Permit • CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
h DEVELOPMENT SERVICES PERMIT #: ELR2000 -00210
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/14/00
SITE ADDRESS: 09451 SW WASHINGTON SQUARE RD A -16 PARCEL: 1S126C0 -01107
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
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:
PPR WASHINGTON SQUARE LLC ALLEN/FALK INC
P.O.BOX 21545 9020 SW GEMINI
SEATTLE, WA 98111 BEAVERTON, OR 97008
Phone: Phone: 646 -0533
Reg #: LIC 47238
SUP. 781JLE
ELE 34258CLE
FEES Required Inspections
Type By Date Amount Receipt Elect'l Service
PRMT CTR 9/13/00 $60.00 2720000000 • Elect'l Final
5PCT CTR 9/13/00 $4.80 2720000000
PRMT •CTR 9/14/00 $15.00 2720000000
5PCT CTR 9/14/00 • $1.20 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
require 'UM - follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -► -0010 throu• OAR e .2- 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 1987.
Issue. • y �i A/14/Wk Permittee Signature ,g
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 / /q- 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 • : r -
13125 SW HALL BLVD Date Rec' • : '' -,1- 'O
TIGARD dR 97223 PRINT OR TYPE
V - 503 - 639 -4171 X304 Permit #: - 9,/b
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
Q 1 Restricted Energy Fee $60.00
C:Street re 5 I &10 vs10,s t d S, f.Cj . (FOR ALL SYSTEMS)
JOB Address e #
ADDRESS W *I 15on s Lux -tn,r A -1 lQ Check Type of Work Involved:
Cit /State Zip r1 3 Phone # ❑ Audio and Stereo Systems
o ff O R °
,
Na ❑ Burglar Alarm
OWNER Mailing Address
El
Door Opener*
City/State Zip Phone # ❑ Heating, Ventilation and Air Conditioning System*
Name n Vacuum Systems*
A11e.X\ I Calk ❑ Other
CONTRACTOR Maili Address ^
c 1.0 C�2 rv:t v6 t U Y wt- TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a ty /State Q Zip Phone # Fee for each system �g66.00'
copy of all licenses vty °I`laly f. Luo-0.533 (SEE OAR 918 - 260 -260) 75,Ov
are required if Oregon Con Br ic. Exp. ate
expired in C.O.T. ] Coal DI Check Type of Work Involved:
data base). Electrical ontr. Lic. Exp. ate
?) -- a5` D I o n Audio and Stereo Systems
C.O.T. or etro Lic. # Exp. ate
OOOOSC) _ 11 Q ❑ Boiler Controls
Owner's Name
❑ Clock Systems
OWNER - Mailing Address
APPLICANT X 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 n 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;
TI 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. 1 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. / ��
fi FEES: 75
I
Signature ENTER FEES $ ����l� c o
� U
g s----jp 3 jz,v....._ $4 SURCHARGE (.05 X TOTAL ABOVE) $ 4, U 1.1
Authority if other than Applicant TOTAL $ ...Ant; 0
is \dsts \forms\resele.doc 3/98 X ® 0
,_CITV OF TIGARD BUILDING INSPECTION DIVISION nest.
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 •
BUP
Date Requested 74 9 AM s�J PM BLD
Location 9( / Si-. Gcla sk S Suite /'g — / MEC
Contact Person Ph C Lf f 05 PLM
Contractor Ph SWR
BUILDING Tenant/Owner , 1S6 ,.J s Zei44-71,-e—sr-
Retaining Wall ELR . '�
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
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
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
ELECTRICAL
Service
Rough In
UG /Slab
Low Volt;. - ..
Fire •
may ..
' 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 3 j fe)_
Approach /Sidewalk
Other Date . Inspector Ext _
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.