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Permit .. A , . CITY OF T I GARD ELECTRICAL PERMIT - RESTRICTED ENERGY prAJ DEVELOPMENT H B So R 9 2 CES 639 -4171 DATE PERMIT #: ISSUED: E X289 99 -90318 SITE ADDRESS: 11735 SW QUEEN ELIZABETH ST 101 PARCEL: 2S110CD -00104 SUBDIVISION: KING CITY NO. 2 ZONING: BLOCK: LOT: JURISDICTION: KIN Project 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: JOHN D. MEDAK ALLEN/FALK INC VIUHKOLA, JENNIFER 9020 SW GEMINI 4029 NE SANDY BLVD. BEAVERTON, OR 97008 PORTLAND, OR 97213 Phone: Phone: 646 -0533 ORIGINAL Reg #: LAC 47238 SUP 781JLE ELE 34258CLE FEES Required Inspections Type By Date Amount Receipt Low Voltage Inspection PRMT KJP 12/28/199c $60.00 99- 320698 Elect'I Final 5PCT KJP 12/28/199E $4.80 99- 320698 Total $64.80 • 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 thro AR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -1987. Issued by Permittee Signature „g. - . S. 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: CO TRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: it DATE: LICENSE NO: Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day . CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by: 13125 SW HALL BLVD Date Rec'd: TIGARD OR 97223 PRINT OR TYPE lei /'j V - 503 - 639 -4171 X304 Permit #: EL e' ?99-003/6) F - 503 - 598 -1960 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd: WILL NOT BE ACCEPTED Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY Restricted Energy Fee $60.00 C 7 -e. f \ s - y - - be.ve,\opmgrk ALL SYSTEMS) JOB Street Address Ste# Cpl — Check Type of Work Involved: ADDRESS 11135 Sw Qu¢tan El i zabe4-tn .City/State Zip Phone # ❑ Audio and Stereo Systems K nq CG criaaL4 9LR-a3a3 Nam ❑ Burglar Alarm 9 illn A ❑ Garage Door Opener' OWNER Z ddr r C S 1v01 Zip , on # 7 ' ❑ Heating, Ventilation and Air Conditioning System' QState r &-tt -Q 18 - I P s/ Name / r �/ ❑ Vacuum Systems' Allen ! F K I:r c • ❑ Other CONTRACTOR Mailing Address , 9Dap sIA) C in 1 , r t Ve. TYPE OF WORK INVOLVED - COMMERCIAL ONLY (Prior issuance pity/State �� �ip Q Phone # � Fee for each system $60.00 copy of f all licenses s p� efi ' I � (- p (SEE OAR R 918-260-260) are required if Oregon Contr. Brd # E Date expired in C.O.T. 4 l ). 3 j '�) fl 'rL Check Type of Work Involved: data base). Electri I contr . L. j( 1- Exp. gate - 3.5 3cAz O 100 ck- ❑ Audio and Stereo Systems C.O.T. or Metro . 11' G ❑ J Boiler Controls Owner's Name ❑ 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 ❑ 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 - 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 are required for all other installations authorized to bind the applicant. i ES: / ,, �� / (J IS�TGC FEES: FEES $ ( o.OU Signature (� Q/^� SURCHARGE (.05 X TOTAL ABOVE) $ l • Bo Authority if other than Applicant TOTAL $ LoLl . 80 i:\dsts \forms\resele.doc 3/98 . • ,. KING CITY 15300 S.W. 116th Avenue, King City, Oregon 97224 -2693 ■ Phone: (503) 639 -4082 • FAX (503) 639 -3771 Notice To Contractors Working In King City Due to an intergovernmental agreement with the City of Tigard, many building related permits for projects in King City are issued and inspected by the City of Tigard. If your permit application DOES NOT REQUIRE PLAN REVIEW, simply complete the appropriate application legibly and submit it to the King City staff The King City staff will collect all fees and fax the application to the City of Tigard. City of Tigard staff will then create the permit, issue the permit, and perform inspections. Please indicate on the permit application whether you would like the Tigard staff to call you when the permit is ready for issuance or whether you prefer it to be mailed without any notification. Any incomplete or illegible application will be returned to King City staff for correction and no processing will occur until a complete, legible application is received. If your permit application DOES REQUIRE PLAN REVIEW, this form must be signed by a King City staff person. King City staff will simply sign this form indicating land use approval. Take this signed form to the City of Tigard Development Services Counter located at 13125 SW Hall Blvd, Tigard, to submit applications and plans. Development Services Technicians are available at 639 -4171 Ext. 304 should you have any questions concerning submittal requirements. All permit fees will be assessed and collected at the City of Tigard. The City of King City hereby authorizes applicant to pursue permits at the City of Tigard Building Department for the following project: &Le:64i �aA u t located at: I I r 13 5 S.L) (ategil LC/ \U King City Representativ a - -g 1:'DSTS\XC(NST.DOC • 2/3/00 Activities for Case #: ELR1999 -00318 1:50:47 PM Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes ELRC001 Application Received 12/28/99 KJP RECD No Hold KJP 12/28/99 ELRC003 Permit Created 12/28/99 KJP DONE No Hold KJP 12/28/99 ELRC725 Low Voltage Inspection 12/28/99 KJP No Hold KJP 12/28/99 ELRC799 Elects Final 12/28/99 12/28/99 12/30/99 BRP PASS No Hold AKJ 1/2/00 ELRC500 (F) Issue permit 12/28/99 KJP DONE No Hold KJP 12/28/99 ELRC800 Case finaled 1/2/00 AKJ DONE No Hold AKJ 1/2/00 • Page 1 of 1 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested XZO I ? 9 AM K PM BLD Location 1 1 - 7;S Qi&LJ MEC Contact Person Ph 2--SS PLM Contractor Ph SWR BUILDING Tenant/Owner ELC 1 q9 1 7 -- 0 0 10 9 7 Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain • Crawl Drain Inspection Notes: /�( 6 �,� _ n • n r SGN Slab Ill - / lLC 0� SIT • Post & Beam Ext Sheath/Shear Int Sheath/Shear Framing Insulation �,,,, p Q Q Drywall Nailing I C — — 0 i 4 S �� I p Firewall • Fire Sprinkler Fire Alarm Susp'd Ceiling // c Roof E Misc: L ( L � — D3/ e Os 7701 Final -. A.- D / 5.1-e . 02-- PASS PART FAIL PLUMBING __ — • d A - X03 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 PASS PART FAIL <'ECECTRICAt> ( Service Rough In UG /Slab Low Voltage Fire Alarm PASS PART FAIL IT Backfill/Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. y at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Other Approach/Sidewalk Date (2 ` - 3 �� Inspector , '� pector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.