Permit AA, ELECTRICAL PERMIT -
CITY �� RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT #: ELR2004 -00285
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 9/8/2004
SITE ADDRESS: 11675 SW 66TH AVE PARCEL: 1S136DD -03800
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 007 JURISDICTION: TIG
Project Description: Limited energy - burglar 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: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
CASEY, EDWARD L JR + ADT SECURITY SERVICES, INC
CASEY, PATRICK D 2815 SW 153RD DR
BY COMMERCIAL REALTY MGMT GRP BEAVERTON, OR 97006
CLACKAMAS, OR 97015
Phone: Phone: 503 469 - 7244
Reg #: LIC 59944
ELE 26- 209CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 9/8/2004 $75.00 Elea! Final
[TAX] 8% State Surchart 9/8/2004 $6.00
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 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Issued by ) Permittee Signature _
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
09/07/2004 09:15FA% 5034697110 ADT SECURITY 0001
glettrical Permit AADIi : \1 ED r elit cii 1 tc ;c tJS off[
of Tigard and )ima� —se , — q ems.• 1, et1' " i 5
13125 SW Hall Blvd•,1Sgaid, OR 97223 PD 1 2004 Review r i t 1 j
' Phone: 503.639 -4171 Fa1c 503,398.1960 Sp O x:ti : I l i in , sat : Other Permit;
Inspection Liao 503.639.4175 ' _ ' Date IteadWay: i / � See Page 2 for
Internet: www.ci-tigentor.11s Of - FICA - Notified/Method: j� Supplemental reformation
■ � ill
Addition/alteration/replacement E�llai.t�Dt�lt I._ � J ° � I I _ ' � I , u ��� � IJ � ' � •� f� i 1 RI' V � � 1. 0 J, 1 -
Il S ' �
1 4 f ,, , , ,.:1.,V41., ii 1 171
..0 r If P , w...:er "�r ..
O New construction Please exk all that
❑ Demolition El �
['Service over 225 amps, comet l ['Hazardous Location
1 r 1 I ❑ Scrn ce over 320 amps — tans 7 g ul dng over 10,
' 000 sq. ft_,
x ; I, i i, ,a pll ° + I d , l q? „f} I , ,, of 1 -and 2- family dwellings 4 or more new residential •
❑ I- and 2 -family dw I' t g Co> t'cial induslria] El Accessory building i °System over 600 volts nominal units in one structure
` ❑ Master builder ❑ ❑Budding over tbt ee starlet] [Weeders. 400 amps or more
Multi -fa�1 y
❑ [occupant load over 99 persons QMenufacnned structures or
' .. t11 1,: a 11 1 , / 4 t t
; � 11, 1 ', l' t RI! park
� [Egtnesllightingplan
,. . ....: ......:.: ....... .. _. ❑Other _
Job no b r ' iI. i ' ` ' I , l 1 .1 / A 1 A [ th facility
�1► Submit 2 sets of plans with any of the above.
City /State/ZIP /, it A / or to 27,3 The above are not applicable to temporary construction service.
i .< : , I , I r 15 J f /_li=�ia .: '�`. �' : ' ".:.
Suite/bldg./apt no.: Project name: f ll_. IP '. Li n Tow
Grose street/directions to job site New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. R or less 14515 4
Subdivision: Lot no.: Ea 3d61 500 sq. ft or portion 33.40 1
Limited energy, residential 75.00 2
Tax,map/parcel no.: Limited residential 75.00 2
:... 1 J °` , I. ti r _; t , Each nufactw d or modular
dwellin_ service and/or feeder 90°.90 . 2
it . I /Al �i ilj AIM Services or feeders Ioatallation, alteratloa, an or relocation
I , 200 amps or loss 80.30 2
,r 1 • 11 i ... : , ( F 1 -,1--' , f11 T
207 arms to 400 amps 106.85 2
401 amps SO 600 amps 160.60 2
Name: iiile(/. a L■ • t .I . 1I 601 amps to 1,000 aanpc 240.60. 2
Address: I Over 1,000 sups or volts _ 454.65 2
Reconnect only 66:85 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: 40 4 d 1 ^ Fa Fax ( ) relocation
IlJ 200 amp or lean 66.85 1
Owner installation; Thi4 installation is being made on property that I own which is not 201 oxlips to 400 amps 10030 r 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 l amps to 600 am 133 - 75 2"
Owner signature: I Date: Branch clrculas — new, alteration, or ottenslon, per panel
1 1 , ; J 11 F , 1 1 ' A. Fee for branch circuits with
_.._ ..- .. _. .. service or feeder fee, each
Business name: branch circuit _ 6.65 2
!3. Fee for branch circuits
Contact none: without service or feeder fee,
46.85 2
each branch circuit
Address: " ”- Each addg branch circuit 6.65 2
City /State/ZIP; Mlscdlaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Itax:: ( )
Sign or outline lighting 53.40 2
E - marl: Signal circuit(s) or limited- •
1 . . ; l ' 1 1 , , ' I . ` 1 I H g 1 -.4 . , Tr ∎ _ I ` 5 .... ' ... ,., 1 1 fi.a1P! • , i,; , l4 , i , 't 4i_:: ;_ ,,, . 'F ri energy panel, alteration, or
extension. Describe: 1 Pige 2 154 2
Business names ADT SECURITY SERVICES, INC. .
Ic .11. 447 s • . Each additional inspection over allowable in any of the above
Address:
1 . a , • : :r,l 1 : Per inspection 62,50
City /State/ZIP: (503) 460.7100 Investigation per hour (1 lv min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour � 73.75
U 5 f 11 S ' l i . 6 1 I . t , 1 , 1 � i 1 4 i, 1i14 j 1 -t 1 Tr '$1� -. i1
:.... �r. � �,.: 1....... ?!. ... , ... ,�!..�,, , , { a.. � r� -_
CCl3 Lic.: 5919L.I. Electrical Lic_: g. a .E Subtotal '7s
Suprv. Electrician signature, required: - A M _ff Plan review (25% of permit fee)
Print name; _ Date: , . • xv' State surcharge (8% of perm t fee)
TO'I•M, FERMIT FEE d i • 00
Authorized signature: Thla permit application espiree it a permit to not obtained within 180
days after it has been aeeepted as complete
Print name: Date: • Pa methodology set by Tri -County Building Industry Service Beard
•• Number of inspections par permit allowed.
i:\HulldlatePemilnAHLGFerndtApp .doe 12/03 a 10.a615111D/D7JCOMPfi
CITY OF TIGARD 24 -Hour
BUILDING ,-_. _ Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business' Line: (503) 639 - 4171 MST
BUP
Received Date Requested 9z'? AM PM BUP
6 s -e&
Location 1 / S _ Suite MEC
Contact Person _ ?.� Ph ( ) 1g3 7 t.r7� PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner . LL _P ,1 — ELC
Footing
ELC
Foundation
Access:
Ftg Drain ELR o?Q D y- v0 6
-
Crawl Drain
Slab Inspection Notes: SIT 7 -
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation • A
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm f(
Susp'd Ceiling
C/
Roof
Other:
Final
PASS PART FAIL
PLUMBING _
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough-In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service -
Rough -In
UG/Slab
Low Voltage
F larm
PASS PART FAIL
D Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITS 111 Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line l 16m g e Av Y
ADA 2) q ® 7 Inspector Pe Sri
Approach/Sidewalk Date
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL