Permit C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
4 2'f^ DEVELOPMENT SERVICES PERMIT #: ELR2005 -00374
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/27/2005
PARCEL: 2S 112DD -00400
SITE ADDRESS: 15912 SW 72ND AVE B17 ZONING: I -L
SUBDIVISION: OREGON BUSINESS PARK I LOT: 017 JURISDICTION: TIG
Project Description: Burglar alarm low voltage.
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:
PACIFIC REALTY ASSOCIATES ADT SECURITY SERVICES, INC
15350 SW SEQUOIA PKWY #300 2815 SW 153RD DR
PORTLAND, OR 97224 BEAVERTON, OR 97006
Phone: 503- 624 -6300 Phone: 503- 469 -7244
Reg #: LIC 59944
ELE 26- 209CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 10/27/200; $75.00
[TAX] 8% State Surchari 10/27/200E $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- -0100. You may o in copies of these rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: / � Permittee Signature: �pftp 0 44'
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 503-639-4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
10/27/2005 07:49 FAX 5034697110 ADT SECURITY 2001
Electrical Permit 1 plic'AUK (�
t, t _ 11 FOR orrice USE ONLY
City of Tigard Fn, D Day /0 7 65 - 1j 6 Pe mit ii ZvoS - 0 4 9 3
13125 SW Hall Blvd., Tigard, OR 97223 WINO' • Plan Review
Phone: 503.639.4171 Fax: 503.5983960 / . .: . , :'tip, y \ Other Permit:
_� . ,
Inspection Line: 503.639.4175 s "/J.,.' Dace e Dat Ry.
� _ Ready/By: ....• RI See Page 2 for
Internet w
ww ci tigard or cis CITY Y O i TI6ARL Notified/Method:
,) Supplemental information
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P ' .' ...2/ ( v 1 I J i. f I 1 � i� S Ir ,, L, sC , 5 .n 2., -1' s ' l r 1 ti_; l
+�f.- . it 1F.'Iu�lk j r I+� S i 1 i 11,74�i.1i " ;','',�,'� �E
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1'i New construction ❑ Addition/alteration/replacement Please check all that apply:
['Service over 225 amps, comm'I ❑Hazardous location
❑ Demolition ❑Other:
I + I` w , I , t , ❑Service over 320 Buildng over 10,000 sq. ft.,
1_ » +t r L in1 .,.:` li .. J- :: �, � _'; �J �,-- , 1 1i I :•i I , ,_ ! , I 'LUl . 1 i i , � .. _ .1 , W .f t y i ,1n � 1 1 1 ':V i. _ II' � of 1 -and 2- family amps - ratio g ❑ 4 or more new residential
❑ 1- and 2- family dwelling !. Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
El Multi- family El Master builder ❑ Other: ['Building over three stories ❑Feeders, 400 amps or more
❑Occu ant load over 99 ersons ❑Manufactured structures or
+`. {ir r �L l ..i lf G1 1 . 71!fi ,I . / a +. 1 �jle.. iif `;., L l i,l I l�ul�
l c Ili 1., r j i ii,, ❑ E s/ll tin plan P RV park
Job no.: 4 - I • lie address: 5 O( % p- ❑Health -care facility ❑Other.
Submit t sets of plans with any of the above.
City / State/ZIP: / `j 4 i ` • -.7 The above are not applicable to temporary construction service.
Suite/bldg./apt no.: J coo 1 u 1 ��,.�;;e' j t i i t 3 t 1- . _: :
Pro ec n am e: 3
Desalpdon Qty. Pee. To1a1 '*
Cross street/directions to job site: New residential single- or multi - family dweling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'1500 sq. ft. or portion 33.40 1
Tax map/parcel no
Limited energy, residential 75.00 2
i� _ :.7...1-,..:-.<-,,,-..,,.-
t,.: _�' , i E ac h rnanufacdrred or mod
�.. 4 ,) • ^ ,pM dwelling, service and/or feeder 90.90 _ , 2
IC aPCJ� fish Services or feeders installation, alteration, and /or relocation
4 200 amp or Tess 80.30 2
f� s' "' l � I . ' l�l''I� 1� l t " - •V C y -'^[s14.iTv 'I'll -t MIQIi 201 amps 10400 106.85 2
}'� h n.._y'_..t : n W .1 _ /_i t J L ) 1 ii : !_i2 , i ' .n r .. N...I' . 1`... *u. ,'. -s 1 !. { rr Ir o.� , � .' i 401 amps to 600 amp3 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/ State/ZIP: , Temporary services or feeders installati alteration, and/or
Phone: ( ) Fax: ( ) relocation
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits- new, alteration, or extension, per panel
y 1 ; A- Fee for branch circuits with
�1FK it >/ .
. ... t :;,,L',-!..; r, t t }t .1 i+ ti I!l Y .. +sl ` : 11 1 J4 t t � . :
. (I ts, `_ '� .' y ,
i , 1_? - ,._ x _ ,1...; f ..., 1 . _ . !... } .:._ ,.! . - .:_ _,..!i ii,__ ? �..._ _. .
: - -... ,a: service or feeder fee, each
Business name: branch circuit 6.65 2
Contact name: i • : U - + r 1 V i B. Fee for branch circuits
.. without service or feeder fee,
Address: BEAVERTON, OR 97006 each branch circuit 46.85 2
it 4 • tit
Ci / State/ZIP
Each add'l branch circuit 6.65 2
tY : Miscellaneous (service or feeder not Included)
Phone: ( ) v. ' Fax:: (i g) If t 9� 711 v Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
1
E i i i Signal circuit(s) or limited -
i1: Is s i . . i_c { r I .. .� s i y
l l ., '� 1 ` t. ! . ..' ill}. !_. r _I , 1 ! 1!... _tR, _ 1111 . ;I: � � O , : ..GI. enelgypanel,alteration , or
1, l 11 I t4L ii ,3 s t I
r extension. Describe: i Page 2 ' 15. et 2
Business name: ADT SECURITY SERVICES, INC.
Address: 1 -' Each additional inspection over allowable In any of the above
11 ■ • t : l:i • Per inspection 62.50
City/State/ZIP: (503) 469 - 7100 Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
CCB Lic.: FBI. 4 Electrical Lic.: , •0 l/V i/ i Y_ G , uprv. Lic.: g� Subtotal
Suprv. Electrician signature, required: : d I P ' VI IR P I FA I I I II. I Plan review (25% of permit fee)
Print name: t..- Date: Q _ is
State surcharge (8% of perrrrit fe 10„ OD
TOTAL PERMIT FEE g i . DQ
Authorized signature: TIi4 permit appllca ion expire if a p er mit Is not obtalned within 180
Print name: d ays after It bas been a cce pted u co
Date: Fee methodology set by Tri -County Building Industry Service Board
•' N umber of ia per pe allo
Bfluilding1PamitaLC- PannitApp.doe 12/03 .,______----?
613r(10/07/COM/WEB
/ ' T
CITY OF TIGARD ,
BUILDING DIVISION PERMIT #: ELR200&00374
.4 " ; 13125 SW Ha ll Blvd., Tigard, OR 97223 DATE ISSUE D: 10/27/2005
Phone: (503) 639 -4171 4 . i ,ICI
Inspection Requests (24 Hrs.): (503) 639 -4175 ' °':_..
INSPECTION WORKSHEET FOR DATE: 11/1/2005 TIME: 7:06AM PAGE: 96
SITE ADDRESS: 15912 SW 72ND AVE B17 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK I LOT #: 017 TYPE OF USE:
PROJECT NAME: COOKIE LEE
DESCRIPTION: Burglar alarm low voltage.
OWN -: PACIFIC REALTY ASSOCIATES, PHONE #: 503 -624 -6300
CONTRACTOR.. ADT SECURITY SERVICES, INC PHONE #: 503-469-7244
Inspection Request Sc'.-duled For: Date: 11/1/2005 Pour Time:
Code # Inspection i. scription Confirm # Contact # Message
135 Low voltage 019933 -01 603- 849-8795 N
\ c• NtA
Corrections /Comments /Instructions:
, \
0
i ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL • n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
�! 11 s� 718- 'l �C
Inspector: �11� Date: 1 • Phone #: (503) 718 [f 'f
p � � ) i