Permit CITYOFTIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT #: ELR2000 -00202
=`' A II 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 8/25/00
SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 200 PARCEL: 1S134BC -00401
SUBDIVISION: ZONING: C -N
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of data telecommunication 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:
SISTERS OF PROVIDENCE IN OR TELECO TELEPHONE CO INC
BY STEVE FOSTER 21954 NE GLISAN ST
PO BOX 13993 GRESHAM, OR 97030
PORTLAND, OR 97213
Phone: Phone: 661 -5462
Reg #: ELE 26- 768CLE
LIC 78609
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 8/25/00 $60.00 2720000000 Elect'l Final
5PCT CTR 8/25/00 $4.80 2720000000
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
require • 1 • • Ilow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -' 11 -0010 thro. gh OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 1987.
Issu - . by / / � i/ Permittee Signature x ��
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
08/24/00 THU 13:43 FAX 503 598 1960 CITY OF TIGARD to001
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by /.....)-PD
13.25 SW HALL BLVD Date Rec'd: g -95
TIGARD OR 97223 PRINT OR TYPE
V - 503 - 639 -4171 X304 Permit #: aRacraJ- ez o9.-
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
(FOR ALL SYSTEMS)
JOB Street Address Ste #
ADDRESS 12K W 5ct,ol(; fe/✓y RO 200 Check Type of Work Involved
- City /St to Zi Phone ❑ Audio and Stereo Systems
• 7 !fetid, Oreyo0 "� Pa 5 537 .
Name ❑ Burglar Alarm
OWNER Mailing Address El
Door Opener'
City /State I Zip Phone # ❑ Heating. Ventilation and Air Conditioning System'
•
Name ❑ Vacuum Systems' •
' re If CO - re I of 1oi e Co. _roe, D Other
CONTRACTOR Mailing Address
2 /9 -y ,NE 61:41/7 5-1 TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a City /State Zip Ph ne # Fee for each system $60.00
copy of all licenses &r€y/a, Ore9o'1 _17030 b Z (SEE OAR 918 - 260 -260)
are required if Oregon Contr. Brd Lic. # Exp. Date ,
expired in C.O.T. _ 7$ / 2_/ t' 00 ( v ®O — Check Type of Work Involved:
data base). Electrical Contr. Lic. # Exp. Date
14 7 /'- / -Od ro %0 ❑ Audio and Stereo Systems
C.O.T. or Metro Lic. # • Exp. Date
2 `I 71 1 01 /O/ ❑ Boiler Controls
Owner's ,. nA
I "! Ae / Paul AA( ( My ❑ Clock Systems
OWNER - Mailing Address 54-,.200
APPLICANT ) 2 ( (y 2 'I/t) Sck ell'./ AD J/ Data Telecommunication Installation
City /State Zip Phone # •
• , 1" ;gced Ore 91z ? _21 2- 35 37 ❑ 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.
FEES:
Signature ENTER FEES $ Of O
8% SURCHARGE (.OBX TOTAL ABOVE) $ L 'a , 0
•
Authority if other than Applicant TOTAL $ L -[ 40
is \dsts\forms\resele.doc 3/98
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 l '/ 5 'v �Sc /�) 4:2i'yk Suite .2-4 MEC
Contact Person Ph 6 5ir% v PLM
Contractor • e -(•/ 0 eG Ph SWR
BUILDING Tenant/Owner D - Cc l ELC
Retaining Wall ELR >UO GOZG Z
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Fire wall (>(14,/
Fire Sprinkler av7"
Fire Alarm
Susp'd Ceiling
Roof f
Misc:
Final /� I
PASS PART FAIL � I
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
Service
Rough In a21`a•-
UG /Slab /
Low Voltage cp
Fire Alarm
Final
:,/ 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 f reinspection RE: ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.