Permit CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC2000 -00370
DEVELOPMENT SERVICES DATE ISSUED: 07/03/2000
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S113AB -00800
SITE ADDRESS: 16135 SW 74TH AVE
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -P
BLOCK: LOT : JURISDICTION: TIG
Proiect Description: (1) signal circuit
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL: 1
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
DUNCAN, JOHN A AND ADT SECURITY SERVICES, INC
JANICE LEE 2815 SW 153RD DR
7060 SW PALMER WAY BEAVERTON, OR 97006
BEAVERTON, OR 97007
Phone: Phone: 503469 -7100
Reg #: LIC 0059944
ELE 26209CLE
FEES Required Inspections
Type By Date Amount Receipt Elect'I Final
PRMT DST 07/03/200C $60.00 0003433
5PCT DST 07/03/200C $4.80 0003433
Total $64.80 RIGIN,
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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE ISSUED BY: 6,
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:
CaII 639 -4175 by 7:OOpm for an inspection the next business day
503 598 1960 e,
03/17/00 FRi 12:15 FAX 503 598 1960 CITY OF TIGARD
41003
CITY OE TIGARD
13 SW HALL BLVD. Electrical Permit Application Plan Check#
RECEIVED Rec'd By
TIGARD OR 97223 Date Recd & - Zq -CP 0
Phone (503) 639 -4171, x304 JUN 2 9 2900 Date to P.E.
inspection (503) 639 -4175 Date to DST
Print of Type N � I Permit # Do10 - ,.O _ p
Fax (503) 598 - 1960 Incomplete or illegible will hi reWa peed ll" • r
Called PIZ
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) C, Service included: Items Cost Sum 4 -
Address 141.1 36 ''I r^ 4a. Residential - per unit
City /State /Zip ( v/' , , C� Cl -I-2;24 Z-� t ' 1000 sq. ft. or less $ 117.75 4
`� �"T Each additional 500 sq. ft. or
Commercial El Residential
El
thereof $ 26.75 1
Limited Energy $ 60.00
Each Manufd Horne or Modular
2a. Contractor installation only: - -- Dwelling or Feeder $ 72.75 2
(Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders
information for COT data base). Installation, alteration, or relocation
Electrical Contractor ADT Security Services, Inc. 200ampsorless $ 6425
Address 2815 SW 153rd Dr . 201 amps to 400 am s 2
P $ 85.50 2
City RaavPrYprl State �R Zip 97006 401 amps to 600 amps $ 128.50 2
Phone NO. (5 . - 601 amps to 1000 amps $ 192.50 2
��� Over 1000 amps or volts $ 363.75 - 2
Job N0. _ Reconnect only
Elec. Cont. Lice. No. 76_209c,T,E Exp.Date 10/2000 $ 53.50 • 2
OR State CCB Reg. No. 59 944 Ex Date Installation, Temporary Services or Feeders
p• 5 � 7 /01 Installation, alteration, or relocation
CQT Business Tax or Metro No. Exp.Date 200 amps or less $ 53.50 2
201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n 11 �1 4 , 401 amps to 600 amps $ 100.00 2
Over 600 amps to 1000 volts,
License No. ` i2745-._ C" Exp.Date see "b" above.
Phone No. 4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits
�(-- with purchase of service or
feeder fee.
ne �i 1. , s "'ifiiittt��lCttfame a v A i Wak.\ -r '• i Each branch circuit $ 5.35 2
Address / b) The fee for branch circuits
City State Zip
without purchase of service
Phone No. or feeder fee.
--= c�>L� -�L� X 7 i First branch circuit $ 37.50
Each additional branch circuit $ 5.35
The installation is being made on property I own which is not
intended for sale, lease or rent. 4e. v c e ous
. (Sery ice feeder not inGuded)
Each pump orfee or irrigation circle • $ 42.75
Owner's Signature Each sign or outline lighting $ 42.75
Signal circuit(s) or a limited energy
3. Plan Review section (if required):* panel, alteration or extension 1 $ 60.00 $ 60.00
Minor Labels (10) • $ 100.00
I I Please check appropriate riate item and enter fee in section 5B. 4f. Each additional inspection over •
, 4 or more residential units in one structure the allowable in any of the above
Service and feeder 225 amps or more Per inspection $ 50.00
1' ' ' • - System over 600 volts nominal Per hour $ 50.00
In Plant • $ 59.00
Classified area or structure containing special occupancy as
described in N.E.C. Chapter 5 5. Fees:
Sa. 8% S Enter total Surcharge above fees $ 4_ R n
* Submit 2 sets of plans with application where any of the above apply. Surcharge (.08 above
total fees)
i • Not required for temporary construction services. $
Subtotal $
NOTICE 6b. Enter 25% of fine 5a for
Plan Review if required (Sec. 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $ $64.80
' iS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account #
AT ANY TIME AFTER WORK IS COMMENCED.
Total balance Due
$ $64,..80
is \dsts\forms \e Iectric. doc
CITY OF TIGARD BUILDING INSPECTION DIVISION °
24-1-lour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
/ / BUP
Date Requested q[ 26 l AM PM BLD
Location /6'l3S Set) - 741'4 Suite MEC
Contact Person G Ph 6 1 - e - 8gfs8 PLM
Contractor Par— Ph SWR
BUILDING e Tenant/Owner
r �1117 —rve S70
Retaining Wall ELR
Footing Access:
Foundation 1 FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Fire wall
Fire Sprinkler -
Fire Alarm
Susp'd Ceiling
Roof (�
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
P PART IL
•
ELECTRICAL
Rough In
UG /Slab `r
Low Voltage a °
Fire Alarm
Final 5C
PASS P FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk /�
Other Date 0 Inspector / Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.