oa5 t BAH K - KC t (FOR ALL SYSTEMS)
JOB Street Address p y Ste #
ADDRESS 3 '/O 54C1 ~c / a/{/ Check Type of Work Involved:
ct rKr t, a?/
City /State Zip Phone # ❑ Audio and Stereo Systems
N a no rd Dre3 97a 2,3
Na a Egr Burglar Alarm
0 ,. V ‘ WO ❑
Garage Door Opener*
OWNER Mailing Address
h 1(�tn S P El Heating, Ventilation and Air Conditioning System*
, 9 Ci / tale i P one #
IS/%S . "� (� lZ � ❑ Vacuum Systems'
Name
❑ Other
CONTRACTOR Mailing Addr
/
� Sf "lti a yt 3/ TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a ty /S Z ip / Phone # Fee for each system $40.00
copy of all licenses rQ tit ne, 9, ,211 X -1 �
31v D 7-- S (SEE OAR 918 - 260 -260)
are required if Oregon on Conte. Brd Lic. # xp. Date
expired in C.O.T. 6 , --Q----err— heck Type of Work Involved:
data base). Electrical Contr. Lic. # Exp. Date
Ats -01e/3 C(6 /0-/- 9 ei ❑ Audio and Stereo Systems
C.O.T. or Metro Lic. # Exp. Date
Do v 0 Y6 3 6 ❑ 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; .
/ :, l Protective Signaling
5. Assume responsibility for calling for a final inspection when all of the
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 bind the applicant.
il l FEES:
Signature ENTER FEES $ 4
5% SURCHARGE (.05 X TOTAL ABOVE) $ a
Authority if other than Applicant TOTAL $ 9C7
i:tdstsIresele.doc 7/97 —
. i KING CITY
15300 SW. 116th Avenue, King City, Oregon 97224-2693
Phone: (503) 639 -4082 • FAX (503) 639 -3771
Notice To Contractors Working In King City
Due to an intergovernmental agreement with the City of Tigard, many building related permits
for projects in King City are issued and inspected by the City of Tigard.
If your permit application DOES NOT REQUIRE PLAN REVIEW, simply complete the
appropriate application legibly and submit it to the King City staff. The King City staff will
collect all fees and fax the application to the City of Tigard. City of Tigard staff will then create
the permit, issue the permit, and perform inspections. Please indicate on the permit application
whether you would like the Tigard staff to call you when the permit is ready for issuance or
whether you prefer it to be mailed without any notification. Any incomplete or illegible
application will be returned to King City staff for correction and no processing will occur until a
complete, legible application is received.
If your permit application DOES REQUIRE PLAN REVIEW, this form must be signed by a
King City staff person. King City staff will simply sign this form indicating land use approval.
Take this signed form to the City of Tigard Development Services Counter located at 13125 SW
Hall Blvd, Tigard, to submit applications and plans. Development Services Technicians are
available at 639 -4171 Ext. 304 should you have any questions concerning submittal
requirements. All permit fees will be assessed and collected at the City of Tigard.
The City of King City hereby authorizes applicant to pursue permits at the City of Tigard
Building Department for the following project: 0 -1- lli1','► c j e, ‘v44 - c L.e4,
located at: 453 j r Y
cep a2. j.„.....____ _
King City Representative
I.'DSTST.CINST DOC
•
02/17/2000 Activities for Case #: ELR1999 -00215
2:49:47 PM •
• Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRC001 Application Received 09/14/1999 BON DONE No Hold BON 09/14/1999
ELRC003 Permit Created 09/14/1999 BON DONE No Hold BON 09/14/1999
ELRC725 Low Voltage Inspection 09/14/1999 BON No Hold BON 09/14/1999
ELRC730 Elect'I Service 09/14/1999 09/14/1999 No Hold BON 09/14/1999
ELRC799 Elect'l Final 09/14/1999 09/14/1999 10/06/1999 CD PASS No Hold AKJ 10/06/1999
ELRC500 (F) Issue permit _09/14/1999 BON DONE No Hold BON 09/14/1999
ELRA800 Case finaled 10/06/1999 AKJ DONE No Hold AKJ 10/06/1999
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