Permit CITY OF
DEVELOPMENT SERVICES ELECTRICAL PERMIT -
-4 °• 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 RESTRICTED ENERGY
PERMIT #: ELR98 -0300
DATE ISSUED: 11/04/98
PARCEL: 2S101AA -06400
SITE ADDRESS °° °:12323 SW 66TH AVE
SUBDIVISION °WEST PORTLAND HEIGHTS ZONING:C —G
BLOCK LOT °024 JURISDICTN: TIG
Pro.j ect Description : Add protective signaling.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO AUDIO & STEREO. °: INTERCOM & PAGING ° °:
BURGLAR ALARM BOILER ° LANDSCAPE/ I RR I GAT.
GARAGE OPENER CLOCK MEDICAL
HVAC DATA /TELE COMM. .: NURSE CALLS °
VACUUM SYSTEM FIRE ALARM OUTDOOR LANDSC LITE:
OTHER: °• HVAC PROTECTIVE SIGNAL. .:X
INSTRUMENTATION °: OTHER ° °: NO
TOTAL # OF SYSTEMS: 1
Owner: FEES
FARMERS INSURANCE EXCHANGE type amount by date recpt
12323 SW 66TH AVE PRMT $ 40 °00 GEO 11/04/98 98- 310555
PORTLAND OR 97223 5PCT $ 2 ° GEO ,11/04/98 98- 310555
Phone #: •
Contractor:
WILSONVILLE LOCK & SECURITY $ 42.00 TOTAL
PO BOX 517
REQUIRED INSPECTIONS
WILSONVILLE OR 97070 Low Voltage Insp
Phone #: 682 -2323 Elect' 1 Final
Reg #° .: 000493
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. 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. ATTEENTION: Oregon law requires you to follow rule 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 uestio s o OUNC at (503)246 - 1987.
4
Issued by 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: ,04 • DATE:
LICENSE NO:
•
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
' Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD RECEIVTRICTED ENERGY ELECTRICAL APPLICATION Recd by:
13125 SW HALL BLVD Date Rec'd:
TIGARD OR 97223 NOV 0 4 1998 PRINT OR TYPE
V - 503 - 639 -4171 X304 Permit #: i ct-te r 300
F - 503 - 684 -7297 CO MUI,ITY DEVELOPMP OR ILLEGIBLE APPLICATIONS Cust.Call'd:
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee $40.00
Fat P.m.er2 5 any u Ra n ce (FOR ALL SYSTEMS)
JOB Street Address ��� Ave. e #
ADDRESS I g3D3 SW tw�rt 'i Y"ri..Jrc Check Type of Work Involved:
S te ti cl jE ' I tvo- , 9D3 14 S13Q ❑ Audio and Stereo Systems
Name `7 ❑ Burglar Alarm
OWNER Mailing Address ❑ Garage Door Opener'
City /State Zip Phone # ❑ Heating, Ventilation and Air Conditioning System*
1 � N ,� a � , ❑ Vacuum Systems*
Wl� ,I3 nui Ile )_orIL 91' dgeue ❑ Other
CONTRACTOR ruin ddress
-Z CnC 51 TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a Cit / tate P� one # Fee for each system $40.00
copy of all licenses W1�3Cr,VII '7 Orb lo�J (SEE OAR 918-260-260)
are required if re o ontr. rd Li Exp. Date
expired in C.O.T. 49 3 .09 Check Type of Work Involved:
data base). EI ctri I C ntr. lc. # Exp. Date
'��� 0 Audio and Stereo Systems
C.O.T. or Metro Lic. # Exp. Date
❑ 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 p HVAC
permit and to do the following:
0 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;
gi 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. 1 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.
FEES:
7ao01-7Z ENTER FEES $ ` 0 ��
Signature
5% SURCHARGE (.05 X TOTAL ABOVE) $ V20
Authority if other than Applicant TOTAL $ L iDP °
is \dsts \resele.doc 7/97
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour In spection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested — AM PM BLD
Location /Z. 3 E.3 5- - fir./' Suite MEC
Contact Person / Ph PLM
Contractor Id /iv,/ U1 // h 1 Ph SWR
BUILDING Tenant/Owner ` ELC !3
Retaining Wall ELR 7 -0300
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Drywall on ` ��
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam -
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
$S PART FAIL
(ELECTRICAN,
Rough In
UG /Slab u fl sr
Low Voltage Si
Fire Alarm
Fin
S PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA.
Approach /Sidewalk
Other Date 3 Inspector - Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.