Permit CITY OF TIGARD
DEVELOPMENT SERVICES ELECTRICAL PERMIT —
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 RESTRICTED ENERGY
PERMIT #: ELR97 -0266
DATE ISSUED: 09/16/97
PARCEL: 2S101AA -09800
SITE ADDRESS...:12570 SW 69TH AVE #101
SUBDIVISION •MLP95 -0013 ZONING:MUE
BLOCK • LOT •001 JURISDICTN: TIG
Project Description : Add voice and data telecommunication installation to
existing commercial •
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO...: AUDIO & STEREO..: INTERCOM & PAGING..:
BURGLAR ALARM BOILER LANDSCAPE/ IRRI GAT. .:
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: FEES
JT ROTH JR type amount by date recpt
12600 SW 72ND AVE PRMT $ 40.00 GEO 09/16/97 97 -299282
STE 200 5PCT $ 2.00 GEO 09/16/97 97- 299282
TIGARD OR 97223
Phone #: 639 -2639
Contractor:
NETWORK SOLUTIONS, INC. $ 42.00 TOTAL
1820 SW. VERMONT
SUITE J REQUIRED INSPECTIONS
PORTLAND OR 97219 Ceiling Cover Low Voltage Insp
Phone #: 244 -7244 Wall Cover Elect'l Final
Reg #..: 001024
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. 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 188
days of issuance, or if work is suspended for more than 188 days. ATTENTION: Oregon law requires you to follow rule adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 9552 01 through OAR 952 801-0088. You may obtain copies of
these rules or dir ques ;f r (583)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: O9-
LICENSE NO:
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 6:00 P.M. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + ++ + + + + + + + + + + + + + + + + + + ++
.CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by:
13125 SW HALL BLVD Date Rec'd:
TIGARD OR 97223 PRINT OR TYPE
V - 503 - 639 -4171 X304 Permit #: C-7? 97 - oa66
F - 503 -684 -7297 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL
Restricted Energy Fee $40.00
XeC V k h (FOR ALL SYSTEMS)
JOB Street Address , Ste #
ADDRESS 1151 0 5 ■n1 b e - l 1 I \ Check Type of Work Involved:
�4y /State Zip Phone # El Audio and Stereo Systems
\ ‘ 5e.r• d ry
Name ❑ Burglar Alarm
OWNER Mailing Address ❑ Garage Door Opener
City /State I Zip I Phone # El Heating, Ventilation and Air Conditioning System*
N me
* a ❑ Vacuum Systems*
l 1 A -vhtIL Sclko + .S Sv,,c ❑ Other
CONTRACTOR Mailing Address
V8a0 5 t,J V et •440. 1:t—S— TYPE OF WORK INVOLVED - COMMERCIAL
(Prior to issuance a ty/State Zip Phone # Fee for each system $40.00
copy of all licenses t ty {- U r i I `n2\A 2 )zk-ly (SEE OAR 918 -260 -260)
are required if Oregon Contr. Brd Lic. # Exp. Date
expired in C.O.T. I 172ti' Check Type of Work Involved:
data base). Electrical Contr. Lic. # Exp. Date
l US to Th L- G. ❑ Audio and Stereo Systems
C.O.T. or Metro � �c # Exp Date ❑
-. Boiler Controls
Ow,4 er's Name D
\S{ V Cr._ ( v 0./∎ ❑ Clock Systems
OWNER - Mailing Address ,
APPLICANT \11.. p 5t.„) V ersMt)h.V_ v12-7— ICS Data Telecommunication Installation
C' /State I Zip I Phone # ❑
(X Ore_ COI-1c\ 9-`tV -1).44 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:
❑ 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;
El 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 ❑ 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. 1 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 bind the applicant.
A O ""' L ' f i t - reAU-di -kw E R FEES 0, /
ignature $
5% SURCHARGE (.05 X TOTAL ABOVE) $ Aa
Authority if other than Applicant TOTAL $ 4
i:1resele.doc 12/96 —
1 11 •
0 911 I
C TY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: AO /3 - 9 7 AM. P.M. MST: •
Location: 1,2_570 pp X� � ( / (�� BUP:
Tenant: El CU� Suite: l6/ / Bldg: MEC:
Contractor: ■.01 _I .4 ,_//,, 11 Phone: V y.-- 7� 9 PLM:
i �� /
Owner: • /. .��1 /� � _...__ . /lt .4 Phone: ELC:
ELR: p / 7-00...1.66
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL LECTRICAL ) SITE
Site Post/Beam Post/Beam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service NIISC.
Masonry Ceiling Rain Drain A/C UG Slab •
Shear /Sheath Fire Spk1r /Alm Crawl/Found Dr Heat Pump ow ' o (x ,
Approved Approved Approved • . . • ved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved • - ..roved Not Approved
FINAL FINAL FINAL FINAL FINAL
4.1111M ' .. ,Id s.
--- - ( 7 5 -
O Call for reinspection O Reinspection f $ required before next inspection O Unable to inspect
(
Inspector: e ( ` Date: j 7 �` 7 Page i of