Permit A. CITY OF TIGARD
�.� i ��,� DEVELOPMENT SERVICES ELECTRICAL
ENERGY
PERMIT #: ELR99 -0027
DATE ISSUED: 02/18/99
PARCEL: 25112DD -00800
SITE ADDRESS...:1567O SW UPPER BOONES FERRY RD
SUBDIVISION ZONING:C —G
BLOCK • LOT • JURISDICTN: TIG
Proj ect Description : Installing video camera
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO...: AUDIO & STEREO..: INTERCOM & PAGING..:
BURGLAR ALARM • BOILER • LANDSCAPE/ IRRI GAT. .:
GARAGE OPENER • CLOCK • MEDICAL •
HVAC • DATA /TELE COMM..: NURSE CALLS •
VACUUM SYSTEM • FIRE ALARM • OUTDOOR LANDSC LITE:
OTHER: .. HVAC • PROTECTIVE SIGNAL..:
INSTRUMENTATION.: OTHER.. :VIDEO ::X
TOTAL # OF SYSTEMS: 1
Owner: FEES
CHEVRON USA PRODUCTS CO type amount by date recpt
6001 BOLLINGER CYN RD BLDG L -1114 PRMT $ 40.00 B 02/18/99 99- 313069
SAN RAMON CA 94583 5PCT $ 2.00 B 02/18/99 99- 313069
Phone #: 510 -842 -9500
Contract or:
ASSET PROTECTION PARTNERSHIP $ 42.00 TOTAL
2352 WILLAMINA AVE
REQUIRED INSPECTIONS
FOREST GROVE OR 97116 Ceiling Cover Low Voltage Insp
Phone #: 503 - 359 -4344 Wall Cover Elect'1 Final
Reg #.. : 117887
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. 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 rule adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952 -001 -0080. You may obtain copies of
these rules or di questio s to OUNC at (503)246 -1987.
Issued by V Permittee Signaturex
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: Ivtt DATE:
LICENSE NO:
+++++++++++++++++++++++++++++++++++- i-+++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
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: Z
TtiGA OR 97223 PRINT OR TYPE ,,.. pp
V - 503 - 639 -4171 X304 Permit #: -5l�gil - 017
F - 503 - 684 -7297 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
- 1 _ Restricted Energy Fee $40.00
1
I •'i SCdr !e C1 VeYO Y1 (FOR ALL SYSTEMS)
JOB Street 4Alddress Ste #
ADDRESS / %-/ Q Sc() Va►er 13c -cerY 6 Check Type of Work Involved'
Zip Phone # ❑ Audio and Stereo Systems
LL(,e er 3 '_ q 63i-3
Name ❑ Burglar Alarm
OWNER Mailing Address ❑ Garage Door Opener'
City /State Zip Phone #
El Heating, Ventilation and Air Conditioning System*
Name f ❑ Vacuum Systems*
ikSSG� o { 'k ) 41 r +Me di t p ❑ Other
CONTRACTOR Mailing Address '/�
0235- (tii t ( ,� 9 A v e TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a City/State Zip Phone # Fee for each system $40.00
copy of all licenses forest-- Grove T (I(,, -0 '355-4 34 (SEE OAR 918 - 260 -260)
are required if Oregon Contr. Brd Lic # Exp Date
expired in C.O.T. 1 (`) ca T? Check Type of Work Involved.
data base). Electrical 4p91r.pc. it Exp Date
'-39 — 4 S7 C.(_ ❑ Audio and Stereo Systems
C O.T or Metro Lic. # Exp Date
❑ 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;
1 1 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 V V '
corrections are completed. M. Other I U eO rev' S
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 o bind the applicant.
A y.? � Egg a:
ENTER FEES $ 10 0
Signature
5% SURCHARGE (.05 X TOTAL ABOVE) $ 2-
Authority if other than Applicant TOTAL $ 02. 00
i \dsts \resele.doc 7/97 —
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 0 . AM PM BLD
Location 75 7 E> eJ 7Gr- Suite MEC
Contact Person Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner GA. -ur---v ELC W 06
Retaining Wall ELR — 67 .0 — 77
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 E- 9k -
Firewall
Fire Sprinkler
Fire Alarm / / DEG
Susp'd Ceiling L�G�� / — DD -7 •~ - ,V-rg /rr
Roof
Misc:
Final
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 _PAR: FAIL
ELECT AL --�
ernce
Rough In
UG /Slab
Low Voltage
Fire Alarm
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
Other S_s
other Date � ,y�� Inspector - C� — L Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.