Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
A DEVELOPMENT H B p E r SERVICES 2 PERMIT 00202
- 13125 1 639 -4171 DATE ISSUED: SSUED: % 9
ED: 99
SITE ADDRESS: 12559 SW 69TH AVE * ** PARCEL: 2S101AA -09108
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 030 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: DATAJTELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
•
PORTER, DENISE + CTI CORPORATE TELECOM
BENNETT, SUE 16369 NE CAMERON BLVD
7991 SW MOHAWK ST PORTLAND, OR 97230
TUALATIN, OR 97062
Phone: Phone: 503 - 254 -3302
Reg #: LIC 68997
ELE 26- 722CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT GEO 9/1/99 $60.00 99- 318047 Elect'I Final
5PCT GEO 9/1/99 $4.20 99- 318047
Total $64.20
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 •52- 001 -1080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
Issued by 4 ��� �4��� Permittee Signature \
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 /JA DATE: q-/- 9�
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
08/26/99 THU 15:08 FAX 503 598 1960 CITY OF TIGARD Ij002
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by:
1312 ,SW HALL BLVD Date_Rec'd:
' TIGARO OR 97223 PRINT OR TYPE
V - 503 - 639 -4171 X304 Permit #: f /9f"4 U-7
F - 503 - 598 - 1960 INCOPOLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
WILL NOT'BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
y,� Restricted Energy Fee $80.00
`r )P :Ai/IP_ hf I (a' A- 'C ice. (FOR ALL SYSTEMS)
JOB Street Address Ste #
ADDRESS 4;,1557 sw 6 • Check Type of Work Involved:
City/Stale - Zip 2 Phone # /' ❑ Audio and Stereo Systems
I♦ - .
Na ❑ Burglar Alarm
R a - D \ P Ot(Yi 2 \- �'C to of , \ N4 ❑ Garage Door Opener'
OWNER Mailing Address
City /State I Zip f Phone # ❑ Heating. Ventilation and Air Conditioning System'
Name t ❑ Vacuum Systems*
•
0 TI 0 hi int0 T .f(cs o ❑ other
CONTRACTOR ailing Ad re / •
�
I U ,`)I0 IV (" v11 e V , v • TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a , y /Sta - * Zi • Phone # Fee far each system... $80.00
copy of all licenses p e /_ 8 \ • 0 - - •) r 1SEE OAR 918- 260 -260)
are required if Oregon ontr. = • ic. # •
expired in C.O.T. / • / �•� ( Check Type of Work Involved:
data base). n Exp. Oat
i ; , j ) j4 • ❑ Audio and Stereo Systems
C. • T. or etro LIc. # Exp. • ate
, - _ .del'— ❑ Boiler Controls
' • ner's Name
❑ Clock Systems .
OWNER - Mailing Address
APPLICANT [il 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:
El 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 803439- 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 Q Outdoor Landscape Lighting'
inspector are done, and;
❑ Protective Signaling
5. Assume responsibility for calling for a final inspection when all of the Fl corrections are completed. I Other .
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. Nuritber 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
autho • to bind the applicant. i
FEES:
.i p0
Sjnature ENTER FEES 8
`j% ko SURCHARGE (.05 X TOTAL ABOVE) $
Authority if other than Applicant TOTAL S
1;Wsts formsvesele.doc 3/98
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
T---22-?/' BUP
Date Requested AM PM BLD
Location 1 2559 (0'1'114 -- Ave Suite MEC
Contact Person (21--
,) Ph X (0 G f — / (D q g PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC �
Retaining Wall ELR I / p (Q 9 -00 G.0
Z
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
e t
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
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
LECTRIC
Service
44
1JWS a
Fire arm
Final
PART FAIL
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 r ' nspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.