Permit J •
CITY OF TIGARD RESTRICTED ELECTRICAL PERMIT -
RESTRI ENERGY
_44I1;� DEVELOPMENT SERVICES PERMIT #: ELR2002 -00088
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/16/02
SITE ADDRESS: 08770 SW SCOFFINS ST PARCEL: 2S102AA -02800
SUBDIVISION: TIGARD HIGHWAY TRACTS ZONING: CBD
BLOCK: LOT: 026 JURISDICTION: TIG
Project Description: Low voltage for Data Cabling.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPEIIRRIGAT:
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:
TUALATIN VALLEY MENTAL HEALTH GREENLINE INC
8770 SW SCOFFINS RD PO BOX 230755
TIGARD, OR 97223 TIGARD, OR 97223
Phone: 503 - 617 -3827 Phone: 968 -1978
Reg #: LIC 103033
ELE 34 -397CL
SUP 3345JLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 5/16/02 $75.00 2720020000 Elect'l Final
5PCT CTR 5/16/02 $6.00 2720020000 •
Total $81.00
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 -0010 through R 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987. _
Issued by �` ,�,��/L Permittee Signature pr), G/w_ • fi
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: 6) G , DATE:
LICENSE NO: -V 5.T1-g
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
05/09/2002 10:31 5039682058 GREENLINE PAGE 01
if r ,d. r .
Electrical Permit Application.
�1 Date received: / 0 v 3,' ,� � � 1 . �� : .
= i C' Q ga r� "� ' ,, g 1` s D Project/8pp%. Expire dam:
City of Tigard Address: 13125 SW Hall Blv cigar 2213 ii. Date issued: By: 21 Receiptno.:
Phone: (503) 639 -41 , Case file no.: Payment type:
Fax: (503) 598 -1960 M.AY a ?
Land use approval: — UI' i xCyl .D T /G�
"1 a•i'i: or P110111
O 1fic 2 family dwelling or accessory 0 Commercial/industrial ❑ Multi- family 0 Tenant improvement
ew construction ( dition/alteration/replaoement O Other: 0 Partial
JOB SlU.1N FOR01ATION
Job address: 5i/0 S sfJ�ir' /JS 54 - Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: Subdivision:
Project name: r ._,..14, tdle C je....I j Description and location of work on premises: g P OW. // 4,14
- Estimated date of completion/inspection: 5 Leo
CONTIZ:ACTOR :11'I'I.ICAI ION 1 S( I Ii:DL1,l;
Maas
Job no: oo Qty Toml tro ax loop
Business name: lS'dr�•lin -� "P c • NewnaidetttW- tangleormalti-fiuilyper
Address: (. o , S ?7i)1 % d ot. Include, sittachedgttrage.
City: & State: p(k ZIP: 0 /7 221 Saavleemdaded: 4
1000 sq, n. or less
Phone: qb8 —1115 IF �5- 7� 5 $ email: Each additional 500 sq. ft. or portion thereof
CCB no.: 10303'5 Elec. bus. lie. no: 3- i C LS Limited energy. residential 2
City /metro ic. no.: Limited worry, non idential MEM 2
r Do
Each manufactured home or modular dwelling III NI 2
• ...-- Service and/or feeder
S o , lens of , ;s electrician (required) Date 11111
5er.ice6 or feeders- bxatallation.
Sop. elect name (print): : .1 • { � alteration ar relocation:
P It 011.1211 MN N1:.K 200 amps or less 2
201 amps to 400 amps
Name (print): 401 amps to 600 II
s to 1000 s
City: lvlailtng address; 601 yaP emP III
II
State: 2
: ZIP: Over 1000 amps er volts 2
Phone: 1 17ax: I E-mail: - Rerbltltec t only aervibes or feeders -
Owner installation: The installation is being made on property l own •� iTallatla4altes� Orfe or refoeatiow
which is not intended for sale, lease, rent, or exchange according to 200 amps arts 2
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps 2
Owner's signature: _ _ . -- Date: 401 to 600 a ■ NM M iMilli
ENGINEER Branch drealts - nee.Ilteration.
or exta+don per panel:
Name: A. Fee for branch circuits with purchase of 2
service or feeder fee, each branch circuit
Address: B. F�xforbtancledteuitewithorapgrdtnse
� State: ZIP: 2
City: _ - of service or feeder fee, first branch circuit:
Phone: Fax: E -mail: Each Additional brunch circuit.
. PLAN ItEV11:A1 (I'Icew thee': all that app) }) Mlae.(Setvl ee or feeder not Included): I __—
Q r more 400 l O H ealth-catefacilily Each pomp or irrigation dale O Se ova 2200 matIng o I Each sie or outline lighten family over 320 amps-rating of 18x2 O Hazardous ove 10.0 are feet four or Signal circuits) or a limited energy panel.
El
family over 600 1]Buildingoveralunit s in one structure '
TOTE residential units alteration, or extension* O Buil over r t ee a nominal O F eeders, amps o (-A 9)1...A tJ '
CI Building over throe gtode -a *Description' - <4 k 'P
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection overthe allowable In any of the above:
O Egress/lightingPltn 0 der: - Per ins 'on
Submit sets of plans wills any of the above.
The above are not applicable to temporary construction service. O t h er Permit fee $ _2,,c_ o0
Itcation ed
tva weep dolt cads,) call jurisdiction for mote mro,me oa notice: 'this permit app i Plan review (at . --r %) $ .
xpi if a t is not obtain p
V is e O M asresCard bG ll� = i
wt 180 da after it has been State surcharge (8%) $ (` O --
Credit card numb - 4024 141(0 t a ccepted as complete. TOTAL $
rmy . l%�-07�1 l
N drown o r . , creei cmd ' ,r T PvC,41 e t 6IDO /Cb
Annuli ( .. a v< 51+ ; S 44o t.O
f10 1Aer rigaatati a cemn \ • - yr J col s 1 .
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested / — / 9 AM PM BUP
Location ")7
a, "C i.4.4.2 Suite MEC
Contact Person Ph ( ) S`'! 7- - X3 '-b PLM
Contractor _ t `. / _ L De . ( ) SWR
BUILDING Tenant/Owner T , ELC
Footing
ELC
Foundation Access: e2 S8'
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fi rewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm •
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
? PART FAIL
SITE El Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 11>t / ! j C)2, Inspector — �� Z / (?f) Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site
PASS PART FAIL