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Permit ELECTRICAL PERMIT - CITY TIGARD RESTRICTED ENERGY 1 DEVELOPMENT SERVICES PERMIT #: ELR2001 -00208 A 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171 DATE ISSUED: 08/10/2001 SITE ADDRESS: 15905 SW 116TH AVE PARCEL: 2S110CD 00107 SUBDIVISION: KING CITY NO. 2 ZONING: BLOCK: LOT: JURISDICTION: KIN Project Description: Installation of data and telecommunication system.. A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATA/TELE COMM: X NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: 1 Owner: Contractor: NORTH SHORE CORP, THE ADT SECURITY SERVICES, INC BY BANK OF AMERICA OREGON 2815 SW 153RD DR PO BOX 6400-UNIT #2814 BEAVERTON, OR 97006 PORTLAND, OR 97228 Phone: Phone: 503 - 469 - 7244 Reg #: LIC 59944 ELE 26- 209CLE FEES Required Inspections Type By Date Amount Receipt Low Voltage Inspection PRMT CTR 08/10/2001 $75.00 2720010000 Elect'I Final SPOT CTR 08/10/2001 $6.00 2720010000 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 thwgh OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -1987. Issued by e ..,, , Permittee Signature 7 44,l / 1 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: G / ���/�'�� DATE: LICENSE NO: F Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day 08/07/2001 10:20 FAX 5034697110 ADT SECURITY 0001 /001 r - r Electrical Permit Application Datereceived: Permit no.: / , OU ° �� i56: � I City of Tigard t( � / „. 4 `-. Project/appl.no.: Expire date: City of Tigard Address 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: BR I Recei it no.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory *•C ❑ Multi- family ❑ Tenant imprc ement ❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial • JOB SITE INFORMIATION Job address: 15105 SO 116 , ti e Bldg. no.: Suite no.: Tax map /tax lot/account in : Lot: I Block: I Subdivision: Project name: ; , k. , 2 s6 Description and location of work on premises: , n I Att i,1/ e , sc r, 7 . Estimated date of corn .letion/inspection: V X , il !lit 9 CONTRACTOR APPLICATION FEE SCHEDULE` Job no: 0.10(1: - -LLVIMINIIIIIIIIMMI1 Fee Max Business name: a t Descri . don Qty. ea.) Total no. insp Address: 2B15 S.W. 153R Dr. New wasidential -single or multi-family per City: Be: verton, C. Rat 701/6 serTiccinaided: Phone: , Fax: - mail: 1000 sq. ft. or less 4 CCB no.: a L _ Each additional . ft. or portion thereof E. City /met • . Limited energy, residential 2 Limited energy, non - residential NM 2 _./, j� g/ 7/O7 Each manufactured home or modular dwelling Signature of supervising e ectrician (required) Date I Service and/or feeder 2 Sup. elect. name (print): , • a (A License no 'r *r Services or feeders- installation, alteration or relocation: PROPERTY OWNER 200 amps or less 2 Name (print): • 201 amps to 400 amps i 2 401 amps to 600 amps ' 2 Mailing address: 601 amps to 1000 amps 2 City: I State: I ZIP: Over 1000 amps or volts 2 Phone: !Fax: I E -mail: Reconnect only 1 Owner installation: The installation is being made on property I own Temporary services or feedets • - which is not intended for sale, lease, rent, or exchange according to iaahallatlon ,aIteration, 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'circuita- new, alteration' lil-' .r - - - — A. Fee for branch circuits with purchase of - -� ® f -- — • Address: service or feeder fee, each branch circuit 2 City: I State: [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. (Serriceor feedernot lncluded): ❑ Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle - 2 ❑ Service over 320 amps- rating of 1&2 ❑ Hazardous location Each sign or outline lighting 2 family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, ' ❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2 ❑ Building over three stories ❑ Feeders, 400 amps or more *Description: ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional Inspection over the allowable in any of the cab i re: ❑ Egress/lightingplan O Other. Per inspection • I (, J Submit ` sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ 0 Visa ❑ MasterCard expires if a permit -is not obtained Plan review (at _ %) $ _ Credit card rumba- I / within 180 days after it has been State surcharge (8%) $ _ Expires accepted as complete. TOTAL $ _ . Name of cardholder as shown on credit card $ Cardholder signature Amount t 0-4615 (60VCOM) 08/10/2001 15:01 5036393771 CITY OF KING CITY PAGE 02/02 s • ` f 41 KING CITY 15300 S.W. 116th Avenue, King City, Oregon 97224.2693 mmilimmilMEW Phone: (503) 689 -4082 • FAX (503) 6393771 Notice To Contractors Working In King City Due to an intergovernmental agreement with the City of Tigard, many building related permits for projects in King City are issued and inspected by the City of Tigard. If your permit application DOES NOT REQUIRE PLAN REVIEW, simply complete the appropriate application legibly and submit it to the King City staff. The King City staff will collect all fees and fax the application to the City of Tigard. City of Tigard staff will then create the permit, issue the permit, and perform inspections. Please indicate on the permit application whether you would like the Tigard staff to call you when the permit is ready for issuance or whether you prefer it to be mailed without any notification. Any incomplete or illegible application will be returned to King City staff for correction and no processing will occur until a complete, legible application is received. If your permit application DOES REQUIRE PLAIN REVIEW, this form must be signed by a King City staff person. King City staff will simply sign this form indicating land use approval. Take this signed form to the City of Tigard Development Services Counter located at 13125 SW Hall Blvd, Tigard, to submit applications and plans. Development Services Technicians are available at 639 -4171 Ext. 304 should you have any questions concerning submittal requirements. All permit fees will be assessed and collected at the City of Tigard. The City of King City hereby authorizes applicant to pursue permits at the City of Tigard Building Department for the following project: located at: /5 ?O 2'f Th Idir ,..,1_, ' King Cry Representative I DSTSKCf $T DOG CITY OF TIGARD BUILDING INSPECTION DIVISION • MST 24 -Hour Inspectton Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested - ( AM PM BLD Location 1 C 1/6 Suite MEC Contact Person _ a 2r..-„„-- Ph , 9 7 c 1 PLM Contractor h' 3 7-- Ph SWR BUILDING Tenant/Owner L dj, ELC Retaining Wall ELR ;-.06/ Footing Access: Foundation 20D J _ = Ftg Drain, Crawl Drain Inspection Notes: Slab Post & Beam ` Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing `i v Fire wall / n Fire Sprinkler [J Fire Alarm Susp'd Ceiling S� e P q( 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 PASS PART FAIL ELECTRICAL Service Rough In UG /Slab Low Voltage Fire Alarm PASS PART FAIL SITE Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next i i • ection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ Unable to inspect - no access ADA Approach /Sidewalk Other Date / " Inspector � �. E Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. BUP - Building Permit ELC - Electrical Permit Inspection Description Date Passed By J Inspection Description Date Passed By Footing /Setback Underground cover Foundation walls Wall cover Footing drain _ Ceiling cover Waterproof bsmt walls Electrical rough -in Slab Electrical service Crawl drain Electrical final Underfloor insulation Post/beam structural Shear walls /anchors ELR - Restricted Energy Permit Roof nailing J Inspection Description Date Passed By Firewall Low voltage Tilt -up panel Electrical final /- / d76 Masonry /Reinforcement _ Framing MFG - Structure set -up MEC - Mechanical Permit Insulation 4 Inspection Description Date Passed By Drywall nailing Post/beam mechanical Suspended ceiling Gas line Engineered soils Mechanical rough -in Welding Lab Final Fire damper Concrete Lab Final Duct work Bolting Lab Final Smoke detector Structural observation Mechanical final Fireproofing Lab Final Final inspection PLM - Plumbing Permit 4 Inspection Description Date Passed By BUP — Fire Protection System Permit Plumbing underslab 4 Inspection Description Date Passed By Crawl drain Sprinkler underfloor /slab Post/beam plumbing Sprinkler rough -in Plumbing top -out Sprinkler final RP /backflow preventer Fire alarm final Rain drain Storm drain Water service SIT - Site Permit Sanitary sewer Inspection Description Date Passed By _ Culvert/catch basin Footings Pump /fill septic tank Foundation walls Plumbing final Sprinkler supply lines Sprinkler underfloor /slab Catch basin /Manhole SWR - Sewer Permit Engineered soils 4 Inspection Description Date Passed By Engineering acceptance Sanitary sewer Final inspection Final inspection Inspection Record - BUP, PLM, SWR, ELC, ELR, MEC, SIT Permits is \dsts \forms \InspRecordBUP.doc 04 /17/01 .. .. A CITY OF TIGARD RESTRICTED ENERGY 46.00� DEVELOPMENT SERVICES ELECTRICAL PERMIT - PERMIT #: ELR2001 -00208 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 08/10/2001 SITE ADDRESS: 15905 SW 116TH AVE PARCEL: 2S110CD -00107 SUBDIVISION: KING CITY NO. 2 ZONING: BLOCK: LOT: JURISDICTION: KIN Project Description: Installation of data and telecommunication system.. A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATA/TELE COMM: X NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: : HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: . TOTAL # OF SYSTEMS: 1 Owner: Contractor: NORTH SHORE CORP, THE ADT SECURITY SERVICES, INC BY BANK OF AMERICA OREGON 2815 SW 153RD DR PO BOX 6400 -UNIT #2814 BEAVERTON, OR 97006 PORTLAND, OR 97228 Phone: Phone: 503 - 469 -7244 Reg #: LIC 59944 ELE 26- 209CLE FEES Required Inspections Type By Date Amount Receipt Low Voltage Inspection PRMT CTR 08/10/2001 $75.00 2720010000 Elect'l Final 5PCT CTR 08/10/2001 $6.00 2720010000 Total $81.00 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes /1 nd all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work i 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 thr h OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -1987. � Issued by ;' �� /�, Permittee Signature d- 7 �,�, �,r�,t IV // 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: I CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: off) (D/ ft/A.; , DATE: N LICENSE NO: 771= ,3 " l Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day 1,4.