Permit CITY T I G A R D ELECTRICAL PERMIT -
4 RESTRICTED ENERGY IT II � VICES
J all DE R
VICES 1639 -4171 DATE ISSUED: g/g gg 99 -00189
SITE ADDRESS: 15575 SW SEQUOIA PKWY 100 PARCEL: 2S112DD -01600
SUBDIVISION: ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
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:
MICRO ELECTRIC VOICE + DATA
SERVICE
24501 S BARLOW RD
AURORA, OR 97002
Phone: Phone: 503 - 266 -5847
Reg #: LIC 131543
• ELE 3- 447CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT DST 8/9/99 $60.00 99- 317486 Elect'I Final
5PCT DST 8/9/99 $4.20 99- 317486
Total $64.20
ORIGINAL
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 t ough 7-0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
Issued by -i / / // Permittee Signature q ' / % / /
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
CITeOF 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 #: E '- c i s rJ
•
F - 503 - 598 -1960 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Cail'd:
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee $60.00
Al R. 700c.“ Ce) l V Gq` (FOR ALL SYSTEMS)
JOB Street Address (4464, Ste #
ADDRESS 45 .50 �c i
� 1'^ � Alb Check Type of Work Involved:
Ci /State Zip Phone # ❑ Audio and Stereo Systems
'7��iz n _ 97L2.-
Name ❑ Burglar Alarm
OWNER Mailing Address ❑ Garage Door Opener*
City/State Zip Phone # ❑ Heating, Ventilation and Air Conditioning System*
Name
p r 11Lt �� -C r�� e . ( ❑ Vacuum Systems*
M IUlD G ► f�1 C.__ Se-fU1Ze5). ❑ Other
CONTRACTOR Mailing Address r
S, RA. 04 TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a pity //Sttatee i Phone # Fee for each system $60.00
copy of all licenses -�W' V y O" 0 1 3 66$'/7 (SEE OAR 918 - 260 -260)
are required if OregoiCgntr. Br ,tic. # ��
expired in C.O.T. `` // 7 1 �i`(�( Check Type of Work Involved:
data base). ectnca Lic. # Exp. ate
— y �L / / / j . ❑ Audio and Stereo Systems
C.O.T. or Metro Lic. # Exp. Date
3 -Ll4 7 Gilt ❑ 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 ❑ 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
authoriz' d to bind the a; plicant.
/ 7. �2 FEES:
Sign. ur- 7 TER FEES $ — uP I o SURCHARGE (.05 X TOTAL ABOVE) $ 4/ a �� V 0 11
Authority if other than Applicant TOTAL $ 6 CI. R
is \dsts \forms\resele.doc 3/98
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
• 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
,qC BUP
Date Requested �d ! / AM PM BLD
Location S 5qU o) a.. Suite / O MEC
Contact Person 6111 Ph T I `3 PLM
Contractor Ph SWR
BUILDING ena Owner ► 7 DL(.C4■-- ELC q
Retaining Wall ELR / / c .' /R7
Footing Access: + /
Foundation —� CO �l G: c . VD ( (-G D
SGN FPS
Ftg Drain ,
Crawl Drain Inspection Notes: bid U�
Slab 7 SIT
•
Post & Beam
Ext Sheath /Shear S
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final i1
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
Low Voltage
Fir- larm
PART FAIL
E
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 ! p e 9 Inspector Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.