Permit A CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
�, DEVELOPMENT SERVICES PERMIT #: ELR2003 -00103
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/4/03
SITE ADDRESS: 15300 SW 116TH AVE PARCEL: 2S110CA 00102
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: KIN
Project Description: Low voltage for 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: BURG ALARM X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
KING CITY, CITY OF ADT SECURITY SERVICES, INC
15300 SW 116TH 2815 SW 153RD DR
KING CITY, OR 97224 BEAVERTON, OR 97006
Phone: Phone: 503 -469 -7244
Reg #: LIC 59944
ELE 26- 209CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 4/4/03 $75.00 Elect] Final
[TAX] 8% State Tax 4/4/03 $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 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699. p _
Issued by ���� Permittee Signature e�'� ,GLQJ1r.�
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
Electrical Permit Application
•
c.V Date received: if -4_0:-..), Permit no.: .� •3_00/0
/,b ) � (✓ ���
y: ' � City Of Tigard � Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Ha1VB vd,Tigard OR `tVt' Date issued: By: its [Receipt
Phone: (503) 639 -4171 D
Fax: (503) 598 -1960 p`` &P FID Case file no.: Payment type:
Land use approval: CV
D , D�v�S�
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory It Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration/replacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: /f30() 5 `ti I j / j Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: 'Block: , l 'Subdivision:
Project name: e f T) OF /< 14 &cr y, . Description and location of work on premises: f �f ,e(�L A-L�-le
Estimated date of completion/inspection: / •
CONTRACTOR APPLICATION FEE SCIIEDU.E '
Job no: 6 3 /e, _5 / Fee Max
Business name: A Securely y (Description Qty. (ea) Total no. Ltsp
Address: , g is Sid i n A Pr- 7 New residential - stogie or multi- family per
dwellingun t. Includes attached garage.
City: ge vierfb State: 0 g ZIP: 417004 Serviceinchtded: •
Phone: 3.4( "'' 1 Fax . j .7 E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: sl it 41,/ l Elec. bus. lie. no: 26-20 LE L;r„itedenergy, residential 2
City /me lie. no.: Limited energy, non- residential 2
11///03 Each manufactured home or modular dwelling
Signatur of supervis g electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): ) Ki2AUS License no: LEA 3 $9 Services orfeeders— itrstallation,
t A
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): C r' T O /= //1/ 4, — i / T 201 amps to 400 amps 2
Mailing address: S A-nl 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: [State: J ZIP: Over 1000 amps or volts 2
Phone;,- ` ,2 ass ,7I Fax: 1E-mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - _ -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am .s 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: [ State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps - commercial 0 Health -care facility Each pump or irrigation circle 2
0 Service over 320 amps - rating of I &2 O Hazardous location Each signor outline lighting 2 -
family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
0 System over 600 volts nominal more residential units in one structure alteration, or extension* I 2
0 Building over three stories 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons O Manufactured structures or 1W park Each additional inspection over the allowable in any of the above:
0 Egress/lighting plan O Other.
Per inspection
Submit sets of plans with any of the above. Investigation fee I f I l
The above are not applicable to temporary construction service. Other
Not all jurisdiction, accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ 75 AD
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8%) $ 8 •
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
Cardholder signature Amount
4444615 (6/00/COM)
CITY OF TIGAf D) 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 _
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
• BUP
Received Date Requested , � AM PM BUP
/6 Location � 3 D 0 1� �-"� -- ti -€_- Suite MEC
Contact Person Ph ( ) 6 2,0 — $ gst PLM
Contractor Ph ( ) 4 1 4 (o C l — 7a-s(o SWR
BUILDING Tenant/Owner ' - • // ELC
Footing ELC
Foundation Access:
Ftg Drain ELR w( l
��
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
Susp'd Ceiling
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
Fir- • larm
vim D Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
I •ASS P RT FAIL
Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA /
Approach/Sidewalk D a i p,� Q Inspector . _ S - Ext
Other: _
Final DO NOT REMOVE this inspection recor rom the ob site.
PASS PART FAIL