Permit Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION I/
13125 SW Hall Blvd.
Tigard, OR 97223 PERMIT # tip 95- D / /a
/t,�,N�� {IC Phone (503) 639 -4171
FAX (503) 684 -7297 DATE ISSUED 9- 7= 96
TDD No. (503) 684 -2772
CITY OF TIGARD Inspection (503) 639 -4175 ISSUED BY CAa.les -SC Lim.df-
PLEASE COMPLETE ALL SECTIONS i •
1. LOCATION OF INS ALI 4. TYPE OF WORK . . ,
� —
Add �� 0 I REST TIAL — Restricted S Fee $40.00
—/ /86-4 I (FOR OR A LL LL SYSTEMS)
S)
City h'` J State Zip Check Type of Work Involved:
PERMITS ARE NON - TRANSFERABLE AND NON - REFUNDABLE AND EXPIRE IF WORK - ❑ Audio and Stereo Systems*
IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR y
180 DAYS. ❑ Burglar Alarm
2. CONTRACTOR APPLICATION ❑ Garage Door Opener*
_ ❑ Heating, Ventilation and Air Conditioning System*
Contractor 43:51 Type Vacuum Systems*
�y /t ) L
Address // q � it) ( ❑ Other
J
Date / -- L s COMMERCIAL — Fee for each system $40.00
(SEE OAR 918 - 260 -260)
Property Owner , .', /l/l/ . _ if _ 1 /A Check Type of Work Involved:
Contractor's Board Reg. No. 400 q ❑ Audio and Stereo Systems*
k3g-i05 ❑ ❑ Cl Systems
Phone# Clock ystems
3. OWNER APPLICATION ❑ Data Telecommunication Installations
/ ') ❑ Fire Alarm Installation
6,z - 9 774 ❑ HVAC
Print Owner's Name Phone No
❑ Instrumentation
Address ❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
City State Zip ❑ Medical
This permit is issued under OAR 918- 320 -370. This applicant agrees to make only ❑ Nurse Calls
restricted energy installations (100 volt amps or less) under this permit and to do the 0 0 or Landscape Lighting*
following:
1. Only use electrical licensed persons to do installations where required. (Certain Protective Signaling
residential and other transactions are exempt from licensing. These have ❑ Other
asterisks( *). All others need licensing).
2. Call for an inspection when all of the installations under this permit are ready
for inspection at 503- 639 -4175.
❑ Number of Systems
3. Purchase separate permits for all installations that are not ready for inspection
when the inspector is out to inspect under this permit. • No licenses are required. Licenses are required for all other installations.
4. Assume responsibility for assuring that all corrections required by the inspector
are done, and
5. Assume responsibility for calling for a final inspection when all of the corrections 5. FEES
are completed.
The person signing for this must be the applicant or a person a. Enter Fees $ 4 / 1 61 Zit
authorized to bin. ' e applicant.
b. 5% Surcharge (.05 x total above) $ . - O v
Sign ture 1 h ` 6
TOTAL $ o ! Uv
Authority if other than applicant
ENERGAP.CHP
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested AM �-C • BLD
Location 1` l ` / Su-_ / d �.- MEC
Contact Person Ph PLM
Contractor D7 _ Ph i All SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR ?
Footing Access:
Foundation CEPS
Ftg Drain SGN
Crawl Drain Inspection Note ' /
lab ' � t4 �� � � SIT
S &Beam �
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation - ■
Drywall Nailing 4__ �,_ _' _ � � _ /AI
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling A -� _•. i
r -0t_AI _ 4
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
Gas Line
Smoke Dampers
Final
PAS PA_RT FAIL
LECTRICAL
ce
Rough In
o Volta
Fire Alarm
Final
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 /� �^)
EXt
Approach /Sidewalk Q
Other (� ' - ���
D ate ' �/ Inspector ��� d /
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.