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Permit 41" CITY OF TIGARD ELECTRICAL ENERGY - RESTRICTED ENERGY �� DEVELOPMENT SERVICES PERMIT #: ELR2003 -00290 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/26/03 SITE ADDRESS: 11308 SW 68TH PKWY 1ST FL PARCEL: 1S136DA-00100 SUBDIVISION: ZONING: MUE BLOCK: LOT: JURISDICTION: TIG Project Description: Low voltage (data /telecommunication) placement from builfding to new PGE pole. 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: Contractor: BENENSON 68TH PARKWAY CHRISTENSON ELECTRIC INC KEY LLC, THE 1631 NW THURMAN BY FIRST AMERICAN TAX VALUATIO 2ND FLOOR WORCESTER, MA 01615 PORTLAND, OR 97209 Phone: Phone: 503- 419 -3608 permit Reg #: L3O3- 34143 16 SUP 3289S ELE 26 -34C FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 9/26/03 $75.00 Elect'I Final [TAX] 8% State Tax 9/26/03 $6.00 Total $81.00 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 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699. Issued by ��� �-� �„� Permittee Signature (7) a/JILL 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 , - -2003 WED 12:42 PM CHRISTENSON CORPORATION FAX NO. 503 419 3636 P. 01 44,8 Electrical Per aut Application Dot: received - ; /, Permit no.: s.' _ , a 0 '' ► 1 ` _ City of Tigard BEG Project/appl.no.: Expire date: ._ • Ciryof7Ygard Address: 13125 SW Hell Blvd, 'f , 9 Date issued: Receipt no.: Phone: (503) 639 -4171 Case Erie no.: Payment type' Fax: (503) 598 -1960 Land use approval: C1T OF TiGARO 111'1: (11 1'11011 CommerciaVindustrial 0 Multi- family 0 Tenant improvement O 1 family dwelling or accessory X 0 Addition/alteration/replacement 0 Outer. 0 Partial 0 Neew w catsuucdon Knit1Ii1 1.IOIt,\I \11 lob address: 11308 SW 68TH PARKWAY T 97 224 Bldg. no.:. Suite no.: Tax mapkal lot/account no.: • 3348 Lot; Block: Subdivision: 4 UESTIONS? CONTACT DEAN SKAAR 03 4 - Project namePROVIDENCE HEALTH. SY V a ti .:on and location of work on premises y0W VOLTAGE DATA TELECOMMUNICAT ! ON Estimated date of corn . letion/ins ∎ on: PLACEMENT FROM BUILDING TO NEW PGE POLE i 111.1 ►1 ,1.1. (();1 11(m Il11(AI'l'I - Fee Job no: - t o pi • Business mime: CHRISTENSON ELECTRIC, INC. New maenad - single ormarlf“umilyper 1111 • Address: • THURMAN ST 2ND ti a , : etladtedgera®e. . a . t State: OR ZIP: Senicebschtdeth 4 IlEn 1000 - fe or less Phone503 419 3600 Fax: 419 3636 1000 additional 500 :ttor Ilion thereof ��� Each 0 0458 - . bus . lie. no: 26 -34G W energy, den SWIM CCB no.: 2 . no.: - 7• ,1 t.iuute teisidentiel �� City/met erir 1111111. 2 m of IS �� Rath manufactured horns or modular dwelling Date Service and/or feeder �. , �n of s .. iii �, ..ui _ Serttoeatorteedati- irs:talla�O Sup. elect rtatne(Ptb gIAN CHRISTOPHER attend= or reload= 111 0 2 1'ittfl'P :Itl l 011 \! It amps to 4 . ;s 1.111111.MI© WWI Name (print): 401, ,. to600 . ,... ��� Mailing address: • 601 ..,... wi000ampa 2 State: ZIP: Over i000 amps or voles =M IMO 2 MEN Phone: Temporary alter°' ar teedetr - � made on property b own baatatiatiott,altar + orretorattmt 2 Owner installation: The installation is being according to _ which is not intended for sale, lease, rent, or exchange g 200 : or leas r 2 ORS 44.7, 455, 479. 670, 701. 201 ,. to 400 amps = fir 2 Owners sl@ttamte: _ —. — — ... _ . __ Date: 40t to see Breach drains -new. 1 \'1:1 \l.lat or extension pee park Name'. -- Fee for branch circuits with purchase of . 6 —�. service or feeder fee. each branch circuit II Address: B Fee for branch circuits witbotu purchase 2 111M1:11*; IMP State: ZIP: of service oc feeder tee. Aran branch c1i min onimilliaza Phone: rrrs l'1 .. \N Iii, \'11.1 \' 11'Ica �'Uccl, ail /hat :1i1pl■ '1 Each 0 Sesviceove 320 a upa'an '� : ' O familydwelli dwellings amps rating of 1A2 0 Building over Signal circuit(a) or a limited energy Panel. � � 2 familydwet 0 Building over 10.000 square feet four or 7 5 . • 0 Systemg over a' 600 volts rigs 400 amps residential units in one structure alteration, or extension al 0 Feeders, mps or more •peacri . tionPATA T - LEC01'41UNI CAT ION 0 Building load three v over park Foch additional Ia spaliaa o ver the allowable fa y enrol above: O Oogtpaant load over 99 persona 0 tNanufauutsd structures or RV 11011••111111 NOM 0 Egress/lightingplau 0 other. 'trills • - 'o Submit ____ sets of plans vttth any of the above. o che: The above are not applicable to temporary contraction service. permit fee $ 75.0p corgi cords. plc call i uiaded rat we oa X100' Notice: This permit application Pla review (at �) $ - 0 a o ma s expires if a permit is not obtained State surcharge (8%) 0 $ 6 o Visa D Mastercard _ � within 180 days after it alas heart TOTAL $ Credit card wtaber. Ever., accepted as complete. TRUST ACCOUNT DEDUCT * * * ___ §1,0_0___ �` * * * erne r shown oa coedit card S 440.4613 (6100ICOM) ■ +FEE ON BACK OF FORM OCTOBER 2000 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 - 4171 MST BUP Received Date R est — 36 AM PM _ BUP Location 11 3 5 a (4 ) Suite /S f L MEC Contact Person J ''')C1!'C Ph ( ) gd6, -2-1& 2- PLM Contractor S S�/yl '/ P.�,P,h ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC g Access: ELR ' .3 - 00290 Ft Drain Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation ■ (-- Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service p`� Rough -In (.� "' " (& %.:lab '� Low Voltage U" IN Fire Alarm 4 � Fin Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. P PART FAIL SITE Please call for reinspecti • RE: • Unable to inspect — no access Fire Supply Line Approach/Sidewalk Date • _ Inspector RP 12 I / Other: Final DO NOT REMOVE this inspection record from the Job = te. PASS PART FAIL