Permit ., CITY OF TIGARD � ISNI,ECTRICAL PERMIT -
` RESTRICTED ENERGY
I; DEVELOPMENT SERVICES O R PERMIT #: ELR1999 -00123
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/13/99
SITE ADDRESS: 11185 SW 109TH AVE PARCEL: 1 S134DB -03900
SUBDIVISION: CARNAHANS ADDITION ZONING: R -4.5
BLOCK: LOT: 001 JURISDICTION: TIG
Proiect Description: Installation of burglar alarm. Job No. 3283 -HB
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: X BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: :
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
JERGESEN, KEITH & KARRIE ALLTEC SECURITY
11185 SW 109TH AVE PO BOX 55310
TIGARD, OR 97223 PORTLAND, OR 97238 -5310
Phone: 620 -8111 Phone: 331 -2620
Reg #: LAC 001188
ELE 26- 307CLE
FEES Required Inspections
Type By Date Amount Receipt Elect'l Final low UoLTY►mt (r.) •
5PCT DRA 5/13/99 $2.00 99- 315391
PRMT DRA 5/13/99 $40.00 99- 315391
Total $42.00
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 01 ugh OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1 87.
Issue by I , a-�,. Permittee Signature , 3 fa • +�. "-
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. ELECN: DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
RECEIVED ___b 3 8 3
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by: CD .zib //n
13125 SW I-PALL BLVD MAY 13 1999 Date Rec'd: 5 -/ 3 'I f
TIGARD OR 97223 PRINT OR TYPE
V - 503- 639 -4171 X3 uMUNITY DEVELOPMENT Permit #: ft- -dG / 3
F - 503 - 684 -7297 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee 540.00
(FOR ALL SYSTEMS)
JOB Street Address Ste #
ADDRESS I t 1 As s I Check Type of Work Involved:
City /State re_
Phone # ❑ Audio and Stereo Systems
T 1 ro i l 1 0(1- _(ZO-�8I Il
Name.; \ C n22 , Burglar Alarm
t `e
I I e. €X .eS ❑ Garage Door Opener*
OWNER Mailing Address
�^ `_ �D
-( f Cl 5 0.YJd u ❑ Heating, Ventilation and Air Conditioning System*
City /State I Zip I Phone #
Name ❑ Vacuum Systems*
U - t - 2c Se_CU 11ti ❑ Other
CONTRACTOR IN cling Ad ss
O • , ,553 it) TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a C ta - J Zip Phone # Fee for each system 540.00
copy of all licenses T K�JV�C,11QR 912: Y 2.1.01 -177 (p (SEE OAR 918 - 260 -260)
are required if Oregon ontr. Brd Lic. # Exp. Date
expired in C.O.T. I I ?A I31 joO Check Type of Work Involved:
data base). Electrical C ntr. Lic. # Ex D to
2 - 3o 1._t= I(p) I9 ❑ Audio and Stereo Systems
C.O.T. or Metro Lic. # Exp. Date
❑ Boiler Controls
Owner's Name
❑ Clock Systems
OWNER - Mailing Address
APPLICANT n 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 ❑ 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 bin. : applicant.
FEES: �/`� w
If Si. atur-
i ENTER FEES $ 10J
2_, 00
z --ter r] ® +� 5% SURCHARGE (.05 X TOTAL ABOVE) $ I
Authority if other than Applicant TOTAL 5 42_ °a
i:kdsts\resele.doc 7/97
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
/ Date Requested 62- 3'1/ AM PM BLD
•
Location t i' DS �v ( Yl � Suite MEC
Contact Person Ca/IA/0e Ph (02 ! / f PLM
Contractor Al 1-e.al Se-C. Ph ZGpt- - 777Co SWR
BUILDING Tenant/Owner ELC C� QJ�y�
Retaining Wall ELR ) / ' 2 g
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 r' 0 leCilfii/1 Q 1/( lJ / 5' )•Q_.1
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final 1 c l _ � S,
PASS PART FAIL t
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
0 °\-1
Gas Line
Smoke Dampers
Final
PASaRT FAIL
Service
Rough In
UG /Slab
Low Voltage
Fir- larm
- ASS PART FAIL
r
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before ne pection. 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 (C/ ✓ / Inspector ■ sa � '— "Xt
Other p
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
05/30/2000 Activities for Case #: ELR1999 -00123
11:27:22 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRA003 Application received 05/13/1999 DRA DONE No Hold DRA 05/13/1999
ELRA010 Permit created 05/13/1999 DRA DONE No Hold DRA 05/13/1999
ELRA725 Low Voltage Inspection 05/13/1999 DRA No Hold DRA 05/13/1999
ELRA799 Elect'l Final 05/13/1999 05/13/1999 06/03/1999 BRP PASS No Hold AKJ 06/03/1999
ELRA500 (F) Issue permit 05/13/1999 DRA DONE No Hold DRA 05/13/1999
ELRA800 Case finaled 06/03/1999 AKJ DONE No Hold AKJ 06/03/1999
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