Permit C1TY OFTIGARD ELECTRICALPERMIT -
RESTRICTED ENERGY
A I A DEVELOPMENT SERVICES PERMIT #: ELR2002 -00255
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 11/22/02
SITE ADDRESS: 11205 SW SUMMERFIELD DR PARCEL: 2S110DC -00700
SUBDIVISION: WILLOW BROOK FARM ZONING: R -25
BLOCK: LOT: 016 JURISDICTION: TIG
Project Description: Low voltage: Voice and data cabling.
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:
CONGREGATE CARE ASSET V, LTD PTN NETVERSANT CASCADES INC
BY FALCON FINANCIAL 9020 SW GEMINI DRIVE
PO BOX 12188 BEAVERTON, OR 97008
SALEM, OR 97309
Phone: 503- 646 -0533 Phone: 503- 646 -0533
Reg #: ELE 34- 258CLE
LIC 47238`
SUP 2903LEA
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 11/22/02 $75.00 Elea! Final
[TAX] 8% State Tax 11/22/02 $6.00
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 OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699.
Issued by it / ` � ' / Permittee Signature t)'l .c £ -C&
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: (JTt DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
11/20/2002 11:39 FAX 503 641 6613 NetVersant Cascades, Inc la 001
Date received: /- .pPermitno.:' ' - �e) t C ity of Tigard Project/appl. no.: Expire date:
City ofTgard Address: 13125 SW Hall Blvd , �EIED Date issued Receipt no.:
Phone: (503) 639 - 4171
Fax: (503) 598 Case file no.: Payment type:
NOV 20 1002
Land use approval: CITY OF TI
0 1 & 2 family dwelling or accessory Commercial/industrial 0 Multi- family 0 Tenant improvement
O New construction Addition/alteration/replacement 0 Other. 0 Partial
.10B SITE INFORMATION.
Job address: 11205 S W ,SuryirtiRrii cid DZie Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: ( Block: I Subdivision:
Project name:Sodt nemel/ C'(Ubhous( <app Description and location of work on premises: v0 i CE i Dicyriar 641%1_1 A) Cpl
Estimated date of cam' letion/inspection: .S
CONTRACTOR APPLICATION FEE. SCHEI)L1LE :..
dab no: 1011.017f9011 Fee Max Description Qty. (ea.) Total no. insp
Business name:NENERS t'fl $(JAIpe3.. ''vie. New residendal-single or multi- family per
Address: x02.0 S.W. G EWti ✓l1 ORiJE dwelinganitmdudes attached garnge.
City: 7, i, =► ./V State: O R. ZIP: 9'700 Serviceincluded:
Phone:503. Fax: lo41 -Lao c E -mail:
1000 sq. ft. or less 4
Each additional 500 sq. ft or portion thereof
CCB no.: 00 4'1 Z.Z. fS I Elec. bus. lic. no: 3 y . ZSS LE Limited energy, residential 2
City/metro lio. no oC 0 O 3 S S s- energy, non- residential 2
= /.r•f. - I I -20-62. Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): L I S , t 2 A Ucense no: • o3 . Services or feeders - installation,
alteration or relocation:
200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: f State: I ZIP: Over 1000 amps or volts 2
Phone: f Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - .
which is not intended for sale, lease, rent, or exchange according to hutailatitur,alteration, orrelocatioa
ORS 447, 455, 479, 670, 701. " - 200 amps or less 2
201 amps to 400 snips 2
Owner's signature: Date: 401 to 600 am . s 2
ENGINEER Branch circuits - new, alteration,
Name: or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: f State: • I ZIP: B. Fee for branch circuits without purchase
Phone' Fax: E - mail: of service or feeder fee. first branch circuit: 2
Each additional branch circuit
PLAN. REVIEW (Pl'ease•check all :that: apply)::. Misc. (Service or feedernot included):
1 —....---.
O Service over 225 amps- commercial - 0 Health-care facility Each pump or irrigation circle 2
O Service over 320 amps -rating of 1&2 Cl Hazardous location Each signor outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* 1 76. 7S. OC 2
O Building over three stories 0 Feeders, 400 snips or more *Description:
0-Occupant load over 99 persons Cl Manufactured structures or RV park Each additional Inspection over the allowable In any of the above:
O Egtessllightingplan 0 Other. Per inspection 1. l L I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
tztpi all Jw credit accept edit cads, please cell Jmtsdiaioa for mare infmmadoa. Notice: This permit application Permit fee $ '7 S. 0 CD
Visa 0 Ma expires if a permit is not obtained Plan review (at _ %) $
CIttal0E1111Iattc,q10 y 3100 000 N q 7311 . q/ o I / Q3 within 180 days after it has been State surcharge (8%) .... $ (o. O
LCAh K. N4I SON Ex accepted as complete. TOTAL ....................... $ S1 • 0 Cl •
D
• nag of cateald card to shown on credit d $ p' O
AO a.n etas te;eoorcOM1
O a /I �.. Amount
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
!�l BUP
Received Date Requested 0 _ r AM PM BUP
Location l (' 0 S c Suite MEC
Contact Person Ph ( ) PLM
Contractor ` t A �N� . 4 's e-ph ( ) 5 ✓.— c l `1 ' SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access:
Ftg Drain ELR " a 6 oZ S s
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final ., va
PASS PART FAIL 1 1,7 PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer _ i*
Rain Drains "AT
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
<r a) PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
O ADA D 1 IBC' Qp9 Ins ector Approach/Sidewalk o p ft Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL