Permit . I
CITY ("TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
„ DEVELOPMENT SERVICES
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PERMIT #: ELR2005 00100
_,,,, c . DATE ISSUED: 4/28/2005
_
PARCEL: 1 S135BC -01100
SITE ADDRESS: 11117 SW GREENBURG RD ZONING: I - P
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Security alarm system.
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:
ROBINSON, E LEE + EVELYN L AMERICAN SECURITY ALARMS
PO BOX 91305 5411 SE MCLOUGHLIN BLVD
PORTLAND, OR 97291 PORTLAND, OR 97209
Phone: Phone: 503- 231 -0303
•
Reg #: LIC 58640
ELE 26- 283CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 4/28/2005 $75.00
[TAX] 8% State Surcha 4/28/2005 $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.
Issued By: / Permittee Signature: '� C;)
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.
e 03/13/2002 17:52 FAX 5035981960 CITY OF TIGARD !J002
Electrical Permit ApplicOtion OFFICE USE ONi.Y
! Date received: c a, - 05'9 0- - Permit no.: e ' /
oil ` ..1 11 Ci}y. of Tigard Sao e�
. -_ `'J � Projaedeppl. n o.: , Expire date;
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97228
Dart issued: $y: Receipt co.:
Phone: (503) 639.4171
Fax: (503) 596 -1960 Case file no.: ) Payment type:
• Land use approval: •
TYPE OF PCItJerr
• 1 & 2 family dwelling or accessory 0 Commercial /industtapl OMulti- family 0 Tenant improvement
❑ New construction ' t Additlon/alteration/r4lacement O Other: 0 Partial
JOR SITE. INEORMc1TION
Job address: n � li/ii [ - VePoi'i hl l is j'. i'L • : ;1dg, no,: Suite no.: Tax map /tax lot/account no.:
Lot: b lock: (Subdivision:
Project name: likii f.Yi.t TL.k,i I Descdption and 1ocaion of work on premises: ,
Estimated date of completion /inspection; . 1 a a •
( :OiNTRACTOR APPLICATION FIT SCIfl DULF
Job no: Foc Max
Business name: gmPrioan SP.Cvllrit AlAr1r1S. ins Description Qty. (ea.) Totn1 ne.insp
Y t New residential-sleek or multi- familrPer
Address: 5411 SE Mr'Lnpehlin l3lvcl dwellingu it.lacIudosattechedgarage.
City: Portland 1 State :R ZIP: 97209 saMceiacluded:
Phone503- . 231- 0303I Fax – 1044E -mail: 1000 q.rt.or 4
CCB no.: 58640 Bloc. bus. lie. no: 2 8_2R3 CF. J Each additional 500 eq. ft or portion thereof
i,
Limited energy, residential 2
Ciryltnetro " . 0.: 279 Limited energy, non•roaideneial 2
'.b2(-Z` Each manufactured home or modular dwelling
Sigma of $ cruising olootacian (required) Date Service and/or feeder 2
Sup rune e (print): acne D List n L nn: % ` { Services or feeders— Installation
*Iteration orrelocation: ,
200 amps or leas 2
Name (print): q ate ti( i a_ ^ 1 t�i..C 201 amps to 400 amps _ 2
i 401 amps to 600 amps 2
Mailing address: f 601 amps to 1000 amps 2
City: i State: ZIP:
Over 1000 amps or vole 2
Phone: tv g(p -t )(1 'Fax: E -mail: Reconnect on 1
- Owner installation: The installation is being made on property 1 Om Temporary service' or feeders •
which is not intended for sale, lease, rent, or exchange according to installation, aherstGoa,orrelocation:
ORS 447, 455, 479, 670, 701. ( 2 00 snips or less 2
201 amps to 400 amps 2
Owner's si ature: Date: 401 to 600 am S 2
Branch circuits - new, alteration,
Name; • or extension per panel:
1 A. Fcc for breach circulu with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP; 8, Fee for brunch circuits without purchase
Phone: Fax: E-mail: of service or feeder fee, fist branch circuit 2
Each additional branch circuit:
PLAN ItE 'iE (Please cited► all (h:11 apply) Misc .(Serriceorfeedernotlncluded):
Ci Service over 225 ompa-commercial 0 Eimdth•care facility Rich pump or irrigation circle 2
•
Cl Service over 320 aatpe•rating of I &2 Cl Hazardous locadon Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal citcuit(s) ore limited energy panel, 1 ,�6
0 System over 600 volts nominal more residential units in one seticrtitr alteration, or extension' 75.~ 2
0 Building over three stories ❑ Feeders, 400 amps or more 'Description'
0 Occupant load over 99 persona 0 Manufactured structures or RV parif Each additional Inspection over the allo within in any ofthe above: ..
0 Egrosallightin6 plat 0 Other: I per inapeetion • r I i i
Submit — sets of plane with any of the above, investigation fee
The above are nut applicable to temporary construction service. Other
Not all Jurisdictions arras credit cards. please call jurisdiction for more inremution. Noti e: This penult application Peanit fee $ .
CI Visa ❑ MasterCard tap' es if a permit is not obtained Plan review (at a e) $
Credit cud number; _ / / with. n 180 days after it has been State surcharge (8%) S to (26 •
Expire, seed sled as complete. TOTAL $ Sj 1 . 00
Name of cardholder is ahowit on credit card
a
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1404615 (6/00 /COM)
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CITY OF TIGARD
BUILDING DIVISION - ' PERMIT #: ELR2005 -00100
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/2812005
Phone: (503) 639 -4171 °4h1p416j�1'�
Inspection Requests (24 Hrs.): (503) 639 -4175 =�
INSPECTION WORKSHEET FOR DATE: 6/2/2005 TIME: 7:12AM PAGE: 43
SITE ADDRESS: 11117 SW GREENBURG RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MATERIAL FLOW
DESCRIPTION: Security alarm system.
OWNER: ROBINSON, E LEE + EVELYN L, PHONE #:
CONTRACTOR: AMERICAN SECURITY ALARMS PHONE #: 503- 231 -0303
Inspection Request Scheduled For: Date: 6/2/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 008199-01 503 -231 -0303 Y
G Corrections/Comments/Instructions:
PASS 0 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: l Date- - Phone #: (503) 718 -