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10180 SW NIMBUS AVENUE BLDG J STES 5 & 6 9+Sr:HAS' SflWVIN AIS 08101 9 �.n h U c10 0 � Q V� d � 3 m w � 10180 SW NIMBUS AVE J5+6 ..CITY OF T I GA R D ELECTRICAL PERMIT _ PERMIT e: ELC2003-00695 ®EVELMMENT SERVICES DATE ISSUED: 11/26/03 13125 SW Hall Blvd.,Tigard,OR 97223 (503) 6394171 PARCEL: 1S134AA-01800 SII E ADDRESS: 10180 SW NIMBUS AVE J-5+6 SUBDIVISION: SCHOLS BUSINESS PARK ZONING: I P L BLOCK: LOT: 002 JURISDICTION: TIG Project Description: 5 branch circuits. Job No. 77-39613 RESIDENTIAL UNIT _ TEMP ERVC/FEEDERS _ MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMPIIRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANE HMI SVC/FDR: 601+amps- 1000 volts: MINOR LABEL (10): SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION: 201 - 400 at d: I at W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 4 IN PLANT: 601 - 1000 amp: _ _ PLAN REVIEW SECTION 1000+amp/volt: >=4 RES UNITS: >600 VOLT NOMINAL: Reconnect SVC/FDR>=225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: ROBINSON,C 7NSTA..,E A+ CHRISTENSON ELECTRIC INC ROBINSON,LYNN+ BELL,KAY ET 1631 NW THURMAN BY INSIGNIA COMMERCIAL GROUP 2ND FLOOR BEAVERTON,OR 97008 PORTLAND,OR 97209 Phone: Phone: 503-419-3608 permit Reg#: W3-341-3" SUP 1299S FEES I"1,F 26-34C Description Date Amount _ Required Inspections [ELPRMT]ELC Permit 11/26/03 $73.45 "" -- [TAX]8%State Surcharge 11/26/03 $5.88 Rough-in _ Elect'I Final Total $79.33 This Permit is iusued subject to the regulations contained i,i 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 N work is suspended for mor ,an-W days. ATTENTION: Oregon law requires you to foNow rules adopted by the Oregon Utility Notification Center. Those rules are set to n OAR 952-001-00,10 throughAR 952-001-0100. You may obtain.copies of these rules or direct questions to OUNC at(503)2466699 or 1 00-332-2344. Issued By: Hermit Signature: / N-•=� OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rsnt. to OWNER'S SIGNATURE: �,_ DATE: a W _J CONTRACTOR INSTALLATION ONLY _ SIGNATURE OF SUPR. ELEC'N: c .PL DATE: _ LICENSE NO: _ 9735 Call 6394175 by 7:00pm for an Inspection the next business day IO.' -6--2.003 WED 02:5B PM CHRISTENSON CORPORATION FAX '40. 503 119 3636 P. 02 Man tion RaccivV " t ' T!"EU ,Plamtng APprova City oaf Tigar4 � -13125 SW Hnll Bh 1. NOV r� f� Plan Reviow —.- Tigard, Tigard,Oinon 97.23 ZQC Post-Review - -- Lam Use Phone- 503-639-4171, F&t1"F 0F*1MQRU La Cast Yntcrnet Nxw.ci. aia.o Q [[y�cc pp''v�/'' Conus 7utie.: 8sa FRO 2 for 24-hour Inspection equest,5�3-1b34-41T5S1 NwiE(M thud: �� Sd I W Ir adoa. CONFIRMED WITH CITY OP TIGARD IS IN JURISDICTION Demolition Service over 12s atop. 1711.Hi arlm-care utility New construction cc�eial Hazardous location Additi0nlalteration/re lac(emerlt Other: ❑Servtec over?20 anl"-.ting of uilding oyes 10,Ot)Q Coate feet, 1&2 famliy dwellings four or more residcntial unite in -Farm/ dwellingColntttereiaUtllduab-ifil Building°"K r d"e stories nnrnieil one gin,4 e � Building over thrr<e#tnr�ea Need'.,,400 amps ur more Accessory Building_ Multi-Famil Occupant load avec 99 penums Man &tend smiLwres nT RV perk Other: agmm/ligtuins plan Otber: _, _ Master Builder Submit _-s:ie o(plans with any ottlre above. abovet a °able n Job site address: 10170 SW NIMBUS AVE SUITE J y K..---arf °r«f.a.j MrmiT�,r•i° Dae��'� Pro'ect Name: FAVJRQ LK1AI nW retldeatlal{hrgla or oeultl-tuaay per J Cross street/Directions to job site: dNdiing aorto Iltlada tgerYed ramp. QUESTIONS?CONTACT GREG KENNEY(503)539-1536 ��■�"' Iac 4 Rath or _ Subdivision: l✓ot / sate/#: sack Mrnut whood the or m6aw"awes z #swore and/or feeder rvites or(ceders-IretellatMa. alttretbn or rowistioa: 10•J 2 --- do---- 600; to.,1�00.0., 4 6 2 66./3 2 Name: _ — -- - -t Only Temporary servleee or reeden-larmlation, Address: _ _ ._ alteration,or relocatlaw 1 66.15 " o, --- i . 0 2 Phone: Fax. 4al a 13rareh rirevits-now,Wrorstfen.or NaIIle: _ est•neleup,per pare/: ,— — A.Fee ibr brwa ci m to with'P v'*—of 6.65 2 Address: -- "s" - ---- I F„ WMw pttrcheee of1 .4 6.8 5 2 _CitylState/7•iA: e< — 2 ra Phone: h c !+ F - Mlec oo ar not luded): E-mail: Bac asign it 0 "r�–f--- ? Job No: 77- L613--_ sisal ei<of , A moos�ency p� .c1�0 2 (n Business Name: CHRISTENSON ELECTRIC# INC_. L►eccnptbn LNW Address: 1631 THUM41a4 ST 2ND FL J �ditlo.�l.,�pe• 1...r_� OD Ci /State/Zi : PO 0 47209-255 Por�!qL_--�t2 Phone: (503)419-3600 Fax: (503)419-3636 1" dO — W CCH Lic. #. 458 Lic.#: 7.613.4,7 - -J 11/26/0 � '� supervising Plectsirian p R ew 25Yo of P c Fee s turn ro ug ireri: — Soso lurch t�e_t dK�fPeta►it Fee �_ 8 Print NarnesItl l Is ISTO H ic.#. ) - Fon P�1tMsi FE s Notfce: This permit oppilesdon°spirts if a Permit**t b*alined Y44do*** Authorized 180 days after It bar been accepted as complus VISA Signature: _ Dare:_-_- - gar _ •Ree methodolna eet.bf'I1rl^^CouotY HNI141eR Ipduetry Service Board. (Plexsc print name) _ t V%ta\Permit Form NMcpermitAPP.do, 0:/03 ,ITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 INSPECTION DIVISION r Bllslness Line: (503)539-4171 MST OUP _ Received Date Requested /:�=/� AM_ PM BUP Location /D I_�_.Al Lfn1�a-k!!�,-- vim_ Suite "$ MEC Contact Person _— -�+�-�^-� --- Ph( --) --(,v '71 PLM Contractor_ A___----- Ph(--) —_ SWR BUILDINGS Tenant/Ownec -C'o-Ps'+� : ,rte► �'�°-�v — —O�� rs:�S Footing ELC Foundation Access: -- Ftg Drain ELR Crawl Drain _ Slab Inspection Notes: SIT Post&Beam Shear Anchors —- ---- Ext Sheath/Shear Int Sheath/Shear -- "'-' Framing -- -- Insulation Drywall Nailing ------- - ___7 --_ — Firewall Fire Sprinkler -- ---- ---- _ - _ Fire Alarm Susp'd Ceiling - - --- — _ Rcof Other:_ _ - -------- -- Final �- PASS PART FAIL — PLUMBINQI._ Post&Beam Under Slab Rough-In - Water Service Sanitary Sewer Rain Drains --- -- - -- —__ Catch Basin/Manhole Storm Drain -- -- -- Shower Pan Other. -- -- ---- ------- -- -- _ Final ----------,--- PASS PART FAIL -- — ----T— —` —-� - - MECHANICAL _---_—_ _- Post&Beam -- — -- ��— -- �— Rough-in --- -- -- —_ --- Gas Line 06 Smoke Dampers - --- - - - -- QC Final PASS_ FAIL - - - -- - — E--CTRIC ce m z� Rough-In 11G/Slab `— W Low Voltage --�---- ---- - -- Fir Alarm I P#ina Mion fee of$ required before next PAS PART FAIL - inspection. Pay at City Hall, 13125 SW!fall Blvd. SITE _ Please call for einsp ion RE: _ _ __ —_ Unable to Inspect-no access Fire Supply Line ADA Approach/Sidewalk DOM --3 Other: Final -- — --- DO OT REMOVE this InSpedba record 11111 slRr•. PASS PART FAIL CITY OF TIGARD 24-dour BUILDIh1C, Inspection Line: (503)639-4175 0 MST INSPECTION DIVISION , Business Line: (503)6394171 -- �- BUP Received � � 5�bate Requested_�L AA+I PM _._ 8U Location L.��'.L � 6U, ` _Suite22 Contact Person y i 1�_ — Ph VZQ5 7 7 PLM _—.. Contractor Ph( ) __ SWR BUILDING Tenant/Owner __�!r7� /1�����2.yt .rz�t._ ELC Footing ELC Foundation Actress: Ftg Drain Q r � S w ELR 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 - - - - - Root Other: -'- --' Final -- �- - PASS PART FAIL - PLUMBING Post&Beam Under Slab — Rnugh-In Water Service --- -- Sanitary Sewer Rain Drains --- -- - Catch Basin/Manhole Storm Drain - - Shower Pan Other: - - - -"-- ---- Final FAIL - Post eam Rough—In Gas Line (LSpok�Dampers --- ------ -- -- 12 Fi t~APPART FAIL -- - E RICAL --- — --- - ---- Service m Rough-In -- _-- --- - --- - - -_. j UG/Slab Low Voltage -- Fire Alarm Final Reinspection fete of S.�—�-- required before next Inspection. Pay at Clty Hall, 13125 SW Hall Blvd. PASS PART FAIL Please ease call for reinspection RF: _ _ _ ct Unable to inspe -no arocess Fire Supply Line el-711%, ADA /�_ Approach/Sidewalk Daft--'� � Other:______ Final - DO NOT REMOVE this Inspection record from tin Job sib. PASS PART FAIL CIT" OF TI C AR D MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT#: M 18/03 -00698 13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 DATE ISSUED: 121 PARCEL: 1 S13-34AA-01800 SITE ADDRESS: 10180 SW NIMBUS AVE J-5+6 SUBDIVISION: SCHOLLS BUSINESS PARK, ZONING: I-P BLOCK: LOT:002 JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: COM UNIT HEATERS: VENT FANS: 1 OCCUPANCY GRP: B VENTS W/O APPL: 0 VENT SYSTEMS: STORIES: BOILERS/COMPRESSORS _ HOODS: FUEL TYPES 0 - 3 HP: DOMES. INCIN: 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15-30 HP: REPAIR UNITS. FIRE DAMPERS?: 30-50 HP: WOODSTOVES: GAS PRESSURE: 50+ HP: CLO DRYERS: FURN < 100K BTU: _ SIR HANDLING UNITS GTHER UNITS: FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS: > 10000 cfm: Remarks: Relocate existing exhaust fan. Owner: _ _ FEES ROBINSON, CGNSTANCE A + Description Date Amount ROBINSON, LYNN + BELL, KAY ET [MECH] Permit Fee 12/8/03 $72.50 BY INSIGNIA COMMERCIAL GROUP [TAX]8%State Surchaq 12/8/03 $5.80 BEAVERTON, OR 97008 $78.30 Phone: Total ----- Zontractor: HUNTER DAVISSON INC 1800 SW PERSHING PORTLAND, OR 97202 REQUIRED INSPECTIONS _ Phone: 503-234-0477 Mechanical Insp Final Inspection Reg#: LIC 01612 CL a J_ W This permit is issued subject to the regulations oontained:n the Tigard Municipal Code, State of Orr.. Specialty Codes --r and all other applicable laws. All worts will be dome in accordance with approveo plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more!han 180 days. ATTENTION: Oregon law requires you to follow rales adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00 Issued By: PennIttee Signature' Call(503) 639-4175 by 7:00 P.M.for Inspections needed the next uslness day Meph%nkal Picrmit Application Received Mechanical Dale/B $ _Pcmiit No.P -)( ;�-00tgs City of Tigard Planning Aliptakal Building Date/By Permit No _ 13125 SW Hall Blh•d. Plan Revie Other �— I igaret,Oregon 57223 i)ate/e ,permit No Phone: 503-639-4171 Fac: 51)3-598-1900 Post-Re" w land Uic Date/By: Case No Internet: specti t tiZ ardor us Contact _ Juns.�ee Page 2 for LS-hour Inspectiim Requesi: 503-G39-4175 Name/Method �/ Supplemental Informatlon. TYPE OF WORK --- _COMMSRC'IAL FEV SCHF"JULE-USE CHECKLIST New construction Demolition Mechanical permit fees*are based on the eotai value of the work Addition/alteration/re lacement I EJ Other: performed. Indicate the value(rounded to chc nearest dollar)of all CATEGORY OF CON TRUCTION mechanical materials,equipment,labor,overhead and profit. I & 2-Family dwelling_ rOtuh mercial/Industrial Valle' S �a00 S-.Page 2 for Fee Schedule AccessoryBuildingMulti-FaRESIDENTIAL RESIDENTIAL EQUIPMENT/SYSTElK,%FVV SCHEDULZ — Master Builder � eDescrfptlon y Feeea. Totalr: _ xe;nna/Co�au� _ JOB SITE INFORMATION and LOCATION -add-on air conditioning** 14.00 Job site address: 1$a S(�) !l(Dy�`Q��_ Gas heat um 14.00 Suite#:^ Bld ./A t.#: 3' Duct work _ 14.00 --- li dronic hot waters tem 14.00 Project Name: C� �'s ._— Cross street/Dlrections to fob site: Residential boiler for radiator or hydronic system 14.00 �w',� Unit heaters(fuel,not electric) in wall,in-duct,suspended,etc. 14.00 Flue/vent(for any of above____ 10.00 _ Subdivision: Lot#: Repair units –12.15 _A Other Fuel A N_anees Tax ma / arcel#: water heater _ 10.00 _ DESCRIPTION OF WORK Gas fireplace 10.00 -- _ Flue vent water•heatertgas fi lace) 10.00 Log lighter(gas) I0.00 —� Wood/Pellet stove _ 10.00 —_ Wood fireplace/insert 10.00 —Chimney/liner/flue/vent 10.00 _ El PROP TY OWNER I iffTEMANT Other: 10.00 �)�t�,s��tu>ll Name: _-n EnArvemmtal L:hansil•Veadiatlea Address:AONID JlLwlqRange hood/other kitchen equipment 10.00 ^ — Cit /State/Zip: 3 Clothes dryer exhaust 10.00 Single duct exhaust Phone: 49 Fax: (bathrooms,toilet compamra:nts, APPLICANI 1.2MONTACTP•ERSON utility rooms 6.80 Name: L Attic/ct twl space fans _ 10.00 Address: �r��Mhc�VL ---- Other: – --10.00 _ Rud 11"I OIL_ _ City/State/Zip: ••53.40 for fIrat 4,41.00 each additional Fl IL _I__— Fumace,etc. •+ one: Fax: — Gas heat pump •• N i -mail: —� Wall/suspendedlunit heater CONTRACTOR Water heater •• _ Business Name: k11011 Ai AfL IA,S,1,6 Fireplace •• oJ—o Address: ( Range Cit /State/Zip: '-1hA BBS-- — Clothesd er as�_ •• w Phone: _� �� Fax: Other: --I -- _� _.. � r�.�_ " CCB Lic. #: __ Total: Mechanical PernYt Few* AuthorizedLg* Q Subtotal: S Signature: DTtr� a Minimum Permit Fee S72.50 S —�fQ '1-frr v_ Plan Review Fee(25%of Permit Fee) S _ (Please print name) State Surchar a 8%of Permit Fee S _ TOTAL PERMIT FRE S Notice: This permit application expires If a permit Is not obtained within *Fee methodology set by Tri-Couniy Building Industry Service Board. Igo days after It has been accepted as complete. "Site plan required for exterior A/C units. 1 ADsts\Permit FormsWeePermitApp doe 01/1)3 Mechanical P%,,mit Application -City of Tigard Page 2 - Supplemental Information , Commercial Fee Schedule: TOTAL VALUATION: PERMIT FEE: $1.00 to$2,000.00 Minimum fee$72.50 S2 001.00 to$5,000.00 $72.50 for the first$2,000.00 bnd$2.30 for each additional$100.00 or fraction thereof,to and T5.00 _ including$5,000.00. $5,001.00 to$10,000.00 $141.50 for the first$5,000.00 and$1.x30 for each additional$100.00 or fraction thereof,to and including$10,000.00. _ $10,001.00 to$50,000.00 $231.50 for the first$10,000.00 and$1.35 rbr each additional$100.00 or fraction thereof,to _ and including$50,:100.0( $50,001.00 to$100,000.00 $771.50 for the first 550,000.00 and$1.25 for each additional$100.00 or fraction thereof,to and including$100,000.00. _ $100,001.00 and up $1,396.50 for the first$I 00,000.000and S 1.10 for each additional$100.00 or frcction thereof. All New Commercial Buildings require 2 sets of plans. 1- r� 6- 3 C7 W J is 8uildingTermlt FormsxMecPe,mRAppPg2 09-01-03.doc CI'JV OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 639-4175 Busineu Phone: 639-4171 Date Rei))uee1 1�/—' /9 7 A.M. P.M. MST: i.ocatiort ` W ��`�/'//LG'L t�GIJ BUP:,_� Tenant: /A�61JA MEDtC,4t. Suite: Bldg: _ MEC: Contractor: l_�7.1/ Z erz& mme: S I7 /O PLM: — Owner:_ Phone: ELC:_ M�j� --— -----. �— — _ ELR:�" X7at _ _ SM BUILD—IN_G BLDG(con't) PLUMBING — M1011A. ICAL ELECTRICAL SITE Site Post/Beam Post/Beam 1'.A/Beam mover ue 9evver/Morm Footing Roof Un&V,9)ab Rough-In Ceiling Water Line Slab Framing Top Out Lias Line Rough-in UG Sprinkler Foundation insulation Sewer tiood/Duct Reconnect vault Bsmt Damp Drywall Stony Furnace Temp Service M15C. Masonry Ceiling Rain Thain A/C Uta Slab Shear/Sheath Fire Spklr/Alm Crawl/Found M Heat Pump w o Approved Approved Approved Approval Approved Appr/Sdwlk Not Approved Not Approved Not Approved Not Approved Not Approved FINAL. FINAL FINAL FINAL FINAL _ Malig co —.4�rC7�, _ t 41- eq b - 44 G` 119 i a J m W n Call for reinspection einspection fee of S required before next in�Vection rl Unable to inspect. Iagwtor —-- - — — -- Dete: r-�L—_ PW--of__—_� CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 639-4175 Business Phone: 639-401 71 Date Requested: -7- C,%,/� _ A.M. - M, P.M. MST: --- Location: -t-2J —/, BUP: Tenant: --- '/1!1x f _ SuiteBldg: _ MEC: — Contractor: Phone: p PLM: Owner: - - - Phone: _� •3-d C U ��_ ELC: ELR: SIT. _ BUILDING BLDG(con't)_ PLUMBING: MECHANICAL ELECTRICAL SITE Site Post/Bmn PoW. Beam Post/Beam Cover/Service Sewertstorm Footing Roof UndFUSlab Rough-In Ceiling Water Line Slab Framing Top Out Gam Line Rough-In UCi Sprinkler Foundation Insulation Sewer Hood/Duct Reconnect Vault Bsmt Damp Drywall Storm Furnace Temp Service MISC. Masonry Ceiling Rain Thain A/C UG 3 Mb Shear/Sheath Fire Spklr/Alm Crawl/Found Ih Hent hunpV t Approved ApprovfA Approved Approved Aplx/Sdwlk Not Approved Not Approved Not Approved ved Not Approved L FINAL FINAL FINAL FINAL FINAL ---1�N _A IJ-61 � .- ---------- -------------- --- a m W C]Cell for reinVpecti Reinspection fee of S ;7ired ore next inspection 171 Unable to inspect Inspector:_ Dat lr Page of - CITY OF TIGARD DEVELOPMENT SERVICES ELECTRICAL PERMIT — 13125 SW Hall Blvd.,77gard,OR 97223 (503)6394171 RESTRICTED ENERGY PERMIT #: ELR97-0186 DATE ISSUEDs 07/07/97 PARCEL: IS134AA-01800 SITE ADDRESS. . . : 10180 SW NIMBUS AVE #J-5 SUBDIVISION. . . . : 1 KNOLL. BUSINESS CENTER T'IGARD ZONINGsI—P BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :2 JURISDICTN: TIG Project Description: add protective signaling A. RESIDENTIAL---------- B. COMMERCIAL-------------------------------------- AUDIO & STEREO. . . : AUDIO & STEREO. . : INTERCOM & PAGING. . : BURGLAR ALARM. . . . : BOILER. . . . . . . . . . : LANDSCAPE/IRRIGAT. . : GARAGEOPENER. . . . : CLOCK. . . . . . . . . . . : MEDICAL. . . . . . . . . . . . : HVAC. . . . . . . . . . . . . : DATA/TELE COMM. . : NURSE CALLS. . . . . . . . : VACUUM SYSTEM. . . . : FIRE ALARM. . . . . . : OUTDOOR LANDSC LITEs OTHER: : : HVAC. . . . . . . . . . . . : PROTECTIVE SIGNAI-. . :X INST'RUMENTATION. : OTHER. . : TOTAL # OF SYSTEMS: 1 Owner: ----------------------------------------------------- FEES FORUM PROPERTIES type amount by date recpt 8705 SW NIMBUS PRMT $ 40. 00 GEO 07/07/97 97-296805 SUITE 230 5PCT $ 2. 00 GEO 07/07/97 97--296805 BEAVERTON OR 97008 Phone #: Contractor: --- ----------------------------•-------------------------------------- 205 ELECTRIC 42-. Z0 TOTAL, ROBERT A CARON 7831 SE JOHNSON CK BLVD ------- REQUIRED INSPECTIONS ------- PORTLAND OR 97206 Ceiling Cover Elect' l Final Phone #: Wall Cover Reg #. . : 000342 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 rill be done in accordance with approved plans. This permit will expire if work is not started within !(0 days of issuance, or if worw is suspended for more than 19! days. ATTEMION: Oregon law requires you to follow rule adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-*1-M11 through MR 952.011-001. You may obtain copies of these rules or direct questio at (583)24(r-1997. Issued by Per-mittee Signature IL R ------OWNER INSTALLATION ONLY----------------------------- U) The installation is being madr- on property I own which is not intended for sale, lease, or rent. J OWNER' S SIGNATURE: DATE: m 0 ------------------- ----CONTRACTOR INSTALLATION ONLY----------------------------- tu SI(,NATURE OF SLIPR. ELF_C' N: `yt/ DATEs LICENSE NO: +++++++++++++++++++++++++..++++++++++++.+++.+++++++++++++++++++a-++++++++++++++++ Call 639-4175 by 6:00 P. M. for an inspection needed the next business day +t+f f+....4........ .......I.... ...f-4,4....+t+tf.4................ ....+++++t...I..... z Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION 13125 SW Hall Blvd. Tigard,OR 97223 PERMIT M Phone(503)639-4171 FAX(503)684-7297 DATE ISSUED TDD No. (503)684-277.2 CITY OF TIOARD Inspection (503)639-4175 ISSUED BY PLEASE COMPLETE ALL SECTIONS 1. LOCATION OF INSTALLATION 4. TYPE OF WORK ©h0 1 9 A n ��� RESIDENTIAL--Restricted Energy Fee. . . 11p.0p (FOR ALL SYSTE9S) City Q State Zip Check Tyne of ft-k Involved: PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND EXPIRE IF WORK ❑ Audio and Stereo Systems IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK r5 SUSPENDED FOR Ys 180 DAYS. ❑ Burglar Alarm 2. CONTRACTOR APPLICATION ❑ Garage Door Opener* _��� �r ❑ Heatin Ventilation and Air Conditionin S em' Contractor_6ml 'Raype Q�>ml`kd m g _ ❑ Vacuum Systems• Address lqb f)w I ❑ Other_ _ Date_3iQ (� 6 l (r1 _ COMMFR(:IAI --Fee for each system . _ . . . . . . . Q� 1�Q M (SEE OAR 918-260-260) Property Owner. Contractor's Board Reg. No. "�-- ❑ Audio and Stereo Systems ❑ Boiler Controls Phone# D3—,L a.) ❑ Clock Systems 3. OWNER APPLICATION ❑ Data Telecommunication Installations ❑ Fire Alarm Installation ❑ HVAC Print Owner's Name Phone No ❑ Instrumentation Address — ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control" City State Zip ❑ Medical This permit Is issued under OAR 918.320-370.This applicant agrees to make only ❑ Nurse Calls restricted energy installations(100 volt amps or less)under this permit ind to do the ❑ Outdoor Landscape Lighting' fnllowing: 1. Only use electrical licensed persons to do installations where required.(Certain Protective Signaling 4. residential and o!her transactions are exempt from licensing.These have Other asterisks(*).All others need licensing). 2. Call for an ins ion when all of the installations under this y F— pest permit are read tJ1 for inspection at 503-6394175. ( Number of Systems 3. Purchase separate permits for all installations that are not ready for inspection J when the Inspector is out to inspect under this permit. No kerns are required Lkemn are mqulmd for aI adser Initell.Bem. 4. Assume responsibility for assuring that all corrections required by the inspector are done,and 5. Assume responsibility for calling for a final inspection when all of the S, FEES .a corrections are completed. The person signing for this permit must he the applicant or a person a. Enter Fees $40_ authorized to hind the ap licant. b. 5%Surcharge(.05 x total above) $ l JL Signature TOTAL $ Authority if other than applicant It+ERGAP.CHP