Permit CITY OF T' GARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00511
�r . DEVELOPMENT SERVICES DATE ISSUED: 08/28/2000
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
Project 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 CTR 08/28/200C $60.00 2720000000(
5PCT CTR 08/28/200C $4.80 2720000000(
Total $64.80
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:
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:OOpm for an inspection the next business day
03/17/00 RR( 12:15 FAX 503 598 19110 503 598 I T 60 OF TIGARD � ' dS l
>_• 003
CITY OF TIGARD
13125 SW HALL BLVD. Electrical Pe a - a • lirtga5WED Plan Check
n � Rec'd By
TIGARD OR 97223 0� a Date Recd
Phone (503) 639-4171, x304 1 o " �� F AUG 2 2000 Date to P.E.
Inspection (503) 639 -4175 • • Date to DST
Fax (503) 598 -1960 TYptUMMUNITY DEVELOPMENT Permit# ttGydpp - pt) Of
•
Incomplete or illegible will not be accepted called
•
1. Job Address: • 4. Complete Fee Schedule Below:
Name of Development .
Name (or name of business) 11 Number of Inspections per permit allowed
C Service included: Items Cost Sum
Address 1 Lr13 6 i1 • ---- q A- �
4a. Residential -per unit
City /State/Zip Cl'1/ irr, , (1,y� � C ri-Z 1000 sq. ft. or less $ 117.75
f! Each additional 500 sq. ft. or 4
Commercial 0 Cj Residential ❑ portion thereof $ 26.75 1
Limited Energy $ 60.00
Each Manufd Horne or Modular
2a. Contractor installation only: Dwelling Service or Feeder
$ 72.75 2
(Prior to
permit Issuance, applicants must provide contractor license 4b. Services or Feeders
Information for COT data base).
altera
Electrical Contractor ADT Security Services, Inc. 1n 200ampsorless n , orrelocation
Address 2815 SW amps 153rd Dr, 201 amps to 400 $ 64.25 2
Ci $ 85.50 2
ry Renvprtnn State DR Zip 97006 401 amps to 600 amps $ 128.50 2
Phone No. - 601 amps to 1000 amps $ 192.50 • • 2
_c---3 - V Over amps or volts $ 363.75 2
Job No. 0
r Reconnect only $ 53.50 2
Elec. Cont. Lice. No. ?6_7f9CT,E Exp.Date 10/2000 • 4
OR State CCB Reg. No. 9q q /, Date Ins Temporary Services to or Feeders
_�• 5� 7/f11 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 4 / / t „. _ 401 amps to 600 amps $ 100.00
Over 600 amps to 1000 volts, 2
.License No. _ j21:3 C Exp.Date see "b" above.
Phone No. 4d. Branch Circuits
New, alteration or extension per panel •
2
•
b. For owner installations: The fee for branch circuits
with purchase of service or
l ✓ n f `t I t feeder fee.
Address e s are a1 V\ 1 Each branch circuit 2
$ 5.35
b) The fee for branch circuits
without purchase of seer /ce
City State Z
Q (�- x 21 or feeder b ran fee.
Phone No.
D 5 •(�~ V t� First branch circuit $ 37.50
made on property Each additional branch circuit $ 5.35
The installation is being p perty I own which is not 4e. Miscellaneous
intended for sale, lease or rent.
(Serv
Each piceumor p feeder or irrigation not in circle ude ) $ 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
. Please check appropriate 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
• System over 600 volts nominal Per hour $ 50.00
cy as
Classified area or structure containing special occupancy In Plant $ 59.00
described in N.E.C. Chapter 5 5. Fees:
* Submit 2 sets of plans with application where any of the above apply. �• 8% S r total of above fees $
Not required for temporary construction services. Subtotal t orcharge (.08 X total tees) $
Subtotal $
NOTICE 64. Enter 25% of line 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 ❑
AT ANY TIME AFTER WORK IS COMMENCED. Trust Account #
Total balance Due $ $$
i :\dsts\forms \electric. doc.
- CITYY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested / AM PM BLD
Location ((o/ 3) 5L) 7V-Pt Suite MEC
Contact Person Ph 801./ 7 35 PLM
Contractor 0 Ph SWR
BUILDING Tenant/Owner ELC 2-08-4v° UG //
Retaining Wall - ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof ¢ mss _
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
PAS PAR FAIL
LECTRICA
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
• RT FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin AP
Fire Supply Line [ ] Please call for reinspection RE: / [ ] Unable to inspect - no access
ADA A
Other
Approach /Sidewalk Date 1 1 Inspector � `� W //I %I Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.