Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
i � DEVELOPMENT SERVICES PERMIT #: ELR2003 -00001
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13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 1/7/03
SITE ADDRESS: 14100 SW 72ND AVE PARCEL: 2S112AA -01000
SUBDIVISION: PP1992 -007 ZONING: I -H
BLOCK: LOT: 001 JURISDICTION: TIG
Project Description: Job No. 083 - 15899 -03
Convert 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:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WILLIAMS CONTROLS INDUSTRIES INC ADT SECURITY SERVICES, INC
14100 SW 72ND AVE 2815 SW 153RD DR
TIGARD, OR 97224 BEAVERTON, OR 97006
Phone: Phone: 503 469 - 7244
Reg #: LIC 59944
ELE 26- 209CLE
FEES Required Inspections
Description Date Amount Ceiling Cover
[ELPRMT] ELR Permit 1/7/03 $75.00 Wall Cover
Elect) Final
[TAX] 8% State Tax 1/7/03 $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 throuc
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Issued by j c_a_ VYt Permittee Signature .4 $j / ✓�i�� _ ,� ` _,�
OWNER INSTALLATION ONLY
The installation is being made on property! 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:
CaII 639 -4175 by 7:00 P.M. for an inspection needed the next business day
01/02/2003 12:37 FAX 5034697110 ADT SECURITY Z001
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Electrical Permit Application •
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Dat tecdved Permit no.; a oc. !
• .0 ! City of Tigard q yED E I projeedappl. no.: Expire date:
ci of Tigard , Address: 13125 SW Hall Blvd, fgif 9722 Date : By: I Receipt no.:
Phone: 03039 639
Fax: (503) 598 -- 1960 1960 2003 1JAN 0 2 Case Mono.: Payment type:
Land use approval: CITY OF TIGARD
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TYPE OF l'FlliIIT
❑ 1 & 2 family dwelling or accessory VI Commercial/industrial O Multi - family 0 Tenant improvement
O New construction 0 Addition/alteration/replacement 0 Other 0 Partial ,
,TO13 SI I E INFOIOTATION 1
Job address: )4-1013 O 72_ sAl Bldg. no.: Suite no.: Tax map/tax lot/account no.: •
Lot: '` I Block: Subdivision: •
Project name: ' ' ■ t14 ., i • Description and location of work on premises: C ..: [, o V 'Ai, s
Estimated date!of completion/inspection:
Job not 08 -15 9 Cf .-0?, • Fee • M•t
Description (ea.) Total no. Business name: Apr St!tetlrl!/ New -yam.
Addres ZUr g _153vA 1,f , deapmgaal4 Includes attached garage.
City: g I S�: ORLZIP :• 97406 senkelamae& .
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Phone S tl4,'fl I Fax5Q•(K7• j E -mail: 1000 sq, It ell= • 4
Each adfitional 500 s* ft or portion thereof w
CeB no.: S 9 1 Elec. b us. lic. ao: 6 .2Ote L Limited eaetgy, readeatiel - 2
City/m lit~ no.: Limited eoergy,nontesidendal 2
O� A sl. d e - //Z O 3 . Each manufactured home or modular dwelling
S' of n pe rvt s electrician (required) be • Santee andlor 2
Sup. elect name (punt): iM) KRA11S L1ce no: LEA3 —sel'ket r �
200 amps or less 2
Name (print): �,6YYf'A g1 Gt1 A,v 4 Phi IA05 201 amps to 400 amps 2
Mailing address: 401 atnpat o 600 amps . 2
' 601 amps to 1000 amps 2.
City: 1 X 474. State ZIP: Over 1000 Quips or volts 2
Ptxorre a -inC0 I Fax: 1E-mail: Reconneeronly 1
Owner installation: The installation is being madc on property 1 own T =vices or feeders - • •
which is not intended for sale, lease, rent, or exchange according to aaO�a os,otrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or leas 2 2
Owner's signature: Date: 401 to 600 amps 2
ncl dfeulti -new, alteration, - •
or extension perpaa
Name:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: ZIP: 11. Fee for branch circuits without purchase
of service or feeder fee, runt branch circuit: 2
•Pltolle: I Fax: E-mail: Buda additional braadidreuit
PLAIN Itl',VIILW check all that apply) Mlic . (Service or feeder not lnduded): • .
O Service over 225 amps-commercial 0 Health-cam facility Each pump or irrigation circle 2
0 Service over 320 imps-rating of 1&2 0 Hazardous location Bach sign or outline li ghting 2 -
family dwellings ; O Building over 10,000 equate feet four or Signal circuits) or a limited energy Panel. 7S 0 System over 600 volts nominal more neaidenti*l units in one structure alteration, or extension* 1 7 S 75 2
0 Eailding over three atories 0 Feeders, 400 amps or mote •DesrriEtio4: . -
O Occupant load over 99 persons 0 Manufactured structures or RV park Z et iiooal
0 egreaalIighIk*Splan 0 Other - hE inspection over the a11otmbkinmryof the nhov6
Per inspection C r • 1 l
Submit _ lets of plans with any of the above. • Investigation fee c
The above are not applleable to temporary construction sd7lce. Otiw•
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Na all lu ladictiooa =opt audit cards, please call Jurisdiction for more lofo®m ad Notice: This perm Pernik fee $ 7 v '
O V O lsa Master .ard a e app
expires if er permit is not obtained Plan review (at _ %) $
Cash card number: I / J within 180 days after it has been State surcharge (8%) $ •
Name of card alder as shown on credit eeM accepted as complete. TOTAL S R
S
Cardholder elgnature Amount 440.4615 (6100/COM)
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 3 a 0 AM PM BUP
Location 1 �0 ,Q a via Suite MEC
Contact Person t?.LC'd" " L17a. ' Ph ( ) g 'f 8'6 0 0 PLM
Contractor � � Ph ( ) Go -1(0 SWR
BUILDING Tenant/Owner 11" i I L 2 2 -1 61/ i 11-61 ELC
Footing
Foundation ELC
Ftg Drain Access: ELR 3 — OdO O
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
R Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING Zky__}
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 -ln
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
f1;14 r Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SIT Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date � . c) `4 3 Inspecto • Ext
Other:
Final DO NOT REMOVE this Inspection record rom t Job site.
PASS PART FAIL