15842 UPPER BOONES FERRY ROAD ADDRESS:
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CITY OF TIGARD BUILDING INSeECTION DIVISION
24-Hour Inspection Line: 6394175 Business Phone: 6394171
Date Requested: A.M. P.M. MST:
Location: L� ? _ �� Jr ��1 �.( BUP:
Tcnant: B Suite:
_ _ ---Bldg: MEC:i
Contractor Phone: 7�"��– PLM:
Owner: Phone:
—_._-- ELC:
-- ELR: )
SIT:
BUILDING BLDG(con't) PLUMBING _'MECIiANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Cover/Service Sewer/Storm
Footing Root- UndFI/Slab Rough-In Ceiling Water Line
Slab Framing Top Out Lias Line Rough-In Ula Sprinkler
Foundation Insulation Sewer Ilood/Duct Reconnect Vault
Dsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C
Shear/Sheath Fire Spk1r/Alm Crawl/Found Dr I feat Pump
Approved Approved Approved �--A proved Approved
Appr/Sdwlk Not Approved Not Approved Not Approved `Neyed Not Approved
FINAL FINAL FINAL FINAL FINAI,
D Call for reinspection n Reinspection feco�1 ra:luirecl before next inspection Unahle to inspect
Inspector: , Date: C _ZZ _ Page of—�--
/A\ MITI( OF TIGARD
®EVELOPLENT SERVICES
13125 SW Hall Blvd., T*rd, OR 97223 (503)639•4171
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yf."P7A.. i 1 i.r
Will 1 Cry rrar
'his peroit is issued subject to the eg%Mations contained in the '%garrd Municipal Code, :State of Ore. Specialty Codes and all cit?
pplicatie Taws. ��I1 work mit be done it accordance w:`" approved pia,. ,i-iS peroit will 4�;r.re _F wewk ►4 ort started within
Says of issuance, or if work is suspendca far- ogre t�rar; "N days, p"FE.N LIN: Oregon ia+r requires you to follow rule adopted by the
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-e, r.,.,` r 17 011-0010 through OAR ^`.2WI-080, lou oay ^blain cop:o
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Recd by.
13125 SW HALL BLVD Date Recd:
TIGARD OR 97223 PRINT OR TYPE
V - 503-639-4171 X304 Permit
F - 503-684-72�1 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Cali'd:,_ .�-
WILL NOT BE ACCEPTED '�T
Name of Development Project TYPE OF WORK INVOLVED -RESIDENTIAL
Restricted Energy Fee...v............................... $40.00
> (2 (FOR ALL SYSTEMS)
,JOB Street Addreds Ste N
ADDRESS f 5 �� /� �cc��e, ,-, R / Check Type of Work Involved
City/State Zip Ph ne# Audio and Stereo Systems
Name Burglar Alarm
Garage Door Opener•
OWNER Mailing Address
`�i S S'u IS `' f
City/State Zip hon u r� �k��' ' ❑ Heating,Ventilation and Air Conditioning System'
PN
Pe r- keo2`
Name Vacuum Systems"
❑ Other —_- - - -.-_-
CONTRACTOR Mailing Addresa
r C #jC, TYPE OF WORK INVOLVED - COMMERCIAL
(Prior to issuance a ty/S ate zip Phot*# Fee for each system.............................................. $40.00
copy of all licenses / , 2 7,L21 (SEE OAR 918,260-260)
are required if Oregon Contr.ffird Lic.# Exp.Date
expired in C.01S' / it Check Type of Work Involved:
data base) Electrical Contr.Lic.# E p. ate
- �7 LLE r Audio and Stereo Systems
C.O.T.or Metro Lige# Exp.Date
l /i -1/Z
Boller Controls
_. Ow 5 Nam
Clock Systems
OWNER - Mailing Address -��
APPLICANT �� 7•t `9' ❑ Data Telecommunication Installation
City/State Zip Phone# ❑
Fire Alarm Instariation
This permit is Issued under CAE 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 fcr'owing
Instrumentation
1. Only use electrical licensed persons to do installations where required.
Certain residentl¢I and other trar,actions are exempt from licensing. ❑ Intercom and Paging Systems
These have asterisks('). All others need licensing;
Landscape Irrigation Control*
2 Call for Inspections when installationunder this permit are ready for
inspection at 503.639-4175; Medical
3 Purchase separate permits for all installations that are riot 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 Systeme
The person signing for this permit must be the applicant or person No licenses are required Licenses are required for all other installations
authorized to bind the applicant.
FEES:
SignatureT - ENTER VEES $ ! _
5%SURCHARGE(.05 X TOTAL ABOVE) O &
Authority it other than Applicant TOTAL
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