Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
4rAvis� DEVELOPMENT H BMEN So R 9 2 639 -4171 DATE PERMIT #: ISSUED: 0%079 99 -90207
SITE ADDRESS: 13900 SW PACIFIC HWY PARCEL: 2S103DD -01201
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Proiect Description: Data telecommunication installation.
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:
MILLER, PRUDENCE M CHRISTENSON ELECTRIC INC
4220 SW GREENLEAF DRIVE 111 SW COLUMBIA
PORTLAND, OR 97221 STE 480
PORTLAND, OR 97201
Phone: Phone: 241 -4812
Reg #: LIC 000458
SUP 3289S
PLM 2468S
ELE 26 -34C
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT GEO 09/07/199E. $60.00 99- 318127 Elect'l Final
5PCT GEO 09/07/199E. $4.20 99- 318127
Total $64.20 ORIGINAL
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 follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0010 throu• OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
Issued by / 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: X:34l 7 F
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
. ..1 FRI 16:11 FAX 503 598 1960 CITY OF TIGARD II002
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by:
1314 SW HALL BLVD Date Rec'd:
' TIGARD OR 97223 PRINT OR TYPE
V - 503-639-4171 X304 Permit #:C LX 1197 - Do 4 07
F - 503 - 598 -1960 INCOMPLETE OR ILLEGIBLE APPLICATIONS CustCall'd:
JOB: 50 - 01470 WILL NOT BE ACCEPTED
MCBRIDE Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
ELECTRIC 24 HOUR FITNESS. Restricted Energy Fee »... »..... ».. » »..»..... $60.00
(FOR ALL SYSTEMS)
JOB Street Address Ste # Type of Work Involved: Check
•
C
ADDRESS 13900 SW HWY 99
TIG R t AD I 97224 Phone # ❑ Audio and Stereo Systems
Name ❑ Burglar Alarm
P €a.UP,,€ Ai //fizz f
�c 0 Garage Door Opener'
OWNER e o al�g p x�J egetfrosstovr
CS(@tg J,ig , / Phone #
❑ Heating, Ventilation and Air Conditioning System*
QUESTIONS? Name 1`j ❑ Vacuum Systems*
DERRICK LEWIS CHRISTENSON ELECTRIC, INC. 0 Other
CONTRACTOR Mailing Address
111 SW COLUMBIA, SUITE 480 TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a City /State p Phone 6 Fee for each system.................. ....... »w........... » ». $60.00 .
copy of all licenses PORTLAND OR • 9 241 (SEE OAR 918-260-260)
are required If Oregon Contr. Brd LW # F Qata
expired in C.O.T. 45 d 5 / 63 to Check Type of Work Involved:
data base). E C Contr. tic. # EPo9 t ❑ Audio and Stereo Systems
. 0 2, T. b or Metro Uc. # Ep ! y y ❑ Boiler Controls
Owner's Name
❑ Clock Systems
OWNER - Meiling Address
APPLICANT Data Telecommunication Installation
City /State I Zip I 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 asterlsks(1. All others need licensing;
2. Call for inspections when installation under this permit are ready for ❑ Landscape Irrigation ControM
Inspection at 603.639-4175; ❑ Medical
3. Purchase separate permits for all installations that are not ready for an ❑
inspection when the inspector is out to inspect der this permit; Nurse Calls
ct
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 - transferable and non- refundable and expire if work Is not
started within 180 days of issuance or if work is suspended for 180 days. Number of Systems
The person signing for this permit must be the applicant or a person • No licenses are required. Licenses we required for as other Installations
authorized to bind the applicant
J FEES:
Signature ENTER FEES $ 60.
9/1/99
i ! , t URCHARGE(. S( TOTAL ABOVE) 1 1 1 2 1 0 $ 4.20
Authority if other than Applicant / TOTAL $ 64.20
thdstslforms reseie.doc 3/ae
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP
Date Requested R- D AM PM BLD
Location )._q 0 o t \ \1S`C \) Suite MEC
Contact Person. Ph PLM
Contractor Ph SWR
BUILDING • Tenant/Owner ELC
Retaining Wall ELR 0
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT \1 (
Post & Beam
Ext Sheath /Shear N \ 'MY\ `
1—� V"
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Fire wall \ /
Fire Sprinkler Y
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab V tv■Rc C
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam S
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
CI L T .E 7 CTRI AL
Rough In
UG/Slab
L - i
ire Alarm
Fin
P SS PART FAIL
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 < — Q
Other Date Inspector ffi " Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the " . b site.