Permit CITYOFTIGARD- ELECTRICAL PERMIT -
RESTRICTED ENERGY
l�i DEVELOPMENT SERVICES PERMIT #: ELR2001 -00302
'=-° 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/27/01
SITE ADDRESS: 11410 SW 68TH PKWY PARCEL: 1S136DA -00101
SUBDIVISION: PERS SITE ZONING: MUE
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of protective signaling. Job No. 1100035.
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: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
OREGON, STATE OF PUBLIC PROTEC INC
EMPLOYEES' RETIREMENT FUND 720 NE FLANDERS
11410 SW 68TH PKWY PORTLAND, OR 97232
TIGARD, OR 97223
Phone: Phone: 235 -4000
Reg #: LIC 55414
ELE 34 -215CL
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 11/27/01 $75.00 2720010000 Elect'l Final
5PCT CTR 11/27/01 $6.00 2720010000
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 % I 1 gh OAR 952 - 001 -0080. You may obtain copies of these rules or direct ques ' ns to OUNC at (503)
246 - 19':7.
Issued .y . a:: Permittee Signature jed. i,leet
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
S0•d 111101
4,, . Electrical Per ''
lime .. r 6 I II I I ga 0/ Permit no.: fG, / -uv�
D _ ceve4; // A
,-:iy': :i City of 'I gard Pro}adappl,no.: P.xpiredate:
Ciryof Tig Address: 13125 SW Hall Blvd. Tiga k7032001 Due issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598-1960 CITY OF TIGARD Case file no.: Payment type:
Land use approval: BUILDING DIVISION'.
TYPE OF PF.R311T
0 1 & 2 family dwelling or accessory 0 Commcreia1/1 dusttial • . 0 Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration/replacement 0 Other. , __ ' - ❑ Partial
JOB SITE INFORMATiON
Job adde=rs: - u r:,J " V� - . Bldg. no.: Suite no.: Tax map/lax lot/account no,:
loot Block: Subdivision:* -
Pro see name //, r L'T/ I
Estimated date of completion/Inspection: - 311 •• - 0'- v -e 1 r4 ."' so. - s �� 2.* i P —_
CONTRACTOR A PI'LICATIOti FEE S( :l1EIJU.E
Sob not E �
U O r3 Foe ltax • _
'fro }ac. mrt 1 . Dacriprioa Qty- (es) Total no. blip
Business name:
t , L New raid • shade on ottd- rarnBy per
Address: • 7 . -5 . dweirsagunit . irretrtdrsal�ebad
Cry: - Pe. -Pe..-4-1 ° 11 E . �' a d. 1 State: alj ZIP: 4 /.723 - Senitel teladetb
Phone: 23s 4v n i' I Fax: 235 -o3 ./E-mzil: 1000'4 ft. or ku o 4
- z 1 9 L L E Limi additional Sao sq, rt-or portion thereof
CCB no.: 554 1 4—
Flee. bt1L ilea no: • \ lJmitrdlav;y,resldeorial _ 1 Z
City/metr0 lie. n 4z . 0 Limited . . 2
ri/' Each manufactured home or modular dwelling
Sie awre - ervising electrician (rcauired) Date �-1 v --to ServIce snd/afeeder 2
so. - osme(priLW: -J-.)K B.tr e+ei a .- Licenreno: 2 /ii ` Services or feeders- ttyltstien.
orrekwattoo:
-' . -.� • 111( It CV OWNED. 200 amps or leas 2
2
Name (print): —
401 .apt to 600 sops 2
Meiling address: Gal amps to 1000 slaps 2
City: State: I ZIP - Over 1000 amps or volts 2
Phone: F ax: Email: Reconneamtly ` 1
Ouena installation: The installation is being made on property 1 own Tempora'ywvle s or readers - - ,
which is not intended for sale. lease, rent, or exchange according to installado4alh*attegerreloestied
200 amps or less 2
ORS 441, 455. 479. 670. 701.
ea t amp: to 400 amps 2
Owner's Si • .tart~ _ Darn 401 to 600 amps - 2
LNG IIS LER Beaoen eireolts - nen, alteration,
or extension per panel
Name: A, F for branch circuits with purchase of
Address: service or feeder k e. each traneh circuit 2
City: ' S�� - I ZIP J B. Pee for branch circuits without purchase
of service or feeder fee. rust brancth circuit: 2
Phone: Fax: E , p add►6ons1 breech Cie MAC
I'LAN RE; %'IE\V (beck all trot :apply) mis (Service or feeder set tadvded):
o Un iceover 2 S aterps- ooratrereial 0 Health-cps: facility Each pump or irtis ttioh Cite!! 2
O Ser■ice over 320tmps- ratingof1Bt2 0 Hazardous location Bull sign ar outline lighting 2
hmitydwellings 0 Building over 111400 sou to feet four or Signal eireuit(sl or a limited cl ergy panda X
O Simon over 600 volts nominal MOM tCS /dC4tiatrnit1 arm structure 21tetatiom ormitension - . I - 75" 2
O Building °earthtee stories O Feeders, 400 sops a more ■Description
O Oecuno m load ever 99 Pm -v:1ns 0 Manufactured bU GC WI pars: Each additional Inspeetioa over the atlowabk to any of Iles above
0 Egreserlighlirtspler. O Oder _ Peeinspeedon I • -1 1
Submit _ sets or plans with any of the above. Iaveati; anon tee
The above are not appliable to temporary coo:traction service. arm - •
rase el • • warp( vita eedit wed.. rle>,.t eta Jurisdiction le' mete lefamation. Notice: This permit application Permit fee 5 '� `
o and expires it • permit is not obtained Plan review (u _ 96) 5
c,ad:e Care w ar . S 7 c,. • 6/ : . a • or OZ within 180 days after it his been State surcharge (3%) . - :. S _ � - 5'�
:. - . ., - • I. o ea accepted as complete. TOTAL -. s 431 • 0 0 a.c
m • • - -War 'sown a+ • - t coat S O �( l do
NOV=20 -2021 11 :28 97 ' Stri4 ?1 4F,G1 o ? i o WI
T @ /TO'd 2920SEZ2OS 03108d TS:91 TEME -OE -r'ON
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
$, BUP
Received Date Requested , L I AM PM BUP
Location / ( H 6 6 8 - --- Suite MEC
Contact Person Ph ( ) good PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR , 00 /
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors 0 n j
Ext Sheath/Shear `'
Int Sheath/Shear
Framing
Insulation Poe&
Drywall Nailing r
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In l/
Water Service
Sanitary Sewer r /
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
Rough -In
UG/Slab
Low Voltage
Fire Alarm
i ina Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Date .2 - L
Approach/Sidewalk ( 4 Z- �nspe Z
Other:
Final DO NOT REMOVE this Inspection record from th job site.
PASS PART FAIL