Permit I
CITY OF TIGARD ELECTRICAL ENER -
RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT #: ELR2002 -00279
- 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/5/02
SITE ADDRESS: 08015 SW HUNZIKER ST PARCEL: 2S101 BD -00300
SUBDIVISION: ZONING: I -L
BLOCK: LOT: JURISDICTION: TIG
Project Description: Fire alarm add -on.
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: X OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PERFORMANCE CONTRACTING INC ADT SECURITY SERVICES, INC
8015 SW HUNZIKER ST 2815 SW 153RD DR
TIGARD, OR 97223 BEAVERTON, OR 97006
Phone: 503- 684 -5533 Phone: 503- 469 -7244
Reg #: LIC 59944
ELE 26- 209CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 12/5/02 $75.00 Elect'I Final
[TAX] 8% State Tax 12/5/02 $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. / 2
Issued by c�
L4- /
Permittee Permittee Signature 411 _ ! ,
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: 6 s%i d1.7 / DATE:
LICENSE NO: 3 7
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
12/03/2002 10:53 FAX 5034697110 ADT SECURITY 0001
l
- 14- A 16 . Electrical PermitA.pplication
Date received:
I ;•��� � City of Tigard OZ' -CI? Permi no.: j "0 5?
Add 13125 SW Hall Blvd, .Tiggrd 3 � )',:tpiredatc: '�/
City of Tigard 0
Phone: (503) 639 -4171 Dateissucd: 13xeyS Receipt no.;
Fax: (503) 598 -1960 Dem F Case no.: Payment type;
Land use approval: C(. 3 �—
c/
❑ 1 & 2 family dwelling or accessory . 211 Commerci ' • ` "al
'+ D Multi family ❑Tenant improvement
CI New constauction ❑ Addition/alteratio / • placement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Yob address; g01,5 6W11 j '..X )P,„d Bldg, no.: Suite no.: Tax map/tax lot/account no.:
Lot: Block: 'Subdivision:
Project name: c lepv, n Description and location of work on premises:
Estimated darn of com letion/inspection: -
Job no: OFD. -OD Igc2 —/ Fee Max
Business name: } _ Description ��/ l S T��/ Qty. (ea.) Total . no. inap
Address: ( Newrestden m
t- singleuru(tHamityper
Z8 1 3 'nor . dw�ellinpwdt .lncludesattachedgarage.
hone g w State: o *,I ZIP:' g7c06 Servlc included:
W4,,'71 /W Fax it.? E -mail: 1000 sq. B. or leas • ,
C no. 5_9_ , ... E Iec. bu s. lie. no: Zb•2d�C! F Each additional SOOsq. ft_ orpcnion thereof '
N
Limited ens reside
City /Me • tic. [10.! energy. hi 2
Limited energy, non-residential ntial . 2
• w 4 _t _ _ 121 D,/D2 Bach maim factored home or modulardwelling
Signatu of supery A g electrician (required Data Service and/or feeder 2
Sup. elect- name (print): ltceitseno: LEA 389 Services orfeoders— installation, `
I'1 {UI'ERT1' OWNER alteralton orrdocation:
200 amps or leap 2
Name (print): -.c - Marl( 47) 201 amps to 400 amps 2
Mailing address: 401 amps to 600 amps - 2
Cit' . 601 (Strips l0 1000 amps 2
y; I State: I ZIP Over 1000 amps or volts 2
Phone: 5103-6234 -5533 I Fax: I E -mail: Reconnect only - - 1
Owner installation: The installation is being made on property I own Temporary sernces'or feeders -
which is not intended for sale, lease, rent, or exchange according to
instillation, alteration, orrelor�tion: .
ORS 447, 455, 479, 670, 701. zoo amps or les 2
201 amps to 400 amps "-i
Owner's signs re: Date: - 401 to 600 amps 2
Branch circuits - new, alteration,
Name: pa
or extension per nel:
A. Fee for branch circuits with purchase of
Address: service or teeder fee, each branch circuit 2
City: I State: ZIP: B. Fee for branch circuits without purehuse
Phone: Fax: E-mail: of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
PLAN IULYJEW(Please check all that apply) MI c. Serorkedcrnot included; '
Cl Service over 225 amps-commercial CI Health -care facility Bach pump or irrigation circle 2
O Service over 320 amps - rating of 1&2 . t] Hazardous location Each signor outline lighting 2
family dwellings , C) Building over 10,000 square feet four or Signal circuit(s) ora limited energy panel, '_.__
C] System over 600 volts nominal • more residential units in One structure alteration, or extension* I _ ♦S 76 2
❑ Building over air* stories 0 Feeders, 400 amps or more *Description:
O Occupant load Duct 99 persons El Manufactured slflietures or RV park Each additional Ins --__
O Egress/lighting plant 0 Other pectlon over the allowable In any oflhe above:
Per inspection L _ l
&think sets of plans with any of the above. • Investigation fee k
The above are not applicable to temporary construction service, Other
Nei art jurisdictions accept chit cards, pings cart Judsdlctioe nor more inrosnra,wsi Notice: This permit application Permit fee $ ?,;f _
U Visa O MasterCard C expires if a permit is not obtained Plan review (at _ %) $
Credit card number: • / / within 180 days after it has been State surcharge (8%) ._.. $ { gi , . oe_ "`
Expires accepted as complete. TOTAL , $ 81- 06
Name of cardholder ar shown en credit card
■
cardholder ciRntnlure Amount 440 ((vUWCOIrt)
i