Permit C ITY OF TI GARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
i0 DEVELOPMENT SERVICES PERMIT #: ELR1999 -00312
13125 SW Hall Blvd., Tigard, OR 97223 (503) . -4171 DATE ISSUED: 12/17/99
SITE ADDRESS: 16505 SW 72ND AVE BLDG F 16505-166! PARCEL: 2S113AB -01201
SUBDIVISION: FANNO CREEK ACRE TRACTS (9/ ZONING: I -L
BLOCK: LOT: RISDICTION: TIG
Project Description: Installation of data telecommunication system.
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:
PACIFIC REALTY ASSOCIATES NETWORK CONNECTORS INC
15350 SW SEQUOIA PKWY #300-WMI PO BOX 5361
PORTLAND, OR 97224 OREGON CITY, OR 97045
Phone: Phone: 650 -7748
Reg #: LIC 69942
ELE 3- 313CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT DEB 12/17/99 $60.00 99- 320500 Elect'l Final
5PCT DEB 12/17/99 $4.80 99- 320500
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
requiress yeu10 �ottrn Iles adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0010 through 0' R 952 -00 !'80. You may obtain copies of these rules or direct questions to OUNC at (503)
246 1987. •
lss • d by _J� �� 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 Rec'd • : ' /
13125,SW HALL BLVD Date Rec'd: / 7
TIGARD OR 97223 PRINT OR TYPE
V 503- 639 -4171 X304 Permit #: 52G99 q 003/.
F - 503 - 684 -7297 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
WILL NOT BE ACCEPTED
)e Name of Development Project /
S ' TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
JOB
e/ /t J�l�'/i/1 //VC Restricted
(FOR ALL SYSTEMS) 540.00
Sleet Address
ADDRESS /4 ✓ 05 S 1 � 701 Ste # /104 Check Type of Work Involved:
City/Spe
II vioit7VD p Phone #
b 372 — ( # ❑ Audio and Stereo Systems
Name ❑ Burglar Alarm
Az ligto-
Ei
OWNER Mailing Address Garage Door Opener*
City /State Zip Phone # ❑ Heating, Ventilation and Air Conditioning System*
Name ❑ Vacuum Systems'
iliPrioildt coNe C ❑ Other
CONTRACTOR Mailing Address/ 175
TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a gap (�� 7,� n s ,P n e w #� Fee for each system
copy of all licenses �6rt/ (V f (SEE OAR 918- 260 -260) gon Coontttrr � )
are required if Ore. Brd Lic. # eAd_of Exp. Date v
expired in C.O.T. ((1Q ((�� r' ID-140 Check Type of Work Involved:
data base). Electrical Co tr. Lic. # - 1 —O Exp. Date ;
3- 4 / c (0 /0- D ❑ Audio and Stereo Systems
C.O.T. o Metro Lic. # Exp. Date
0000 31 a- O I ❑ Boiler Controls
Owner's Name
❑ Clock Systems
OWNER - Mailing Address
APPLICANT ® 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:
❑ 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 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 El 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
authori d to bind the applicant. -
iI / / J 0 / � ' FEES: _�' . G
,_
ENTER FEES 5 0
Sig ture
4 � r ;j
8X SURCHARGE (.O8X TOTAL ABOVE) $ • •
Authority if other than Applicant TOTAL $
i:\dstsvesele.doc 7/97 , ///��� L ! / c / e
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested f.-1-/act f'' AM PM BLD
Location / (v cDC Std 7 ' Suite lyd MEC
Contact Person Ph S9' 970 PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC C�
Retaining Wall ELR ig 4 g – M 3/,)-1
Footing Access: •
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: C ✓�,�
Slab �T �'� - SIT
Post & Beam .
Ext Sheath /Shear /
Int Sheath /Shear
./
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling — " -• - ' /5 S
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab rf 9 6'S
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
ou In ^ e m'
UG /Slab
ow oltage
-• -rm
4e
- • SS I 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 reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date 12 - Q9 Inspector Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
4/24/00 Activities for Case #: ELR1999 -00312
1:52:34 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRC001 Application Received 12/17/99 DEB DONE No Hold DEB 12/17/99
ELRC003 Permit Created 12/17/99 DEB DONE No Hold DEB 12/17/99
ELRC400 (F) Ready to issue 12/17/99 DEB DONE No Hold DEB 12/17/99
ELRC799 Elect Final 12/17/99 12/17/99 12/20/99 BRP PASS No Hold RB 12/21/99 Case Final- OK
Wall- Ceiling -Final
ELRC725 Low Voltage Inspection 12/17/99 DEB No Hold DEB 12/17/99
ELRC500 (F) Issue permit 12/17/99 DEB DONE No Hold DEB 12/17/99
ELRA800 Case finaled 12/22/99 JMT DONE No Hold JMT 12/22/99
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