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CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection/Linc: 6394175 Business Phone: 6394171
Date Requested: 16 --_ A.M. P.M. MST:
Location: —k-42- _, BUP:
Tenant: _ Suite Bldg: MEC:_
Phone: f- 0 _^ PLM: -
ic - Phone: ELC:_
I L e��-�-;7' C - ELR:- �•�
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BUILDING BLDG(con't) PLUMBING MECHANICALF,CTRIC SITE
Site Post/Beam Post/I3earn Post/13eam Cover Service Sewer/Stonn
Footing Roof UndFI/Slab Rough-In Ceiling Water I,ine
Slab Framing Top Out Gas Line Rough-In UG Sprinkler
Foundation Insulation Sewer Ilood/Duct Reconnect Vaull
3smt Damp Drywall Stcnn Furnace Temp Service MISC.
Masonry Ceiling Rain I_~..m A/C UG Slab
Shear/Sheath Fire Spklr/Ahn Crawl/Found Dr I Iutt Pump Low Volt
Approved Approved Approved Approv_ Approved
Appr/Sdwlk Not Approved Not Approved Not Approved o oved Not Approved
FINAL, FINAL FINAL FINAL FINAL
C7 Call for reinspecti Iteinslxctiun Icv of I _ require beC a Wert ' c i C7 Unable to inspect
Inspector:_ - /-__-_- -- _.— Date _^� O I`age of
CITY OF TIGAPF)
DEVELOPMENT SERVICES
13125 SW Hall Blvd.,Tigard,OR 97223 (503)6394171
Insta:A a Lrglar 3:&:,s t4 an existing single farily
dwell.'11q.
AUDIO r'!:.I T)T ri
OIL!` X
3nRP(3F
1-1 V")r. . . . I. . . . . .. . . . 1;E
I U' !7)y OUTDOOP LINI)S L T
77'..
1 N"'.7"l-IMF-N AT i(31N. 4, OTHER. .,
TOTAL -4 (.3(-
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PRM T $ '1;7*. 00
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i0nRn nF? 1. 7024 1 C I
$
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perrit is issued subject to t"e regulations contained in the Tigard Municipal Code, State, of Ore, Specialty ~odes and all of
.',icahls Ia.,t, Al' t,:rk kill be done In wit.) approved Mans, This persit will FxOre if work is rot started withir,
,
days Of issuance, or if wore is suspended for tore than 188 days. AT17NTION: Oregon Iasi -equire5' you to fallow rule adapteud by the
i- OAR through OAR 952-0 l-me. YOU 2.;�,
J rent rcies o-
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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#: e-,e
F - 503-684-7297 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:__
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF 4VORK INVOLVED -RESIDENTIAL
+Restricted Energy Fee ...................................... $40.00
(FOR ALL SYSTEMS)
JOB Street Address Ste#
ADDRESS /Lyl ,_3 5—51,-)lC Check Type of Work Involved
Ci /State zm Zi Phone# Audio and Stereo Systems
Na Burglar Alarm
�'~`�' ''YY❑`` Garage Door Opener'
OWNER Mailing Address
City/State Zip Phone# ❑ Heating,Ventilation and Air Conditioning System'
Name ❑ Vacuum Systems'
ADT SECURITY SYSTEMS,INC
703 HANCOCK [� Other
OR WNP
CONTRACTOR Mailing Ad 3)284 3265
_ TYPE OF WORK INVOLVED -COMMERCIAL _
(Prior to issuance a City/State Zip Phone# Fee for oath system.............-.............................. $40.00
copy of all licenses (SEE OAR 918-260-260)
are required if Oregon Contr.Brd Lic.# Exp.Date
expired in C.O.T. %�' LT Check Type of Work Involved
data base) Electrical Contr.Lic.# Exp. Date
;2� - �10� ❑ Audio and Stereo Systems
C.Q.T.or Metro Lic,# Exp.Date
❑ Boiler Controls
Owner's Name
❑ Clack Systems
OWNER - Mailing Address
APPLICANT [] Data Telecommunication Installation
City/State Zip Phorle# rq
L_J Fire Alarm Installation
This permit is issued under OAE 918-320-370 This applicant agrees to ❑
make c 4v restricted energy installations(100 volt amps or less)under this HVAC
permit and to do the following.
Instrumentation
1 Only use electri,4 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;
(
2. Call for inspections when installation under this permit are ready for E] Landscape Irrigation Control'
a inspection at 503-'194175; ❑ Medical
3. Purchase separate per nils for all installations that are not ready for an Nurse Cans
N inspection when the in-ipector 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,Cz ❑
Protective Signaling
5 Assume icsrw ns.bilily for calling for a final inspection when all of the
corrections ere completed. ❑ Other
Permits are non-transferable and non-refundable and ex,)ire if wort,ie!not
started within 180 days of issuance or if work is suspendei for 180 days Number of Systems
The person signing for this Ne it mast be the applicant or a person No ilcenees aro required Licenses are required for all other installations
a0hurized to bind the applic
r�
Signature J� I ENTER FEES
5%SURCHARGE(.05 X TOTAL ABOVE)
AuYtority if other than Applicant - TOTAL
resele dor 121H _