Permit •
CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
�y� DEVELOPMENT SERVICES PERMIT #: ELR1999 -00319
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/28/1999
SITE ADDRESS: 11735 SW QUEEN ELIZABETH ST 102 PARCEL: 2S110CD -00104
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT: JURISDICTION: KIN
Project Description: Data Telecommunication Installation.
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:
JOHN D. MEDAK ALLEN/FALK INC
VIUHKOLA, JENNIFER 9020 SW GEMINI
4029 NE SANDY BLVD. BEAVERTON, OR 97008
PORTLAND, 97213 : 6 47238 ORIGINAL
Phone: 287 -5-5 718 Phone: 646 -0533
Reg #: C
SUP 781JLE
ELE 34258CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT KJP 12/28/199E $60.00 99- 320699 Elect'l Final
5PCT KJP 12/28/199E $4.80 99- 320699
Total $64.80
•
This Permit is issued subject to the regulations contained in the Tigard Muniapal 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 throw R 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987. _ •
Issued by Permittee Signature °L / - • ►•
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:
•
CONT CTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N j �. 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 1%(N Permit. #: F1- R. 19 ?T - 00 3 19
F - 503 - 598 -1960 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
• • WILL NOT BE ACCEPTED
•
. Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee $60.00
G cr\s be.ved\oymork r- (FOR ALL SYSTEMS) •
JOB Street Address SS# f /dam Check Type of Work Involved:
ADDRESS %1735 Sw' QtAwn El;za f .
ity /State Zip Phone # ❑ Audio and Stereo Systems
I n L 91 aa 'VA - P3 a3
' Nam `r ❑ Burglar Alarm
• S h n / 4 e � * She;,44, `U ►kd e
• OWNER ilmg Address � ❑ Garage Door Opener*
d E S * ((" v ❑ Heating, Ventilation and Air Conditioning System*
o L,0 ! Z J am-. J 7s7/?
/ Name ❑ Vacuum Systems*
•
Allen I Falk / - Enc' • ❑ Other
CONTRACTOR Mailing Address
° noap SW Ge.rnin1 • PIri Vt- TYPE OF WORK INVOLVED - COMMERCIAL ONLY '
(Prior to issuance a ty /State Phone # Fee for each system $60.00
- copy of all licenses � e�vt4}ph "1 i j py, $ (pt- i)� -O63 (SEE OAR 918 - 260 -260)
are required if Oregon Contr. Brd # E Date •
expired in C.O.T. L-11 3 9 /)( ✓ Check Type of Work Involved:
data base). Electrical nt Lic. Exp. to '
3or
1— asgGL 1 o of 0 ❑ Audio and Stereo Systems
C.O.T. or MetroSSS I OD ❑
..�� 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; El
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.
i FEES:
�— Si‘7r,74. 6-
Signature ,F TER FEES $ (,QO.00
o ' i ,go
sk SURCHARGE (.05 X TOTAL ABOVE) $
Authority if other than Applicant • TOTAL $ Cpy . $D
• hdsts\forms\resele.doc 3/98
4 •
KING CITY
)II Alle
15300 S.W. 116th Avenue, King City, Oregon 97224 -2693
IMIIIMIIIMIN Phone: (503) 639 -4082 • FAX (503) 639 -3771
Notice To Contractors Working In King City
Due to an intergovernmental agreement with the City of Tigard, many building related permits
for projects in King City are issued and inspected by the City of Tigard.
If your permit application DOES NOT REQUIRE PLAIN REVIEW, simply complete the
appropriate application legibly and submit it to the King City staff. The King City staff will
collect all fees and fax the application to the City of Tigard. City of Tigard staff will then create
the permit, issue the permit, and perform inspections. Please indicate on the permit application
whether you would like the Tigard staff to call you when the permit is ready for issuance or
whether you prefer it to be mailed without any notification. Any incomplete or illegible
application will be returned to King City staff for correction and no processing will occur until a
complete, legible application is received.
If your permit application DOES REQUIRE PLAIN REVIEW, this form must be signed by a
King City staff person. King City staff will simply sign this form indicating land use approval.
Take this signed form to the City of Tigard Development Services Counter located at 13125 SW -
Hall Blvd, Tigard, to submit applications and plans. Development Services Technicians are
available at 639 -4171 Ext. 304 should you have any questions concerning submittal
requirements. All permit fees will be assessed and collected at the City of Tigard.
The City of King City hereby authorizes applicant to pursue permits at the City of Tigard
Building Department for the following project: -C.e.: .
located at: I I '1 3 5 SW aegn l
King City Representative a - „i' - qy
I:'DSTS000INST.DOC
2/3/00 Activities for Case #: ELR1999 -00319
1:54:43 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRC001 Application Received 12/28/99 • KJP RECD No Hold KJP 12/28/99
ELRC003 Permit Created 12/28/99 KJP DONE No Hold KJP 12/28/99
ELRC725• Low Voltage Inspection 12/28/99 KJP No Hold KJP 12/28/99
ELRC799 Elect'l Final 12/28/99 12/28/99 12/30/99 BRP PASS No Hold AKJ 1/2/00
ELRC500 (F) Issue permit 12/28/99 KJP DONE No Hold KJP 12/28/99
• ELRC800 Case finaled 1/2/00 AKJ DONE No Hold AKJ 1/2/00
•
•
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
p BUP
Date Requested Xgc)./ 1 9 AM X PM BLD
Location < < � c?i#t - I \ Suite MEC
Contact Person Ph. 2 SS—'t PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC few —001,c1 7
Retaining Wall - ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: (M ^ ^, _ n p m_ SGT
Slab w �` �l /' lLC-� SIT
Post & Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation f —
Drywall Nailing , _C - l qr c L �j - 0 6 d ? 7 QSS S
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
. Roof / — 0 " , ' . O l
Misc:
Final • PART FAIL A. D • S 0 �,
PLUMBING < l-L — ! Z � L — ' —
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
(
cELECTRI
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
1 PART FAIL
Backfill/Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. y 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 0 - Inspector Ext
Other
Final 111
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.