Permit • CITY OF ' GA R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
1I1n DEVELOPMENT Tigard, (503) 639 -4171 DATE PERMIT ELR2004-00003
13125
SITE ADDRESS: 12323 SW 66TH AVE PARCEL: 2S101AA -06400
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: C -G
BLOCK: LOT: 024 JURISDICTION: TIG
Project Description: Installation of (3) voice /data drops. Job No. 104100 -10101
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:
DICK SOUTHARD DYNALECTRIC
20400 NE 122ND ST 2904 SW FIRST AVE.
BRUSH PRAIRIE, WA 98606 PORTLAND, OR 97201
Phone: 360 - 256 -5764 Phone: 503 - 226 -6771
Reg #: MET 00002545
LIC 066793
SUP 4817S
FEES ELE gegliVed Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 1/12/04 $75.00 Elect'I Final
[TAX] 8% State Surchart 1/12/04 $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 fo ru e 'opted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc
Iss ed by _.� :. . '- Permittee Signature jla i �
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
JRN 12 2004 10:32RM DYNRLECTRIC 503 226 7720 p.2
. a
Electrical Permit Application ` ' 7 M
Datereceived: / fz,
"' Penult no.: R. ,, . r > >, � • � of Tigard Projcct/appl.no.: "`�daoe:
City of Tigard Address: 13125 SW Hall BIv4, B • ; 97223 Date issued: Em Receipt no.:
Phone: (503) 639 -4171 jA 1 Z 2004,
Fax: (503) 598 -1960 Case file no.: Payment type:
Land Lisa approval: ow OF TI D
:. W , , ` . T11 I., oi PLI i 11 ,*
0 1 & 2 family dwelling or accessory Commercial/industrial 0 Multi - family 0 Tenant improvement
construction 0 New s� n/alteration/replacement 0 Other , 0 Partial
Ala
2 1 ::.1`',:-':.":' 4 l+ +: ..
=. A r ho . IOB SfI E INFORMATION : '
Job address: . _ - � ... / � � � _ ,;" Bldg. n Suite no.: Tax map/tax lot/account no.:
Lot Bloc.: Subdivision:
Project name: i.._,Iii .. � scdption and location of work on premises: 6 - p ' , i u• _ r 4, .,e. / j
Estimated date of completion/inspection:
J r s' - (:ONTRACTOIt API'LI[:A 1 ION FEE SCIILUt11 I ': ` _
: /6•Z, f d — /Q c / , Total as
j .
Business name: /-)p i e____ Nenres l- Angle°multi-badly per
Address: a :. qp // 51,) � anellbagmat. Inchdes attached garage.
Ci � 0 1S - I ZIP: 97eA 40 1 sexvlmladnded: 4
Phone: Fax y . a E-mail: 1000 >� ft. or less
f • , � u s. lie. no: .� � �1� Each additional Soo sq. ft or portion thereof
CCB no.: , , !MIN ec. su r . c Lin�itedenergy,r�idenQal 2
• etro lic. no.: e ; Limited energy,non-residential MI 2
diiM iii► r i Each manufactured home or modular dwelling
[ � Servicaand/or feeder 2
feeder Signature o supervising electric • requi •) Date / /o ! Services or or f e en — Insfal latioty
Sup. elect name (prints d v Ucense no: 5 _ alteration or relocadon:
`" i - : PROPCRTY:o1✓Ni;Lr , 2oo ampso r l ess 2
201 amps to 400 amps 2
Name (print): 401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: 1 State: J ZIP: Over 1000 amps or volts • 2
Phone:
Fax: 1E-mail: •
Temporary services or feeders - Reconnect only 1
.
Owner installation: The installation is being made on property I own installation, alteration,orrelocation:
which is not intended for sale, lease, rent, or exchange according to ' 200 amps criers 2
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps
II 2
Owner's signature: Date: 401 to 600 am s 2
s } ) :;. ' ENGIN EI R _: r ora nch circuits new, alteration,
Name: A. Fee for brancbdre itawithpurchaseof
Address: service or feeder fee, each branch circuit 2
ZIP: B. Fee for branch circuits without purchase
City: State: • of service or feeder fee, first branch circuit: III 2
• Phone: Fax: E-mail: Each additional branch circuit•. ME
i"1 `.' ItLVI'FW:(Please check all that apply); Misc. (Service or feeder not tncbuded):
0 Health-care Eaeh pump or irrigation circle 2
D Serervice over 2TS amQs�ortnrtercial facility . Each sign or outline lighting 2
0 Service over 320 amps-rating of 1&2 0 Hazardous location Signal eircoit u limited ewer anal,
family dwellings 0 Building over 10,000 square feet four or final () or a W' p � 7 2
0 System over 600 volts aominat more residential units in one structure alteration, or extension*
0 Building over three stories 0 Feeders, 400 amps or more *Description:
o Oompant load over99 persons 0 Manufactured structures or RV park Each additbnml inspection over the allowable in any of the above:
0 Egress/lightingplan 0 Other: Perinspection 1 i i I
Submit — sets of plans with any of the above. investigation fee
The above are not applicable to temporary construction service. Other
l t cation Permit fee $ 7.1.
N ali Jud erious accept credit cards, please call )uds ; Aron for more informal= ' N o ti ce: This p ermit app
expires if a permit is not obtained Plan review (at _ %) $
visa ❑ Mss
" • . 4 within 180 days after it has been State surcharge (8 %) $ 041
. r 1 _ xn a • Expires accepted as complete. TOTAL $ 1./
Name • • • • der as `• own• i... t card .
S J .,
♦ carT s -r7— Amouat 440.4615 (&00 /COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION . Business Line: (503) 639 -4171 MST
/ BUP
Received X2-7 8 1 '{(o D ate Requested ` -2 C -b 41f AM PM BUP
Location /2,51 _ dad Suite // MEC
Contact Person 2a . Ph ( � gq9 -4/ 07 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 4 ; ELC
Footing
Foundation ELC
Ftg Drain Access: LR - ���
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
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
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
- • e
UG /Sla•
'Low Voltage v G 6 c ILC O - G lag
.r• —421) E J
Fire i
e 1
Final ❑ Reinspection fee of $ • required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE ❑ Please call for reinspection RE: .Unable to inspect — no access
Fire Supply Line
A
Date oach/Sidewalk -6 Inspecto _ / /�i�# Ext
PP /
Other:
Final DO NOT REMOVE this inspection record rom the • b site.
PASS PART FAIL