Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
f`1liA DEVELOPMENT SERVICES PERMIT #: ELR2000 -00156
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 06/22/2000
SITE ADDRESS: 12197 SW QUAIL CREEK LN PARCEL: 2S103CB -11200
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5
BLOCK: LOT: 070 JURISDICTION: TIG
Project Description: Installation of audio and stereo system, garage door opener, and CAT 5 computer network.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: X AUDIO & STEREO: INTERCOM & PAGING:
• BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: X CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER::OMP NETWO : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
MIKE PETERSON OWNER
12197 SW QUAIL CREEK LANE
TIGARD, OR 97223 ORIGINAL
Phone: Phone:
Reg #:
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT KJP 06/22/200C $60.00 0003217 Elect'I Final
5PCT KJP 06/22/200C $4.80 0003217
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 thro OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987. /� � v
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 Rec'd by:
13125.SW HALL BLVD Date Rec'd:
TIGARD OR 97223 PRINT OR TYPE
V - 503 -639 -4171 X304 Permit #: ELg a oso oot5J
F - 503 - 598 -1960 INCOMPLETE OR ILLEGIBLE APPLICATION '°\ Cust.Call'd:
WILL NOT BE ACCEPTED )
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
l \ 1 Restricted Energy Fee $60.00
/ � 1.
6 C 0. - . I r 1 \6 to (FOR ALL SYSTEMS)
JOB Street Address Ste #
ADDRESS Check Type of Work Involved:
l.Z /9 7 s� ro; f c,er.i ,
City /State Zip Phone # JR1 Audio and Stereo Systems
NarM // 0 Burglar Alarm
/ ` ' `-C / ` n e.reir_s- yL
OWNER Mailing Address t Garage Door Opener'
C/?k' „2 P. ❑ Heating, Ventilation and Air Conditioning System*
taZip Phone #
Nap* � O � 4 � ZO'9is � ❑ Vacuum Systems*
M Other C4 /(/eisvos`
CONTRACTOR Mailing Address
TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a City /State Zip Phone # Fee for each system $60.00
copy of all licenses (SEE OAR 918 - 260 -260)
are required if Oregon Contr. Brd Lic. # Exp. Date
expired in C.O.T. Check Type of Work Involved:
data base). Electrical Contr. Lic. # Exp. Date
n A udio and Stereo Systems
C.O.T. or Metro Lic. # Exp. Date
❑ 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;
❑ L andscape Irrigation Control*
2. Call for inspections when installation under this permit are ready for
inspection at 503- 639 -4175; ❑ M edical
3. Purchase separate permits for all installations that are not ready for an ❑ N urse 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 bind the applicant.
FEES:
0
Signature
ENTER FEES $
8% SURCHARGE (.08X TOTAL ABOVE) $ O
Authority if other than Applicant TOTAL $
is \dsts \forms \resele.doc 3/98
' CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
• • BUP
Date Requested ) AM PM BLD
Location / Z/ r 5 W Cp( i f C ti.. J Suite MEC
Contact Person Ph z Z_ -3 / r3 PLM
Contractor ac1 Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR 024U0 -00 /14
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: / Slab 14 w C/ S SIT
Post & Beam /
Ext Sheath/Shear A i - / -c r — �•-
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
PASS PART FAIL
cELEtTRICA
` Srvice
Rough In
UG /Slab
w o
Fir- rarm
ink
ART 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
Other Date lg Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 7'" 3 AM PM BLD
Location f / 5 7 5'.' Quo t ( CiLa i Lfr•- Suite MEC
Contact Person in / /(_e Ph G?.G —4/ 5 L PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR 00/ 5
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
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof _ r ' ! —C Misc:
Final 1
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
Volt
Fire Alarm
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 O3 D0 Inspector Q,7 1.� =�� < Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.