Permit CITY lIGA R D ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 -00132
- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5/25/2005
PARCEL: 1S126C0-00100
SITE ADDRESS: 09225 SW HALL BLVD B ZONING:
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Low voltage: 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: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
MENASHE, R BARRY ADT SECURITY SERVICES, INC
621 SW ALDER, STE 605 2815 SW 153RD DR
PORTLAND, OR 97205 BEAVERTON, OR 97006
Phone: Phone: 503 469 - 7244
Reg #: LIC 59944
ELE 26- 209CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 5/25/2005 $75.00
[TAX] 8% State Surcharl 5/25/2005 $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 95 001 -0100. You ma obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: Permittee Signature: 0*y7 `Cal
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.
05/23/2005 11:52 FAX 5034697110 ADT SECURITY 2 001
+ ,
E�ire Permit Application FOR OFFICE USE ONLY •
City of Tigard Received i7 A ' a% Datc/B : 0 — /'
13125 SW Ran Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 �/� �,,■ ,, oPNHI %'�I rjate/By; Other Permit:
Inspection Line: 503. 639.4175 � Dam Ready/By: firm : E! See Page 2 for
Internet: www.ci.tigard.or - Notified/Method: ` Supplemental Inr r
VV / o radon
rr�r .lh f ". n'i nSti:?sf(':I( ° r1Si1' .g; ';M.:lr!ta ..�, PC; 'a: a:gl „-;N I! .n n .r ,I 1'n: ;velr IC7J r"�
l i. rZt'l 'i'l' �: i a 1 v'. <rla 7' Jr Vi - u. Iti: u:m; Ii i r { fig f A 1.) {_.” 1,0 b - ,11 Gc -
J, nsJ ? •,.,,. :,c !','[ :I „ II I' 1I; , {�i.� a .k , .y , , f,3 i': '� 7 q•,lk.� a �._,. 1 hc :p`•11 ,1n,;,::
1 LNSrCU g:51;e i % ;r19:-k 'rt lti ALI 1 I, 'r 1- {(} ,. +s f -`' L '.111E1 O - 'k., I s% .. r I 5 t ° I '! : ;rr , ,
iltll�,.i;�i: ^ w:lu � �a,L�r + c::i ' sL'•ti' *;1.'�1:5�9� hl �t}t, I. "' h c .�. r I � ,II:• i ,. .r. =. ,
►! ' ew construction ❑ Addition/alteration/replacement Please check all that apply:
• Aelxlolirion Other: ❑Service over 225 amps, comm'I ❑Hazardous location
,. n� I r,� � ? iy m y r ' t " + a'r r ❑Service over 320 amps - rating ['Bulldog over 10,000 sq. ft,,
y� .I Il u' . :iH, 7�, 1 : ;1 I'1i 1 4�1�'Ott' 0 '`' }f o,i ,'�. ern 1 1 1 F' :'; of I - and 2-family dwellings 4 w
N. l bl ,.t ` r . P ' . [: Ititg ,l4 '� .y, �0t I I iarJ , r'. A _ ri L v,. y or more now residential
Al !I i�OR �.>, W.: 1rlh:., u,,: t :th.,�:;,19�.e.'i',.�:,:ol:.t, r �
❑ 1- and 2- family dwelling Il ommercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
111 lvlulti family MI Master builder ❑ Other: ❑Buildin over three stones ❑ Feeders, 400 amps or more
['Occupant load over 99 persons EManufactured structures or
a' °; r ' linl ,i' , tv„',a1, . l , , F cc ;r:- 4� .: e. ar n nl, ,,,. a: q , l r tr m �nr�. ,� r,r, -ic, p p RV
�';,, lr,,,' a?'i:? + it ti 1 f, *..1 1 e II% 4 I bal t 1 1thil4PR (` M ❑ Egres ark
s /lighting
P
,fl I aj it r1 .1i! i l „1 • 1➢7111'1'd�'�Ia�Yntl r .�ll , 7�'T �tW � .i{I ' �T! �5� � 1 ! 1[ i
Job 11o.: icto „ ) 1i1.61:1 site address :goat SW a /m El Health-care facility ❑Other:
submit 2 sets of plans with any of the above.
City /State/ZIP: The above are not applicable to temporary construction service.
1...1 ldg. /apt. no. :. _ Project name: Id V,1 �LLL3 m il =T4tC i s':Ii , �'.' I��� ' i,';ia r rl I `i 1 k� e ��+ l „�. "''
.. Description I Qty. Foe. Total j
Cross street/directions to job site: 1 AC New residential single- or multi- family dwelling unit.
Includes attached garage. _
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no -. Ea. add'l 500 sq, ft. or portion 33.40 l
Tax map/parcel no.: • Limited energy, residential 75.00 2
i i'Cip tt,}rs clvl !t Y. i .3T�'r" ;�P ki1. �qm:1 sn h : r aL p' i PS er:�r, Limited energy, non - residential 75.00 2
.. r . Jl p:l QE ,:I n; "a 11 F (i�'' I ,�; : fi !p :i,� i Il uJ , f l l :Fl p ,:' ; - P
o �� , � Jr , ;: p - f, + 5 � �,-�`_ � fiq$t h n m j J ,[ f I ., i' J I i r +' Y.e
�fr . � .i:s(s`I1411'a':,r ,� r. e!: r�iYlftfe, til! Ji' L�: 1" �f^ �' t" �L"„ 1: �� .14!�ut[,se�r ":'i�!l�ilS"I � E ach manufactured or modular
YiSC I
�
' • dwelling, service and/or feeder 90,90 2
i 1 '"
1�i d , I , ti � 1 1 r „ Services or feeders installation, alteration, and/or relocation
II 200 amps or less 80.30 L 2
it t17 k O 3+' t� ';t� f ' d 'It 11M471 - a „ r Fr �1�1 r� s n l �N; a 0 s to 400 a s 106.85 2
! l�' i +i ll. u �� C" 1 y � I r r.. P
li !I r 1'1 !e.L i1, t APe i elt.'se :onollliirie'ufamt� '" -' T I ok i k∎i t r4i' j�„ ' I ' -7,- -
_
` '`"� ' 2 amps
amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts _ 454.65 2
Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) _ 200 amps or less I 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. r 401 amps to 600 amps 133,75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
rp. W � -r,:. Sri, " f,7 S;l alF, li 77 �'[", t .t„r
';d �'i I °:. j,;]1'i 4': xsr: q l ": r ein �,. n: t :C 4 ,
t ! �r,� 1 � Cal �l" y m' i 7q�t I , i r te ,} PN t Iz�1� 1 A;�p• r.,, n Grtr�.) �'t � �I li �l , A, . A. Fee for branch circuits with
, ? :1 t4. ! z !fl�, l LS7' `L•;tel2;t4�r::o A .6.1vl:la i. 1 r;r {y �, 1 . . asag!J l . f., •I2i..2s. , +Lc. 1•'. 1714 it �'J? , i rd
.u. '�t.L.ny ::1L t.��;✓ � � ,•ill rl aitl(L4w.,w�1�i:) service or feeder fee, each
Business name: branch circuit 6,65 2
A , \ B. Fee for branch circuits
Contac are. I J ` without service or feeder fee, 46.85 2
A. ass: each branch circuit
Each addi branch circuit 6.65 2
t ity /State /ZIP; Miscellaneous (service or feeder not included)
P onc: } ' ) ∎ it _ /HOD Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40
E t '' . Signal circuits) or limited -
]:? orp�74 �JJl;, ?r:A'!`I i�.{ p'1 iP, 7T! r��! n K . r Il r t ..: :gam :ion .r t,C .'gym - ]lt.n; ,,, -: I �� �,.tr ._` uL z:u. .,lam.; ^s!e � mer$ypancl' alteration' or
,�
d'ili '$',53:9'�.t4 1 II+},'r;;l.,[ tSrlg: 6 1I1I °�91[Sin�u ti�I Ll' 3 ,fi�;C.t�:+�5�5i:EiLll ?�`lY��le d3itl3y tk i extension. Describe: I Page 2 �5, 2
-
Business name: AI - ?GURI7-Y- SERVICES; INC.
Address: Each additional Inspection over allowable in any of the above
UFAVFRTON OR 97Df16 Per inspection 62.50
City /State /ZIP: (503) 469-7100 Investigation per hour (t hr min) 62.50
Phone: ( ) I Fax; ( ) Industrial plant per hour 73,75
i.��: ! Ill��t �1 V} I seCg IOW 4 1:ills 4 T:S '" 9 : i ' ; ''.'
CCB Lic.. + ' Electrical Lic.: • . �'; ?�I��.'.�ilKl ��tis�;n'����Ri:� >�[�' "��D ,t
�, ;Ii.: .
" , - 1 +( Le uprv. Lic,: g � Subtotal
Suprv. Electrician signature, required: - Plan review (25% of permit fee)
State surcharge (8% of permit fee) to.
, Print name: 1401 k _tai • C - i A ar t e• - 6) r I . Dd
II 'r r TOTAL rERIVIIT FEE
Authorized signature: This permit Application expires If a permit is not obtained within ISO
'r � . , days after It has been accepted as complete
Print name: MAY 2 �Da�`t Ol0- .2.. DO r Fee methodology set by Tri -County Building industry Service Board
-- Number of Inspections per permit allowed.
itNBuildingiPemuLrtElLG4etRiltppp •doe 12/03 CITY OF TIGAR L�•ae' 4613 Ttio/oucotv/wea
BUILDING DIVISION
05/23/2005 11:53 FAX 5034697110 ADT SECURITY 0]002
J l jctrical Permit Application 7 City of Tigard
P 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
I�II�, *�����i� �t���V�n�1 }�i1�J�� ° %���' ��pp ��y+ ��'��!'�Aj1�;�fl�F��1el��I�i
i. .li,L.,.sr,�.L ,,� W T -�: �,a si,�lr : I3�ftil�i7 4
Fee for all residential systems combined , .. $75.00
Check Type of Work involved:
Audio and Stereo Systems*
J
urglar Alarm
_a
Garage Door Opener*
n Heating, Ventilation and Air Conditioning
,System*
❑ Vacuum Systems*
❑ Other:
i�r� f � r Tl V °'� �`d} � , , "ti �� �,. ii i { i iH 5 i ,. u �' 1 I � . ��r {r9' a 4�a,.
t ;7 A�.�� :� S J�, 1 111 L ! Lg Pad .� l� �N,il li ,.t G �.r ?;yi ,1 1, :1 q. �i 7 fi . �t y �,I 1h
V i! f � G-7mhn,.� i.a�.. ��d0e�y.L ��id�LL�il�ii�l'y���., �:,�1:i�i�,11'�'�1�:if97,
Fee for each commercial system $75.00
(SEE OAR 918
Check Type of Work involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
•
n Fire Alarm Installation
TI HVAC
I I Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
Other 61 O Oir ACLi
Total number of commercial systems: /
*No licenses are required. Licenses are required
for all other installations
lAlluilA ■e$)EatniLAHLC•PertnicApp.dac 04/03
CITY OF TIGARD
BUILDING DIVISION ., PERMIT #: ELR2005 -00132
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/25/2005
Phone: (503) 639 - 4171' " "'E� "yl�i�VGI�� '
Inspection Requests (24 Hrs.): (503) 639 -4175 °`
INSPECTION WORKSHEET FOR DATE: 6/3/2005 TIME: 7:09AM PAGE: 67
SITE ADDRESS: 09225 SW HALL BLVD B CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: KIDS KLUBHOUSE
DESCRIPTION:
� v t ge.' alarm.
OWNER: MENASHE, R BARRY, PHONE #:
CONTRACTOR: ADT SECURITY SERVICES, INC PHONE #: 503 -469 -7244
Inspection Request Scheduled For: Date: 6/3/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 008291-01 503 - 297-1400 N
Corrections /Comments /Instructions:
•
•
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
•
inspector: Date: ®D Phone #: (503) 718-