Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
� i� DEVELOPMENT SERVICES PERMIT #: ELR2003 -00130
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/8/03
SITE ADDRESS: 10998 SW 68TH PKWY PARCEL: 1S136AD -06505
SUBDIVISION: WAY LEE ZONING: C -G
BLOCK: LOT: 003 JURISDICTION: TIG
Project Description: Low voltage for data telecommunications system. Job No. 050803256
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:
BANK OF SALEM RELIANT COMMUNICATIONS
PO BOX 847 PO BOX 20031
SALEM, OR 97308 KEIZER, OR 97307
Phone: 503 -585 -5290 Phone: 503- 393 -7614
Reg #: LIC 64081
ELE 24- 260CEA
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 5/8/03 $75.00 Elect! Final
[TAX] 8% State Tax 5/8/03 $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 ow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 throuc
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Iss ed by i . ,� , <,_ / i 4 . ` Permittee Signature 1,--.„_„,20$34.' -
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
/ 4
Elect !cal Per mitAppliclton (,III ( ►: I • I : (, \ I.1
Date received _. e0 Permit no.: M, ., ,
...,14 City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
I1 l'E OF I'I l "1I I
O I & 2 family dwelling or accessory O Commercial/industrial O Multi- family O Tenant improvement
U New construction O Addition/alteration/replacement O Other: O Partial
Job address: / 0 9 9 f S , (Af , (pc?* PYW y Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: [Subdivision:
Project name: 13f9n k 0.p Tr fan' I Description and location of work on premises: (J,,1
Estimated date of completion/inspection:
CO\ FIZ :I (11Z :1!'1'1.1( :a I IO\ I-( IF: sl Ill Ill I.I_
Job nor Q S o , n T 30) s (C Fee Max
Description , i Qty. (ca.) Total no. trip
Business name: /` u v► f UVtrylmif of ' r00i'3„.., S New -d gleermuld -lendlyper
Address: e 0, e3 C X 010031 dweR>ogunfifndodes ehedgarage•
City: Xe j of v , I State:OR I ZIP: 9 73 0 7 Senice 4
Phone:,S03 - 76/ I Fax:5c3 - 7)7,1 E- mail: - 1000sq. aorless
CCB no.: 6, 1/0 I Elec. bus. lie. no: 07 y -a7 G 0 t - Each additional 500 sq. R or portion thereof 2
Limited energy, residential
City/metro lic. no.: gt4dy ii/i 163 t Limited energy, non- residential 2
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r-�.�_ Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date S -$ -.o'-3 Service and/or feeder 2
Sup. elect. name (print): S,.. -* wci n sit License no: 3$aa Leo Serrkeserkedera- instaladon,
alteraflonorrelocatiom
200 amps or less 2
Name (print): 201 amps to 400 amps 2 2
401 amps to 600 amps
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is n o t i n t e n d e d f o r sale, lease, rent, o r e x c h a n g e a c c o r d i n g to d o n ,
201 amps or ass 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 2
Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each (ranch circuit 2
City: I State: I ZIP: B. Fee for branch circuits withal purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail: Each additional branch circuit
I'I::1:\ HEN IE11 II'le:ixe check all that a►r►rlr) Misc. (Service or feeder not indaded):
O Service over 225 amps- commercial D Heahh -care facility Each pump or won circle 2
O Service over 320 amps -rating of l&2 O Hazardous location Each sign or outline lighting 2
family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, /
in m
D System over 600 volts nominal more residential units e structure alteration, or extension' p,. 2
D Building over three stories O Feeders, 400 amps or more •D r .i /9
D Occupant load over 99 persons D Manufactured structures or RV park Fads additional impecdon over the allowable in any of the above:
U Egress/lighting plan D Other: Per inspection I I I I
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $ ° 75' C ' 96
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
D Visa D MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number I / within 180 days after it has been State surcharge (8 %) $ Gr. OU
expires as complete. TOTAL $ . ' I I. av
accepted Name of cardholder as shown on credit card
S
Cardholder signature Amount 440 -4615 (6/00/COM)
CIT1 01=.TIG 24 -Hour , _ .
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received /1/ b2(e Date Requested .5 AM PM BUP
Location 1 619,8-- 9 9 - - j L ) ) 6 / / Suite MEC
Contact Person ,Q‘ 5e, Ph ( ) X93 7!0 /Y' PLM
Contractor 0Q s�t®® r17 Ph ( ) SWR
/.JGi
BUILDING Tenant/Owner ,GL `!5� ELC
Footing / O
Foundation ELC
Access:
Ftg Drain ELR 3 '00/
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 1 7/ -
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
Service
Rough -In
UG/Slab
owToI -
ire Alarm
Fin Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
- .01SO PART FAIL
SITE Please call for reins ection RE: Unable to inspect - no access
Fire Supply Line f /
ADA
Approach/Sidewalk Date 0 0 3 Inspect -4 /W Ext
Other:
Final DO NOT REMOVE this inspection record fr m the job te.
PASS PART FAIL