Permit v �
CITY OF TI GARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
r DEVELOPMENT SERVICES PERMIT #: ELR2000 -00204
='�'� r ' I I- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/6/00
SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 200 PARCEL: 1S134BC -00401
SUBDIVISION: ZONING: C -N
BLOCK: LOT: JURISDICTION: TIG
Project Description: Move fire alarm.
A. RESIDENTIAL 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: X OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
SISTERS OF PROVIDENCE IN OR METRO SAFETY AND FIRE INC
BY STEVE FOSTER 7055 NE GLISAN
PO BOX 13993 PORTLAND, OR 97213
PORTLAND, OR 97213
Phone: Phone: 231 -2999
Reg #: LIC 63651
ELE 803RET
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 9/6/00 $75.00 2720000000
5PCT CTR 9/6/00 $6.00 2720000000
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 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 que ;ins to OUNC at (503)
246 -1987.
Issued by F Irmway - ' — Permittee Signature , J
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale. lease, or ren
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: .. L6
11125 SS'V HALL BLVD Date Rec'd: 9/4/o-0
TIGARD OR 97223 Incomplete or illegible applications Permit #: CZ/12a oo - do .2a y
v. 503 - 639 -4171 X304 • will not be accepted Cust.Call'd:
F - 503 -598 -1960
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
po 202, /9-1s i._6--._ .
S - L. k V ect.u�c I P,, 4. Restricted Energy Fee $75.00
JOB ` Street Address Ste # (FOR ALL SYSTEMS)
ADDRESS 12.4 SW L Fetgy el cgo o Check Type of Work Involved:
City/State Zip l Phone #
illt+tRO ) n(Z. 57ZZ ❑ Audio and Stereo Systems
Name .
• ❑ Burglar Alarm
OWNER Mailing Address ❑ Garage Door Opener'
City /State Zip Phone # ❑ Heating, Ventilation and Air Conditioning System*
• Name ❑ Vacuum Systems'
CaR.0 Sp.F cia- Fte_t IZNC" ❑ Other
CONTRACTOR Mailing Address
- 70-C''' ■6 Glisiw sr-
(Prior to issuance a C Zip Phone # TYPE OF WORK INVOLVED - COMMERCIAL ONLY
copy of all licenses that U D U U (3 213 a31-495
are required if Oregon Cor Brd Lic. # Exp. Date Fee for each system $75.00
expired in C.O.T. WC,S1 1 -Zo tiZ- (SEE OAR 918 - 260 -260)
database). Electrical Contr. Lic. # Exp. Date
03 gCI 10 -1 -o Check Type of Work Involved: •
C.O.T. or Metro Lic. # Exp. Date ❑
Audio and Stereo Systems
Owner's Name
❑ Boiler Controls
OWNER - Mailing Address
APPLICANT ❑ Clock Systems
City /State Zip Phone # ❑
Data Telecommunication 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 ' Fire Alarm Installation _ 1'•Aou
permit and to do the following: ❑
HVAC
1. Only use electrical licensed persons to do installations where required.
Certain residential and other transactions are exempt from licensing. ❑ Instrumentation
These have asterisks(*). All others need licensing;
❑ Intercom and Paging Systems
2. Call for inspections when installation under this permit are ready for
inspection at 503 - 639 -4175; ❑ Landscape Irrigation Control'
•
3. Purchase separate permits for all installations that are not ready for an • ❑ Medical
inspection when the inspector is out to inspect under this permit:
4. Assume responsibility for assuring that all corrections required by the ❑ Nurse Calls
inspector are done, and; ❑
Outdoor Landscape Lighting*
5. Assume responsibility for calling for a final inspection when all of the
corrections are completed. ❑ Protective Signaling
Permits are non - transferable and non - refundable and expire if work is not ❑ Other
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
authorized to bind the appli . • • No licenses are required. Licenses are required for all other installations
. FEES:
,
Signature ENTER FEES $ / 5 o
8% SURCHARGE (.08 X TOTAL ABOVE) $ '
TOTAL . $ , �� /, a �
Authority if other than Applicant
i:tdstsVormsVesele.doc 8/00
1
,CITY OF TIGARD BUILDING INSPECTION DIVISION MST
,24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
• BUP
/ Date Requested (--/- ? /? AM PM BLD
Location / Z - c 2 - -S Suite -" MEC
S�y - 2-
Contact Person l CG, / Ph �3� y �l �/' PLM
Contractor I "l. �-I i� / Ph SWR
BUILDING Tenant/Owner Dy a ELC
Retaining Wall ELR J '6' G v.•20 q
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab / OW ? I ir a eh"0 SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing 6dee
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab n
Top Out
Water Service
Sanitary Sewer
Rain Drains 0/ Final
PASS PART FAIL
MECHANICAL A I/4' fLA
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ECTRICA
ervie
Rough In
UG /Slab
4 ow Volta. - CE4v4,\
- • arm
Fi
� 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 7 Inspector �.la Ext
Final
PASS PART FAIL DO OT REMOVE this inspection record from the job site.