Permit A CITY OF T 1 G A R D c, �, c
% „ 0 ,,� ;,�� DEVELOPMEN SERVI
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3125 OF HALL BLVD RESTRICTED ENERGY ELECTRICAL APPLLIECIW n Recd by: �� /Z y�9'�
IGARD OR 97223 6 a 3 9 RINT OR TYPE �►C ` ate Recd: J �7� e--/-/ V - 503 - 639 -4171 X304 / / 4 Pe # : LK7P D/.5
• JUN 2 19 9
F - 503 - 684 -7297 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
%3-/ o 31 / —0 / WILL NOT BE ACCEPTWMl1NITY DEVELOPMENT
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Pe_ Restricted Energy Fee $40.00
(FOR ALL SYSTEMS)
JOB Street Address
#
ADDRESS / ,5'W 6 0 iQ P Check Type of Work Involved:
/State ip Ph Audio and Stereo Systems
.e rt4 �a�3_ Cso� o 7o ...e11530
❑ Burglar Alarm
• SG/i'►L a-- ❑ Garage Door Opener*
OWNER Mailing Address
City /State I Zip I Phone # ❑ Heating, Ventilation and Air Conditioning System*
Name ❑ Vacuum Systems*
ADT SECURRTY SERVICES, INC.
703 NE HANCOCK ❑ Other
CONTRACTOR Mailing Addre3PRTLAND, OR
(503) 97212 TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a City /State I Zip Phone # Fee for each system $40.00
copy of all licenses (SEE OAR 918 - 260 -260)
are required if Oregon Contr. Brd Lic Exp. Date
expired in C.O.T. 5Q9 T 17/77/ Check Type of Work Involved:
data base). Electrical Contr Lic. # xp �a ❑
G, - ,� 6 /0 , Audio and Stereo Systems
C.O.T. or Metro Lic. # Exp. Date
❑ Boiler Controls
Owner's Nam ❑
' 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;
❑ 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
El 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
corrections are completed. ❑ Other
Permits are non - transferab . an. ..- refundable and expire if work is not
started within 180 days • iss : ,- or if work is suspended for 180 days. Number of Systems
The person signi or�• - permit must be the applicant or a person • No licenses are required. Licenses are required for all other installations
authorize• • b' t. - applicant.
/ FEES:
LE_ � ENTER FEES $ A /6 r
- ign. ureI n
5% SURCHARGE (.05 X TOTAL ABOVE) $ o� /
Authority if other than Applicant TOTAL $ q 1
i:\dsts\resele.doc 7/97
/5u/ 6532-
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested AM PM BLD
Location / 2- S - 76 (O � T VC . Suite / 19 2 MEC
Contact Person Ph PLM
¢ �-1-'
Contractor ,T 1 — Ph Z ' Y - ?�(ps SWR
BUILDING Tenant/Owner PG L i'lvuo4JJ2 . ELC
Retaining Wall ELR
Footing Access:
Fou dation eft) Oft I
D / � a n n - �- FPS
r 1C s � L
Ftg Drain ILA' ' l:(.�t/ ! ifoYl4,1 SGN
Crawl Drain Inspection Notes: 1'
Slab . / / . I I IAA. ,Nfti ;11 SIT
Post & Beam '
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation Pircv �. Drywall Nailing � ` �'"� / ( o Ai
Firewall
Fire Sprinkler t9 L 4
Fire Alarm
Susp'd Ceiling
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 y -
Gas Line
Smoke Dampers
Final
PA FAIL
LECTRIC
Service
Rough In
UG /Slab
Low Voltage
ElEeZlarm
ina
- PASS PART FAIL
SITE
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 Date Inspector Ext
Other —
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
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