Permit _:. ..',„ . .
A CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
��� DEVELOPMENT SERVICES PERMIT #: ELR2000 -00153
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 06/20/2000
SITE ADDRESS: 12259 SW 69TH AVE PARCEL: 2S101AA- 038006 __ _.
SUBDIVISION: TIGARD CORPORATE CENTER ZONING: MUE
BLOCK: LOT: 00B JURISDICTION: TIG
Proiect Description: Data telecommunication installation.
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:
TIGARD CORPORATE CENTER LP
15400 SW MILLIKAN WAY
BEAVERTON, OR 97006
Phone: Phone:
Reg #:
FEES Required Inspections --
Type By Date Amount Receipt Low Voltage Inspection '
PRMT GEO 06/20/200C $60.00 0003124 Elect'/ Final
5PCT GEO 06/20/200C $4.80 0003124 •
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 th ugh •A:. 952 - 001 -0080. You may obtain copies of these rules or direct quest() to OUNC at (503) • .
246 -1987. /
Issued b / // //% 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: J , DATE: 6 06)
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
,. tY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by:
,13125 SW HALL BLVD Date Recd:
TIGARD OR 97223 PRINT OR TYPE
V - 503-639 -4171 X304 Permit #: fci A6 - BO/ 53
F - 503 - 598 -1960 INCOMPLETE OR ILLEGIBLE APPLICATIONS CustCall'd:
JOB: 119 -9070 WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee._ ..... »_._..._......._........._ =80.00
RENAISSANCE HOLDINGS INC (FOR ALL SYSTEMS)
JOB Street Address Ste*
ADDRESS 12259 SW 69TH BLDG B Check Type of Work Involved
City/State y/ D I /j 7 2 2 3 Phone*
TIGARD ❑ audio and Stereo Systems
Name ❑ Burglar Alarm JUN 1 2000
OWNER Mailing Address ❑ Garage Door Opener' cOMMJ ji iY t)E. ELuPI ; ;:IM I •
City /State I rp Phrnre • ❑ Heating, Ventilation and Air Conditioning System'
QUESTIONS? Name ❑ Vacuum Systems'
CARL STENSRUD CHRISTENSON ELECTRIC, INC. ❑ Other
CONTRACTOR Mailing Address
•
111 SW COLUMBIA, SUITE 480 - TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a City/State Phone* Fee tor each system....... .... ....... ..... - „_..- ....... - -. $60.00 .
copy of all licenses PORTLAND OR .16/201 241 - 4812 (SEE OAR 918 - 280.260)
are required if Ore on 8 ' / 1 / Contr. Brd LLk. # Ft Dom,
expired in C.O.T. 5 Check Type of Work Involved:
data base). Electrica gcn r # 5T /Th0 ❑ Audio and Stereo Systems
4 T 6 orMMettmU # T/n /0)
❑ Boiler Controls
Owner's Name
OWNER - Mailing Address ❑ Clock Systems
APPLICANT IY Data Telecommunication Installation
City /State 14 I 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:
❑ instrumentation
1. Only use electrical rwensed 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 Cantor
2. Cali for inspections when installation under this permit are ready for
Inspection at 503. 6394175; ❑ Medical
3. Purchase separate permits for all installations that are not ready for an
inspection when the Inspector is out to inspect under this permit ❑ Nurse Calls
4. Assume responsibility for assuring that all corrections required by the 0 Outdoor Landscape Lighting -
inspector are done, and;
❑ Protective Signaling
5. Assume responsibility for calling for a final inspection when all of the
corrections are completed. ❑ Other
Permits are non - transferable and nonrefundable and expire if work Is not
started within 180 days of issuance or if work is suspended for 180 days. Number of Systems
The person signing for this perms u the applicant or a person • No licenses are required. Licenses are required for all other installations
authorized to b the applicant
FEES:
6/14/00 60.
Si nature ENTER FEES $
at )SURCHARGE gitTX TOTAL ABOVE) $ 4.80
/
Authority if other than Applicant TOTAL $ 64.80
kldsblforms resele.doc 3199
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639-4175 Business Line: 639-4171
BUP
Date Requested $' ' AM PM BLD
Location /„2 2 r' 5 w Suite G MEC
Contact Person /77I / Ph 9 T mil/ PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR 201/1/ -- e"/ 1 3
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
Firewall
Fire Sprinkler /t�L
Fire Alarm
Susp'd Ceiling
Roof a
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 1 ,
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
,eray VoltagID \
Fire Alarm
CIO 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
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date /3p Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.