Permit CITY OF TI GARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
, 1 , DEVELOPMENT SERVICES PERMIT #: ELR2000 -00091
I - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 04/27/2000
SITE ADDRESS: 11735 SW QUEEN ELIZABETH ST 105 PARCEL: 2S110CD -00104
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT: JURISDICTION: KIN
Project Description: Installing data telecommunications system
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:
MEDAK, JOHN D + MICRO ELECTRIC VOICE + DATA
VIUHKOLA, JENNIFER 300 S REDWOOD STE 120
4029 NE SANDY BLVD CANBY, OR 97013
PORTLAND, OR 97213
Phone: Phone: 503 - 266 -5847
Reg #: LIC 131543
ELE 3- 447CLE
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT BON 04/27/200C $60.00 0001745 Elect'I Final
5PCT BON 04/27/200C $4.80 0001745
Total $64.80 ORIG
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 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987. '/
Issued by j 1I' 1, t at Permittee Signature 4/
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
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by: I
13125 SW HALL BLVD Date Rec'd: 4- .7 - /sots
TIGARD OR 97223 PRINT OR TYPE ,^'
V - 503 - 639 -4171 X304 Permit #: E! ( -1909q1
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
Ad de Restricted Energy Fee $60.00
Tack /4' f - Ko (FOR ALL SYSTEMS)
JOB Street Address Ste #
ADDRESS J/735 s ( 01,A,..6.4 �; avd k 0 S Check Type of Work Involved
City /State Zip Phone # ❑ Audio and Stereo Systems
1 Lr • _ 7 Feo 7 9x9(
Na rffe ❑ Burglar Alarm
�� I A41d& '� i k t " I U' ' ' ❑ Garage Door Opener*
OWNER adrre
ilin �
VO ity /State Z ip Phone # ❑ Heating, Ventilation and Air Conditioning System`
K ' 7z-g 3 51e 7u3
Name ❑ Vacuum Systems`
/rl f t Ltt, b MC-4 (-- ❑ Other
CONTRACTOR Mailing Address
TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a City /State Zip Phone # Fee for each system $60.00
copy of all licenses 31// 3 7 1ig (SEE OAR 918 - 260 -260)
are required if Oregon Contr. Brd Lic. # Exp. Date
expired in C.O.T. / 1 /Su 3 Check Type of Work Involved:
data base). Electrical Contr. Lic. # Exp. Date
3 L [..f 7 Ci- ❑ Audio and Stereo Systems
C.O.T. or Metro Lic. # Exp. Date
❑ Boiler Controls
O.wper's Name /, "� 4. e.,,,V
ri /` -,,m'- - i; /,`R idi) ❑ Clock Systems
OWNER - Mailing Address
APPLICANT ® Data Telecommunication Installation
City /State Zip Phone #
fiB7 q0'I ( n 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:
0 Instrumentation
1. Only use electrical licensed persons to do installations where required.
Certain residential and other transactions are exempt from licensing. n 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.
4 ."- -- FEES:
Signature ENTER FEES $ 60,0
8% SURCHARGE (.08X TOTAL ABOVE) $ `i rl
Authority if other than Applicant TOTAL $ (p.@
is \dsts \forms \resele.doc 3/98
.. ..
41 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: O`-O) V� E-.t (.0
located at: , _ 4 " / , , . '— ' /O6 /
i .
King City Representati4 < /2 / — CIO
I:'DSTSU<C FNS T. DOC
05/15/2000 Activities for Case #: ELR2000 -00091
3:55:13 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRC001 Application Received 04/27/2000 BON DONE No Hold BON 04/27/2000
ELRC003• Permit Created 04/27/2000 BON DONE No Hold BON 04/27/2000
ELRC730 Elect'l Service No Hold BON 04/27/2000
ELRC799 Elect'I Final 05/11/2000 CD PASS No Hold AKJ 05/11/2000
ELRC500 (F) Issue permit 04 /27/2000 BON DONE No Hold BON 04/27/2000
ELRC800 Case Finaled 05/11/2000 AKJ DONE No Hold AKJ 05/11/2000
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Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
yy�� BUP
Date Requested 5 /i i v0 AM PM BLD
Location (l 135 01/twilit 4-A'-z- Suite / D S MEC
Contact Person (TCt Ph S I LP 71L PLM
Contractor Ph 24 S SWR
BUILDING Tenant/Owner ELC ' Z { t ( D - O n 1; p
Retaining Wall ELR 21 — Qj
Footing Access: fJ
Foundation `I S ( FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: 61 otj 1 �P /0�
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof /a
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
PASS PART FAIL
CCECTRICAZ)
Service
Rough In
UG /Slab
Low Voltage
Fire arm
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
Other Date S /l /-�i U �,
Inspector L_� , _ Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.