Permit r
CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
Ail J DEVELOPMENT SERVICES PERMIT #: ELR1999 -00203
44- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/1/99
SITE ADDRESS: 10505 SW TIGARD ST PARCEL: 1S134DD-00102
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:
SCHAEFER, DONALD M + MILYNN 0 CABLE RUNNERS
PO BOX 23697 10500 SW, BOONES FERRY RD
TIGARD, OR 97281 PORTLAND, OR 97219
Phone: Phone: 503 - 245 -3669
Reg #: LIC 122854
ELE 26- 951CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT GEO 9/1/99 $60.00 99- 318052 Elect'l Final
5PCT GEO 9/1/99 $4.20 99- 318052
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 through OAR 952-001-00:0. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
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 /v // DATE: 4 9 - 7 — ' 9
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 SVO BLVD Date Rec'd:
TIGARD OR 97223 PRINT OR TYPE
V - 503 - 639 -4171 X304 V/� q— Permit #: -P/f f'CO1RO
F - 503 - 598 -1960 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
WILL NOT BE ACCEPTED
Name of Deve pment Pro TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee $60.00
C42a S i s eV; E-c 3 (FOR ALL SYSTEMS)
JOB Street Address i Ste #
ADDRESS %oS'OS'. SW / v f CA Check Type of Work Involved
Cam' y/State Zip Phone # ❑ Audio and Stereo Systems
/' � 4 y 7tL 3 22.7 - ehr j -
NamE /l ❑ Burglar Alarm
C OCA C Ce✓ri,&_S
d �
El Garage Door Opener*
OWNER M O g A.DOss 236 9 7
/State Zip Phone # ❑ Heating, Ventilation and Air Conditioning System*
�1 O� c
Na / / 28/ L Z7 -yr /, -
❑ Vacuum Systems*
.j 1 G ? - n K - ❑ Other
CONTRACTOR Mailing Ad ess •
/61 GO (A & x'( / - e, vc i&" TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a Cy /S e Phone # Fee for each system $60.00
copy of all licenses e - 17e 04 / / Q7 yp Z �( ZYf 364? (SEE OAR 918-260-260)
are required if Oregon Conf'r. Brd Li . # E D
expired in C.O.T. % 2-L8 S� S /S/ Q/ Check Type of Work Involved:
data base). Electrical Contr. Lic. # Vaiii e
2i - 9s'/ t 7 ❑ Audio and Stereo Systems
C.O.T. r etro Lic. #
6, 7 j, / / ❑ Boiler Controls
Owner's Name
❑ Clock Systems
OWNER - Mailing Address
APPLICANT li d 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 n 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;
F7 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 n Nurse Calls
inspection when the inspector is out to inspect under this permit;
4. Assume responsibility for assuring that all corrections required by the El Outdoor Landscape Lighting*
inspector are done, and; n
Protective Signaling
5. Assume responsibility for calling for a final inspection when all of the
corrections are completed. n 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 installation
authorized to bind the applicant.
FEES: �/ �
�? ENTER FEES $ �D &k -
Signature -a O
7% SURCHARGE (.05 X TOTAL ABOVE) $
Authority if other than Applicant TOTAL $ -' •
r\dsts \forms\resele doc 3/98
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
q BUP
Date Requested //)(c I ? / AM PM BLD
Location l05 . 5C-0 Tccara S7 Suite MEC
ntact Person fO 8 3`f PLM
Co CAI/LS CO CU Ph
Contractor &X ,� , 1 Ph SWR a
•
BUILDING Tenant/Owner ST �U ( CtS ELC 1 qgq c , S7 �
Retaining Wall EL R 1 c iqq - 0 ,;
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
Misc:
Final /
PASS PART FAIL
PLUMBING /c�h /
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
ETCtRICAL)
S!Vtee
Rough In
UG /Slab
Low Voltage
Fire Alarm
.fir
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 I'O Z / _ `g
' Ins ad/f.2pl Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.