Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
j y� DEVELOPMENT SERVICES PERMIT #: ELR2003 -00288
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/23/03
SITE ADDRESS: 11410 SW 68TH PKWY PARCEL: 1S136DA -00101
SUBDIVISION: PERS SITE ZONING: MUE
BLOCK: LOT: JURISDICTION: TIG
Protect Description: Installation of limited energy for data telecommunications system.
Job No. 39- 00460.
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:
OREGON, STATE OF PUBLIC
EMPLOYEES' RETIREMENT FUND
11410 SW 68TH PKWY
TIGARD, OR 97223
Phone: Phone:
Reg #:
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 9/23/03 $75.00 Elect'I Final
[TAX] 8% State Tax 9/23/03 $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 r opted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 throuc
Iss ed by p`-- C_�'SL Permittee Signature 3)O
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
, SEFI -22 -2003 MON 10:55 AM CHRISTENSON CORPORATION FAX NO. 503 419 3636 P. 01
F Electrical PermitApplication • .
411 ,, _._._...__.____ Date received: 9 AA to Petinnit no.: iPee 3 -oo .. 2 8S
_,..ii` City of Tigard RECEIVE 1 i ftecvap' ao.: : %.. ire date:
Ciry o�gard Add 13125 SW Hall Blvd, Tigard, OR 97223 Date rim IIMM Receipt no.: •
Phone: (503) 598-1960 1 SEP 2 2 2003 • Ca te file no.: Payment
Fax: (503) 59
8 -1960
Land use approval: . •
g Commercial/industrial 0 Multi - family 0 Tenant dwelling improvement
❑ New COnstsUctioa 0 Addition/alteration/replacement 0 Otter. - O padial
Job address: l 410 Rig 6A $ PARKWAY 977 ?'1 Bldg. no.:. Suite no.: _ Tax maphax lot/account no.:
Lot: Block: Subdivision: •
Project name: PERS Description and loCal ion of work on Premises: • a . a a : . % „i„ c 1, 4 ION
Estimated date of com.let onAns - ;on: I UEST'LONS ?CONTACT C : - • • L. IA 1 • •
1.1:1': , ,t'lil . l)1'1 l:
(11` I lt: \( '1 lilt ‘1'1 II' k I It)'. • M �
Job no: • -- a • ' • _ t au• ax • Business name: CHRISTEI+ISON ELECTRIC, INC. New teddaatist- sinaleormaW ' Ie
Address: 1631 NW' THURMAN ST Ti 2• PI. setaebedpine. •
city: • • • .1 ` s State: OR ZIP: ' • — or less 4
. •
Ptlttea 5503 419 3600 Fax: 419 3636 E -mail: 1 000 Sq. lt Eachaddit . onalsoo .ft.or • •atioethemof
CCB no.: 00458 r 4ec. bus. lie. no: 26 --34C. Limited energy. residential M — 2
City /me .. :ati r . no.:
1411 Limited energy. non- msidentiat • Mill • 2
/F'Ae Bach manufactured tome or modular dwelling .I
2
ema(p
Date • f,� t 3 Service and/or feeds[
si:.; '� � �. , -� a -• Seniceyorfeedeas•
Sap. a l u m gIAN' CHRISTOPHER U eeose tto :. 8735 alteration or velat
1'itl)1't:Itl'l (M1;1I It 200 • - orless •0.30 2
201 to 400 amps 2
Name (print): RICK BERRY (503) 603 -7592 aol mQ0 amps 2
Mailing address: 601. • •. to 1000 . s III. 2
State: • ZIP: Over 1000 or volts — 2
• d _ 1
P Fax: E-mail: Reconnect o a or Feeders -
Owner installation: The installation is being made on property I own n,alteradan. orrelocationt
which is not intended for sale, lease. rent, or exchange according to 200 ,,.. * ler�e 2
ORS 447, 455.479, 670, 701. • tot ,,.•- to 400 amps MI 2
Date: 401 to , I ∎ . 2
OWnerS Si._ nature: __ ___ _ — _ Branch cir�db- new, Menden,
I .\ (;1 \ I :I it or extension per (erect
Name: A. Fee for branch circuits with purchase of .. 6 5 2
Address: service or feeder fee, each branch circuit
State: • 1 Fee for branch circuits without purchase 6.8,5 1
Qty: • ZIP: a of service or feeder fee. fast branch circuit:
Phone: Fax: E - ..., additional branch drag*: • . b 9
1'L .1N I(1 .l'If.l1 11'Ir:nc cbccl. :III 112.11 u1)ph► More- (Santee
otfeederttotioeIVAod
O Hedtb-cure facility Bach "amp or irrigation circle 2 •
O Service over 225
amps-rating 14 Each signor outline lighting
O f Service / over 320 empa rating of l �2 O Builds ow location Si al circuit(%) or a limited enemy panel,
Q Building over 10.000 square feet four or 1 r5* 7 g . 2
family more residential units in one structure alteration, or extension* O Building over 600 est stories nominal • e DA • TELECOMMUNICATION - .
O fuilding over duce stories O Feeders, 400 amps or more attend • � on: r
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional bgpecatica over the allowable In any of the above:
O Bgress/lightingplan CI Otter. Per instated= r 1 1 l —
Submit _ sett of plans with any of the above. Invcsti : tion fee
The above are not a , pliable to temporary cor strudiof service. Other
Pernik fee $ - 7
Net an adapt era for meta lof Not This p ermit application .
credit rOO Plan review (at 96) $
CI Yam O MasterCard censers if a permit i& not obta
State surcharge (8%) .... $ 6 • /
C
1
aulk card member: - / / within 180 days alter it has been $ 81.00 1
C aceeptedascamplete. TOTAL * ** * * 81.00 * o* *
N of cardholder as �oara ea crab clad $ TRUST ACCOUNT DEDUCT
A oroaor 4404615 (610NCOM)
OCTOBER 2000 +FEE ON BACK OF FORM
CITY OF TIGARD 24 lour- -
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
/j BUP
0
Received Date Requested - 3 0 AM PM BUP
Location 1 t /0 (O if I" n K I A)). Suite 250 MEC
Contact Person JJ(A )L d. 11.12.4f44.4-- 43F(56231) $6.6 -5 PLM
Contractor e -' am
/Stm ∎ • ,de/u..) .Ph ( ) SWR
BUILDING Tenant/Owner P�S /3 �� • ELC
Footing
Foundation ELC
Access:
Ftg Drain CEO ?j Z
Crawl Drain
Slab Inspection Notes: l SIT
Post & Beam 17/00) MO -'� & e L J7 Pe Pt
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
Service
Rough -In
UG/Slab
olta
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
P PART FAIL
SITE D Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA )
Approach/Sidewalk Date 0 O Inspecto A
Other:
Final DO N • T REMOVE this inspection record from the job site.
PASS PART FAIL