Permit ELECTRICAL PERMIT
CITY TIGARD RESTRICTED ENERGY •
11 DEVELOPMENT SERVICES PERMIT #: ELR2003 -00200
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/14/03
SITE ADDRESS: 16060 SW 85TH AVE PARCEL: 251 13B0 00600 •
SUBDIVISION: SEWER TREATMENT PLANT ZONING: I -P.
BLOCK: LOT: , JURISDICTION: TIG
Project Description: Install Voice & Data cabling.
A. RESIDENT IAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO:- INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: VOICE /DATA X
- TOTAL ' # OF SYSTEMS:. 1
Owner: Contractor:
UNIFIED SEWERAGE AGENCY NETVERSANT CASCADES INC •
150 N 1ST AVE 9020 - SW GEMINI DRIVE
HILLSBORO, OR 97123 BEAVERTON, OR 97008
Phone: Phone: 503 -646 -0533
Reg #: ELE 34- 258CLE
LIC 150328
SUP 2903LEA
FEES : Required Inspections •
Description Date Amount , Low Voltage Inspection
[ELPRMT] ELR Permit 7/14/03 , $75.00 Elect'I Final
[TAX] 8% State Tax 7/14/03 $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
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set, forth in OAR
952 - 001 -0010 through OAR 952-001-0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246-6699. _ •
Issued by , ro cuLf 6.A tat A Permittee Signature
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
07/11/2003 11:34 FAX 503 641 6613 NetVersant Cascades, Inc 1j001
IIe calPermitA►pplieation ,. 'l
A RECEIVED
Date received -/ - Permit no l 9 / - y'"'
, '' �:J ( 1' City of Tigard Pro exUappi. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, T'i Qj iJ R id ?f3 ., Date issued: : Receipt no.:
Phone: (503) 639 -4171 J
Fax: (503) 598 -1960 Case file no.: Payment type:
CITY OF TIGARD
Land use approval: BUILDING DIVISION TAG'
TYPE. OF PERMIT
0 1 & 2 family dwelling or accessory Commercial/industrial 0 Multi- family 0 Tenant improvement
O New construction • Addition/alteration/replacement Cl Other: 0 Partial
JOB SITE INTORNIATION; ..
Job address: 1100(.0 0 SW gS 4 ' A , Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot•. Block: Subdivision: °I PS : ' di n 6 r em ale 1
Project name: ei.pa iA/a Wt. • J met • Description and location of work on premises: lO i.E _ , ►,, —ri°1 ad Al
Estimated date of corn 'letion/ins• ection.
CONTRACTOR. APPLICATION .. . FEE. SCHEDULE
Job no: 0 Oil 3T 1 4790 L Mate
De=al . don MIR Bsc. c. c .F: r./V ETV1 1__iT �. a�t�JLI�J'�T� New res id en ti a l - singieormuld- fantilype Total no. .
Address: 'I 7`(0 SW NI w18u S riven 1/-e_ dwePinguoit Includes atmeltedgarage.
City: ; E ,t, • . nl State:0 p.„ ZIP: 9100 2 Serviceinclade &
Phone:5D • (o (p.(3$3,3 GIZEMEril E-mail: 1000 sq. ft. or less • 4
• ,f4. • • •, 500 ft. 0 a•t t41 naa•fa__
CCB no: 150 "'d° Elec. bus. Bc. no: 3 - 521 es '
Limited energy,res'dental MOM 2
Ci/metrolic.no.:0006sss Limited ___ 2
_
7 -10 -03 Each manufactured home or modular dwelling S■
• _ electrician ...
Signature of s • ' ='•• • e (requited) Date Service and/or feeder 2
Sup. elect name (print): p ' License no: Jo , serr r feeders- loran installation, IIIII
alteration or relocation:
PROPERLY OWNER 200 amps or less 2
. 201 amps to 400 amps MI__ 2
Name (print): 401 amps to 600 amps _ME 2
Mailing address: 601 am. to 1000 amps =NM 2
City: State: ZIP: Over 1000 • •sorvolts _IMI 2
Phone: Fax: E - mail: Reconnectonl 200 amps or less �I� i
2
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, r:
llation ,alteratton,orrelocatio �
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps ME M 2
Owner's sigdattire: _ Date: 401 to 600 am • s IIMMIll 2
ENGINEER . Branch circuits- new, alteration,
or exteasloa per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: • ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit III'
Phone: Fax: E - mail: Each additional branch circuit __ ]'—
PLAN. REVIEW (Please check. all that apply): Misc. (Service or feeder not Included):
t] Service over 225 amps - commercial • • Cl Health -care facility Each • mp or irrigation circle ■ _ 2
Cl Service over 320 amps- rating of 1 & _ 2 Cl O Hazardous location Each sign or outline lighting MI ®� 2
famiiydwellings 0 Building over 10 ,000 square feet four or Signal circuit (s)ora limited energy panel,
O System over 600 volts nominal more residential units in onestrocnue alteration, or extension' - t t 2
O Building over three stories O Feeders, 400 amps or mom *Desert , eon:
0 Occupant load over 99 persons Cl Manufactured structures or RV park Each additional inspection over the allowable In any of the above:
O Eg ghtingpian • 0 Other. Peri • -- on =IBM
Submit _ sets of plans with any of the above. investigation fee
The above are not applicable to temporary construction service. Other
Nat all jtaisdlctions accept credit cards, please call jurisdtctioa for more information. Notice: This permit application Permit fee $ - 1 S. OC
Visa 0 M • -acd expires if a permit is not obtained Plan review (at — %) $
. accepted as
00 0 0 t e n 1/ 41 / OS w i t hin 180 day after it has been State surcharge (8%) .... $ (0 . 0 0
Credit gill tatetbec. I TOTAL $ St-a0
Name •
1 041 _ 1 �i, x.4,1 �•� complete. m at.., : . .., credit card $ 0
., , �' 0 AXE 440 itroorron�
e • Amo D
. 1- 9-(1-03
CITY OFTICARD 24 -Hour •
ns ecti 503 639 -4175. f
BUILDING I p � ) r � = 3
INSPECTION DIVISION Busines 03) 639 - 4171 MST
Q " BUP
-
Received Date Requested 0 - 13 AM PM BUP
Location / lo Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner C. 4 - 0 -5 ELC
Footing T PS &€-€ ELC
Foundation Access: a
Ftg Drain ELR 3 ad 8
Crawl Drain
Slab Inspection Notes: SIT
Post Post & Beam 9cua arl
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
IowVolt .e
Fire arm
41111C-1 FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. .
SITE Please call for einspection RE: El Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date 7J �3 Inspeato
Ext
Other:
Final DO NOT REMOVE this inspection record from the J site.
PASS PART FAIL