Permit A CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
l' 1, DEVELOPMENT SERVICES PERMIT #: ELR2000 -00013
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 01/10/2000
SITE ADDRESS: 11705 SW 68TH AVE PARCEL: 1S136DD -02600
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING:
BLOCK: LOT: 009 JURISDICTION: TIG
Project Description: 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:
SMITH, DEAN W + BRINKS HOME SECURITY
SMITH, JO ANN MONDELLI TRS 8080 SW CIRRUS DR
17880 SARAH HILL LN BEAVERTON, OR 97008
LAKE OSWEGO, OR 97035
Phone: Phone: 641 -0574
Reg #: SUP 2650JLE
LIC 00044421
ELE 34166CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT BON 01/10/200C $60.00 00- 321031 Elect'I Service
Elea! Final
5PCT BON 01/10/200C $4.80 00- 321031
Total $64.80 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 • direct questions to 0 • NC at (503)
246-1987. ed by (
I ✓,�,e Permittee Signature L % ig _AL.!
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: 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: f
13125 SW HALL BLVD Date Rec'd: 1
TIGARD QR 97223 PRINT OR TYPE
V - 503 -B39 -4171 X304 Permit #: EL ,u -- gOk 3
F - 5013- 598 -1960 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
• /) n • Restricted Energy Fee $60.00
nt Vital / ( (/J /�� i 1 J ((FOR ALL SYSTEMS)
JOB Street Ad ress Ste #
ADDRESS 11705 Su) Wt' ave. Check Type of Work Involved:
C Strl �e y � 3 � ❑ Audio and Stereo Systems
Name yJ / ❑ Burglar Alarm
OWNER Mailing Address ❑ Garage Door Opener'
City /State I Zip 1 Phone # ❑ Heating, Ventilation and Air Conditioning System*
Name I ❑ Vacuum Systems*
rl hk S gum_ ,5P Cl -ri t ❑ Other
CONTRACTOR Air -
UrruS 1fr, TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a y /State i Ph ne Fee for each system $60.00
copy of all licenses �[1x` 4��g tU (SEE OAR 918 - 260 -260)
are required if r. r Lic. # Exp. Date
expired in C.O.T. 6 p ID -b[) Check Type of Work Involved:
data base). EI i I n r. r L' . # xp. Date
�� — ❑ Audio and Stereo Systems
C.O.T. or 71tatig# Exp. Date
!D - CO ❑ 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 Ito. /) 4lI I ji „ �
corrections are completed. Other �U
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 ap licant.
FEES:
0.0 graxj4.0_,
ENTER FEES $ I.V V • D O •
Signature ri 9 or �1
:991E SURCHARGE (.O5 X TOTAL ABOVE) $ , -(- R D
Authority if other than Applicant TOTAL $ 64 l-
- ED
is \dsts \forms\resele.doc 3/98
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
�/�
BUP
Date Requested l 1J ' AM PM BLD
Location 1 — OS (o ' " O 4'tJ9, Suite MEC
Contact Person Ph 6/39 767 35 PLM
Contractor 2 „'K" Ph four( - OS29 SWR
BUILDING Tenant/Owner i v rrl() . Pag. . 101 eiti; 1 ELC
Retaining Wall ELR 2.0n0 000 1 3
Footing Access:
Foundation / FPS
Ftg Drain t� f SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing —
Firewall
Fire Sprinkler _ �/
Fire Alarm
Susp'd Ceiling
Roof
Fin
Final
nal
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
PASS PART FAIL
Service
Rough In
UG /Slab
Fire Alarm
Fi•
PART FAIL
E
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date 3 6- Inspector Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
04/21/2000 Activities for Case #: ELR2000 -00013
2:33:56 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRC001 Application Received 01/10/2000 BON DONE No Hold BON 01/10/2000
ELRC003 Permit Created 01/10/2000 BON DONE No Hold BON 01/10/2000
ELRC725 Low Voltage Inspection No Hold BON 01/10/2000
ELRC730 Elect'I Service 01/10/2000 01/10/2000 No Hold BON 01/10/2000
ELRC799 Elect'I Final 01/10/2000 01/10/2000 03/06/2000 CD PASS No Hofd AKJ 03/06/2000
ELRC500 (F) Issue permit 01/10/2000 BON DONE No Hold BON 01/10/2000
ELRC800 Case finaled 03/06/2000 AKJ DONE No Hold AKJ 03/06/2000
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