Permit CITYOFTIGARD
,; i .; � DEVELOPMENT SERVICES ELECTRICAL PERMIT -
L 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 RESTRICTED ENERGY
PERMIT ##: ELRS7- -0075
DATE ISSUED: 0.1/13/97
PARCEL: 2S 1 12AC -02 1 00
SITE ADDRESS...: 14915 SW 72ND AVE
SUBDIVISION....: FANNO CREEK ACRE TRACTS ZONING:I - -L
BLOCK............ LOT .............:47
Project Description: instl 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: 1
-------
OREGON MICRO IMAGING INC type amount by date recpt
14915 SW 72ND AVE {PMT $ 40.00 TAT 03/13/97 97- 291664
SPCT $ 2.00 TAT 03/13/97 97- 291664
TIGARD OR 97223
Phone ff:
Contractor: - - - - --
OOPS $ 42.00 TOTAL
REQUIRED INSPECTIONS
Ceiling Cover Elect'l Service
Phone 4: Wall Cover Elect'l Final
Reg 4... • D
This persit is issued subject to the regulations contained in the / lid
d
Tiara; Municipal C.de, State of Ore. Specialty Codes and all other Permitee ignature
applicable laws. All work will be done in accordance with
/
approved plans. This perait will expire if work is not started / ��� �//
within 183 days of issuance, or if work is suspended for tore �f
than 180 days, Is - red By,
- - - - - -- -- - - - - -- -- • - - - -- - -OWNER INSTALLATION ONLY--------------- -----
The installation is being made on property I on 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 for inspection, - 639 -4175
Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd. 1 (i'�� — 0075
Tigard, OR 97223 PERMIT # VIl VU /
/4,4,41A 1�1 ;f ;i Phone (503) 639 -4171
I FAX (503) 684 -7297 DATE ISSUED
TDD No. (503) 684 -2772
CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BY (� l
PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTALLATION 4. TYPE OF WORK
/ 5i j 12 AID A vE
Address RESIDENTIAL — Restricted Energy Fee 54
r.flarid. 0 A 97 0.00
(FOR ALL SYSTEMS)
City State Zip Check Type of Work Involved:
PERMITS ARE NON - TRANSFERABLE AND NON - REFUNDABLE AND EXPIRE IF WORK ❑ Audio and Stereo Systems
IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR
180 DAYS. ❑ Burglar Alarm
❑ Garage Door Opener*
2. CONTRACTOR APPLICATION •
❑ Heating, Ventilation and Air Conditioning System*
Contractor AAA Aklarn') Type Li / i m EVL ❑ Vacuum Systems*
Address 78 , 0 C r r (t 5 -U C'( V2 Bpoute Ton' ❑ Other
A / -/ g7
Date ✓)7 / A 1 COMMERCIAL — Fee for each system 540.00
A '' f (SEE OAR 918- 260 -260)
Property Owner Or et? 1"` 1 GY'O �.a�1VIU%�! Y5, J JC. Check Type of Work Involved:
�y
Gi �p .G� J
Contractor's Board Reg. No. CO `� 3 a q a U ❑ Audio and Stereo Systems
' / ❑ Boiler Controls
y
Phone # 6 (p - a 7M0 ❑ Clock Systems
3. OWNER APPLICATION ❑ Data Telecommunication Installations
❑ Fire Alarm Installation
❑ HVAC
Print Owner's Name Phone No
❑ Instrumentation
•
Address ❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
City State Zip ❑ Medical
This permit is issued under OAR 918- 320 -370. This applicant agrees to make only ❑ Nurse Calls
restricted energy installations (100 volt amps or less) under this permit and to do the ❑ Outdoor Landscape Lighting*
following:
1. Only use electrical licensed persons to do installations where required. (Certain Protective Signaling
residential and other transactions are exempt from licensing. These have ❑ Other
asterisks( *). All others need licensing).
2. Call for an inspection when all of the installations under this permit are ready
for inspection at 503- 639 -4175. ❑ / Number of Systems
3. Purchase separate permits for all installations that are not ready for inspection
when the inspector is out to inspect under this permit. • No licenses are required. Licenses are required for all other installations.
4. Assume responsibility for assuring that all corrections required by the inspector
are done, and
5. Assume responsibility for calling for a final inspection when all of the 5. FEES .
corrections are completed.
The person signing for this permit must be the applicant or a person a. Enter Fees $ do • 00
authorized to bind the applicant.
b. 5% Surcharge (.05 x total above) $ c 1.00
Signature TOTAL $ `1-- -
Authority if other than applicant
ENERGAP.CHP
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 379/9 9 AM PM BLD
Location /` 9/.C 5 71�'`= Suite MEC
Contact Person nert/ i1'fr�� Ll Ph PLM
Contractor / ,4 Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR 99-00075-
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Ins ectior�otes:
Slab A ZI SIT
Post & Beam
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
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
FAIL
ELE
Service
Rough In
UG /Slab �.
Low Voltage
Fire Alarm A
iat 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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA /
Approach/Sidewalk
Other Date J q Inspector ) Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
6/2/99 Activities for Case #: ELR97 -00075
2:14:10 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRC001 Application Received 3/13/97 3/13/97 TAT 3/13/97
ELRC003 Permit Created 3/13/97 3/13/97 TAT 3/13/97
ELRC700 Ceiling Cover 3/13/97 TAT 3/13/97
ELRC720 Wall Cover 3/13/97 TAT 3/13/97
ELRC731 Elect'I Service 3/13/97 TAT 3/13/97
ELRC799 Elect'I Final 3/13/97 JT 9/16/98 9/16/98 inspection request
(research) to Chuck D.
ELRA500 (F) Issue permit 3/13/97 TAT PASS TAT 3/13/97
ELRA920 Miscellaneous action 4/26/99 AKJ DONE No Hold AKJ 4/26/99 inactivity letter sent
ELRC799 Elect Final 5/4/99 5/4/99 5/4/99 CD PASS No Hold AKJ 5/4/99
ELRC800 Case finaled 5/4/99 AKJ DONE No Hold AKJ 5/4/99
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