Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
N DEVELOPMENT SERVICES PERMIT #: ELR2000 -00186
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/10/00
SITE ADDRESS: 12559 SW 69TH AVE * ** PARCEL: 2S101AA -09108
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 030 JURISDICTION: TIG
Proiect Description: PERMIT FOR PROTECTIVE SIGNALING
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:
Owner: Contractor:
R + D PROPERTY DEVELOPMENT LLC SELECTRON INC
BY BENNETT POWER + ASSOC 7225 SW BONITA RD
7991 SW MOHAWK ST TIGARDND, OR 97224
TUALATIN, OR 97062
Phone: Phone: 639 -9988
Reg #: LIC 00064341
ELE 26- 497CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT GWL 8/10/00 $60.00 0004396 Elect'l Final
5PCT GWL 8/10/00 $4.80 0004396
Total $64.80
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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
Issued by 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:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Recd by: 1/ a ,. /
13125 SW HALL BLVD Date Recd:
TIGARD' OR 97223 PRINT OR TYPE
Vs: 503 -639 -4171 X304 Permit #: fit fL zadd b oif,6
F - 503 - 598 -1960 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
WILL NOT BE ACCEPTED
Name of !Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
'' Restricted Energy Fee $60.00
l rr le..(.44,6tAvei (FOR ALL SYSTEMS)
JOB Street Address Ste #
ADDRESS r'� 55 / 6 9 r / a�� Check Type of Work Involved:
C SCS`vS
to ^ 4 i � er #� �z) n Audio and Stereo Systems C 0
c ame n Burglar Alarm G
n Garage Door Opener* G % o*
OWNER Mailing Address Q► EN
Heating, and Air n ELDeM
City /State f Zip I Phone # n g ��
n Vacuum Systems'
Co* �9�Ystem'
Name I
� n Other
CONTRACTOR Ma g_Add TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a CM Fee #� Fee for each system $60.00
copy of all licenses �/ /�/ f!D� / 6 O (SEE OAR 918-260-260)
are required if Oregon C t Brd Lic. # Ef t
expired in C.O.T. 1 /� Check Type of Work Involved:
data base). Electri I Contr. Llc. # E
(/ - L/q 7GL `(� % 2 0 Audio and Stereo Systems
• C.O.T. or Metro i . # Exp.
(fin / U5 /� Boiler Controls
Owners Name 7 � - / ❑
0 Clock Systems
OWNER - Mailing Address
APPLICANT ❑ Data Telecommunication Installation -
City /State I 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: n Instnmmentatlon
1. Only use electrical licensed persons to do installations where required. .
_ Certain residential and other transactions are exempt from licensing. n 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 503- 639 - 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 n 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 non - refundable 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 permit must be the applicant or a person _ • No licenses are required. Licenses are required for all other installations
authorized to ind the applicant.
FEES:
Signature ENTER FEES $ �L/
8% SURCHARGE (.08X TOTAL ABOVE) $
Authority if other than Applicant TOTAL $ , i1)
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•
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUY
Date Requested P AM F PM , BLD
Location 5" G 9 A -t° Suite MEC
Contact Person icg...67-57
Ph 33, PLM
Contractor ( Ph e 39— P fb SWR
BUILDING Tenant/Owner ( D -�z ELC
Retaining Wall c ELR iw - 'Gu / 6.
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab V ' { S ip , � - l.�' SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing •
Fire wall
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
ELECTRICAL
Service
Rough In
UG /Slab
•
w Volta
e arm
Fin
SS T 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 reinspection RE: r ] Unable to inspect - no access
ADA
Approach /Sidewalk 3 /-
Other Date _ Ins Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.