Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
r, DEVELOPMENT SERVICES PERMIT #: ELR2001 -00307
431- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/29/01
SITE ADDRESS: 07319 SW KABLE LN 500 PARCEL: 2S112AC -01500
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -L
BLOCK: LOT: 022 JURISDICTION: TIG
Project Description: Add on to CCTV
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: CCTV X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES ADT SECURITY SERVICES, INC
15350 SW SEQUOIA PKWY #300 -WMI 2815 SW 153RD DR
PORTLAND, OR 97224 BEAVERTON, OR 97006
Phone: Phone: 503 - 469 -7244
Reg #: LIC 59944
ELE 26- 209CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 11/29/01 $75.00 2720010000 Elect'I Final
5PCT CTR 11/29/01 $6.00 2720010000
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
Issued by . 1 A _A Permittee Signature f rit 0-- 12
s
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale. lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: r Gz °`�`� DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
11/28/2001 14:15 FAX 5034697110 ADT SECURITY 1 j001
Electrical Permit A lication
> til i ® Date received: (/ 0 1 Permit no.: 200 / _ O 7
° ° `° 'i Tigard of Tid
- " I � ' _.. Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tig MVR297,22
Phone: (503) 639 -4171 0 1001 Date issued: By: I Receiptno.:
Fax: (503) 598 -1960 CITY OF TIGARD Case file no.: Payment type:
Land use approval: BUILDING DIVISION
TYPE OF PERAMIT
O 1 & 2 family dwelling or accessory S Commercial/industrial O Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other: Cl Partial
• JOB SITE INFORMATION 1
Job address: 73 Ids SW KA (7 it LN 51 500 Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: Subdivision:
Project name: rxLe reoa(;3ewttd I Description and location of work on premises: 07 1/ Ail oyL..
Estimated date of completion/inspection:
' - •1 CONTRACTOR APPLICATION FEE SCHEDULE ` ,
•
Job no: Q$'3. 13353 -1Z Fee Max
Business name: ALT ' .` eco 4y Description Qty. (ea.) Total no. insp
Address: 28 is 3{Ja 153rd .p I New residential -single or multi - family per
dwelling unit. Includes attached garage.
City: B St Olt' ZIP: 97406 Service included: •
Phone:+, 3.4(x0 «'�( 01 Fax &.140.7 I3 -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: S1744 I Elec. bus. lic. no: r 6 2td?CLE
Limited energy, 2
rgy, residential
City /metr ic. no.: Limited energy, non- residential 2
<-4-111-} / /- 2 2, -dJ Each manufactured home or modular dwelling
Sign o supery si' e ectrician (required) Date Service and/or feeder 2
Sup. elect. name (print): License no: Services or feeders — installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): (037 GTS ,7p/ / 1' O G(,'Qn 201 amps to 400 amps 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: V* 470.37 /Z I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary servicesor 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,
Name: or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I 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. (Serviceorfeedernot Included):
•
O Service over 225 amps- commercial Cl Health -care facility Each pump or irrigation circle 2
O Service over 320 amps - rating of 1 &2 O Hazardous location Each sign or outline lighting 2 -
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, � �
O System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons Cl Manufactured structures or RV park Each additional Inspection over the allowable in any of the above:
O Egress/lightingplan O Other. Per inspection I I I
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 $ '7a • rm
O Visa Cl MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / 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
440 -4615 (6/00/COM)
CITY OF TIGARD 24 -Hour
BUILDING - - • . Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Re uested / — /k ) AM PM BUP
Location '"73 1 Cf Suite MEC
Contact Person A —� Ph ( ) 4-/-6 7 7)5' PLM
Contractor A 0 Se -, , e,i 7 5 r4oC €S Ph ( ) SWR
BUILDING Tenant/Owner 6 70 -3 - 7 1 oZ <� ELC
Footing . ! i r aGti v& ��r`}f 'fir Fc.J ., 411 Q,�Z 2
Foundation ELC
Access:
Ftg Drain ELR '06 / )3c7
Crawl Drain
Slab Inspection Notes: C �� , / SIT
Post & Beam V
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing -
•
Drywall Nailing 10(7 2p
Dryl � b`
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
ELECTRIC AL
Service
Rough -In
UG /Slab
toSVOifiraf3 •
Fire Alarm
r ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Zit PART FAIL
0 Please call for reinspection RE: 0 Unable to inspect – no access
Fire Supply Line
ADA D /`' l E: — (9„2 Gcic 4 Ext
Approach/Sidewalk �
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL