Permit CITY OF T I G A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
it* DEVELOPMENT SERVICES PERMIT #: ELR1999 -00205
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 09/02/1999
SITE ADDRESS: 12144 SW SCHOLLS FERRY RD PARCEL: 1S134BC -00101
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Intercom & 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
Owner: Contractor:
WILLIAM W. SAUNDERS REVOCABLE TRUST CONSOLIDATED BUSINESS MACHINES
111 SW COLUMBIA 831 SE MARTIN LUTHER KING JR B
STE 1380 PORTLAND, OR 97214 -2188
PORTLAND, OR 97201
Phone: Phone: 239 -5910
Reg #: ELE 26927CLE
LIC 00104590
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT BON 09/02/199. $60.00 99- 318079 Elect': Service
5PCT BON 09/02/199. $4.20 99- 318079 Elect': Final
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 O R 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503) E 246 -1987.
Issued by G Permittee Signature - A ,A / ,o4
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: ►V DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
1.
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by: T1
13125 SW HALL BLVD Date Recd:
TIGARD R 97223 PRINT OR TYPE
V - 503 - 639 -4171 X304 Permit #:
F - 503 - 598 -1960 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
CA Q J e Restricted Energy Fee $60.00
(J� (FOR ALL SYSTEMS)
J O B Street Address Ste #
ADDRESS -1-R-4- '5LJ Sc lioLLS Fy Check Type of Work Involved:
City/Stale Zip Phone # ❑ Audio and Stereo Systems
-- r RV 97223
Name ❑ Burglar Alarm
OWNER Mailing Address
El
Door Opener*
City/State Zip Phone # ❑ Heating, Ventilation and Air Conditioning System*
Name ❑ Vacuum Systems*
c- B M INC. 0( /j , I S Other
Cotes ❑
CONTRACTOR Ma4no Man Address
I M L 4 B'/ TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a Ci /State Zip Phone # Fee for each system $60.00
copy of all licenses p 2 Yt / I`1 D s59 59 I 0 (SEE OAR 918- 260 -260)
are required if Oregon Contr. Brd Lic. # Ex p. Date
expired in C.O.T. X L1 a7 /01 GGG Check Type of Work Involved:
data base). Electrical Contr. Lic. # Exp. D to
A4,-9270.5 /O /I /q c ❑ Audio and Stereo Systems
C.O.T. or Metro Lic. # 47 3 S Exp gate
"�' / ❑ 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;
❑ 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.
WI/ Q/,� FEES:
Signature —'(\// ENTER FEES $
7 �o
46 SURCHARGE (.05 X TOTAL ABOVE) $ _ `R
Authority if other than Applicant
TOTAL $ (.Cq'/?v
i:\dsts \forms\resele.doc 3/98
10/08/1999 Activities for Case #: ELR1999 -00205
10:41:07 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRC001 Application Received 09/02/1999 BON DONE No Hold • BON 09/02/1999
ELRC003 Permit Created 09/02/1999 BON DONE No Hold BON 09/02/1999
ELRC725 Low Voltage Inspection 09/02/1999 BON No Hold BON 09/02/1999
ELRC730 Elect'l Service 09/02/1999 09/02/1999 - No Hold • BON 09/02/1999
ELRC799 Elect'l Final 09/02/1999 09/02/1999 10/01/1999 CD PASS No Hold AKJ 10/03/1999 •
ELRC500 (F) Issue permit 09/02/1999 BON DONE No Hold BON 09/02/1999
ELRC800 Case finaled 10/03/1999 AKJ DONE No Hold AKJ 10/03/1999
•
•
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