Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
It DEVELOPMENT SERVICES PERMIT #: ELR2001 -00219
s s 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/4/01
SITE ADDRESS: 12909 SW 68TH PKWY 400 PARCEL: 2S101AD -03200
SUBDIVISION: TIGARD OFFICE BUILDING ZONING: MUE
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of voice and data cabling.
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:
PACIFIC REALTY ASSOCIATES C3 //COMMUNICATION CNNCT CNTR
15350 SW SEQUOIA PKWY #300 -WMI 10950 SW 5TH
PORTLAND, OR 97224 SUITE 110
BEAVERTON, OR 97005
Phone: Phone: 503 - 643 -1922
Reg #: LIC 0117658
ELE 24- 373CLE
FEES Required Inspections
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 9/4/01 $75.00 2720010000 Wall Cover
5PCT CTR 9/4/01 $6.00 2720010000 Low Voltage Inspection
Elect'I Final
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Munidpal 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 thr• . gh OAR 952-001-1180. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
Issued by i , - i 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: DATE:
LICENSE NO: -?q� 3 C./.._g
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
_ � 7 _ 112'0 I
• .,,::
. i. A EIectricalPermitAp scab n
.. `, lratet+eo - • s �L� � fuo .�,44: I!°I ii. if ,14 C ity o f T 'f ' ' I� •
P,o'ect// 1. no.: ire sate:
Ciryafrigard Address: 13125 SW Hall Blvd, Tig , R 9722 Date issued:
Bye I
Receipt no.:
Phone: (503) 639-4171 - �' j
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: J7e /1 Q e3 „52s3 '�69- 7/(.1
TYPE OF PERMIT
O 1 & 2 family dwelling or accessory b Commercial/industrial O Multi- family 0 Tenant improvement
O New construction CI ddition/alteration/replacement 0 Other. 0 Partial • •
JO11 SITE INFORMATION
Job address: / 2 S W 4,91 , Bldg. no.: Suite no.. it r Ta ma lot/account no.:
Lot: Block: Subdivision: .
Project name:///v E 1a4I-uAT,DN . „45sAj Description and location of work on premises: I/ef ee *-2)47 . / . y
Estimated date of completion/ins 'on: / If
Job no: Fie Mme
Business name: C 1 (OM m ut w ■ CA i-1 S =M L pti0° Qty. (ea) Total ao. hasp
Address: 101 511 SW CFI. SE'. m i . j1 IVewse :adaodid- dsrglear mlttraronyper
City: IS fr,�4/ n j state: pq 9/ 0 0 0 S l dad
Phone: by -I11.2 'Fax:Off-no.? E-mail: 00 sq.tt.orless 4
Erich additional 500 sq. ft or portion thereof
CCB no.. 117 1, S $ Elea. bus. lic. no: 2 y - 3 7 LL E Limited may, residential 2
City/metro lic. no.: l.itoited energy. non-residential 2
at Each manufactured home or modular dwelling
t>n o s peRisia required) Date Service anchor feeder 2
Sup. elect. name(prino: Ste' 0 G11 License no: ' , 3Le S ervices or feeder,— installation,
PROPERTY OT1':NER atteratloaorrelocation:
zoo amps or less 2
Name (print): 201 amps to 400 amps 2
Mailing address: 401 amps to 600 am 2
601 amps to 1000 amps 2
City: ' State: (ZIP: Over 1000 amps or volts 2
Phone: I Fax: 1E Reconnect only 1
Owner installation: The installation is being made on pmperty I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to lasfallatlm ,dtervtion,orreloeadon:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owners signature: Date: 401 to 600 am. _ 2
ENGINEER Braath circuits -new, alteration,
or exteutdoa per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I Z1P• B. Fee for branch circuits without purchase
Phone: Fax: E-mail: of service or feeder fee, Brat branch circuit: 2
Each additional branch circuit
PLAN REVIEW (Please check all that appl)) Mtere. (Setiiaeor feeder not included):
O Service over225 amps - commercial 0 I{ealth•carefacility Each pump or irrigation circle 2
O Service over 320 amps - rating of 1&2 0 Hazardous location Each signor outline lighting 2
family dwellings 0 Building over 10.000 square feet fear or Signal circuit(s) or a limited energy panel, y
O System over 600 volts nominal more residential units in one swcture adteration,orexlension' / / ,5 _ 2
O Building over three stories 0 Feeders. 400 amps or more •Descaipuon.
O Occupant Toad over 99 persons 0 Manufactured structures or RV peek E additional inspection over the allowable in any of the above:
O Egress/lightingplan 0 Other. '
Per inspection 1 1 1
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary con fructlon service. Other /
Not all jurisdictions incept aetht cards. please call )arisdlctian for mem informauoa Notice: This pennit application Permit fee $
O Visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $ t J
credit card number. 1 / within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $
Name of molder as abowo oa credit card
S
Cardholder siyoaluro Amo®1 440 -4615 (M WC0At1
1 'd - SB6- LSS -EOS 2ze..i)l uoseC etts :GO TO OE 2nFi
CITY OF TIGARD BUILDING INSPECTION DIVISION ._ 1nsi•:
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 02`7 AM PM BLD
Location 6 PK Suite Li(L) MEC
Contact Person f \A r 4_P , Ph - 7 SV 1 -7 1 y Z4 PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR D
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation /�)
Drywall Nailing � / C JQ iq CO ICJ /e_— 5-
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling `/ / 44,0Y0
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
PASS PART FAIL
ELECTRICAL
Service
ou h
Slab
Low Voltage
Fire Alarm
/ PASS P T 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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk
Other Date ' Ins Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.