Permit C ITY OF TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT
eArA DEVELOPMENT SERVICES PERMIT #: ELR2005 -00145
,.� II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/6/2005
PARCEL: 2S 102AA -04100
SITE ADDRESS: 12230 SW MAIN ST ZONING: CBD
SUBDIVISION: MORINS ADDITION 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:
INTEGRITY INVESTMENTS INC ADT SECURITY SERVICES, INC
2229 NE BURNSIDE SUITE 86 2815 SW 153RD DR
GRESHAM, OR 97030 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 6/6/2005 $75.00
[TAX] 8% State Surchar€ 6/6/2005 $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 • ; - 001 -0100. You obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699.
Issued By 41/ „ A _ , � I Permittee Signature:4')7 /,P'io i4- �(� — ‘_,
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.
Ii .6/03/2005 08:43 FAX 5034697110 ADT SECURITY f�001
lecixlcal Permit App b f_i % ;t ;lt , / FOR OFFICE USE ONLY
t
City,gf Tigard I " -' Received ,
13125 S W Hall Blvd., Tigard, OR 97223 Aat�s : d j Permit No.! ` 2005 -0 0 /�S
Phone: 503.639.4171 Fax: 503.598.1960 I JUN ?Lan Re"10
Inspection Llne: 503
.639.4175
3 201 s : ( Dace/By: Oche Permit
Internet ; ci.tigard CITY o e ®ee t Tor
w P/W,gi.t7 ar.us wee Re !
• N d5 ea/M rhea 1 I Swpplemenca l Information •
4m l !i " y i {i l'i c.d yi ;P!:l_I[ ii - °_ : f: "- u!7-17.1.t..51 L7 °e ^F :i . - 1
4{a,l � r t :, G t ;)' II! I I J l` 11 ) r. H� . , B a l ,. l+- tr ' I 1 b .: I �Ii 11.1 il, i ' rfJ ii %1''1' ' - n 1' ar_, w
Z n :' __L I I t I ;rt t ` - -. ,r rl cCn 1 7 #,•' .. • •
I _ • _ ... - t- .i a _ � ! �>•L "' "':.L:�.z G3�`i ��. ;F�r�liW�l�11�1��il ..al L:1"y L +:l� �: .n� �•�.'
! ►_( New c ons truction "` ''�
❑ Addition/ttltcration / iep edam Please check all that apply:
['Service over 225 amps, comm'l (_]Hazardous location
L 1 El Other:
; l �.�; I rta tit 57,x_ ;51 I'•'S�`i T "r! 1? �- r • ❑Service over 32 9
; r ! I r , + : l e 1 �-, a r t .a 0 dw rang •.. 2 - , 1y 1, �'� �_-� k. mle.. ,Fitt l �`I��L' _ is it' � t l l--t- - 4,. i 5 , ° � s ; l" • 1 ,. of 1• and 2- family dwelli 4 or more new residential
❑ 1- and 2- family dwelling lr.4 Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one atntc
❑B
CI Multi-family ❑Master builds [� pear; uilding over three stories ❑Fee 400 amps or r
„ more
I.',� I I I Ht �,` yI,i !''l�lr, lil "i ir,�i
'! �'ii� „' '' f ` Y ;, r, ❑Occupant load over 99 persons ❑Manufacturedstructuesor
1 .,. t " ' , ti,l, '� :: �:iL>2i1 X71. "- AZ 1. :I J ;i: `d� t , It l t;'{ 4 y ry l V
�� � •? 1 'Sa�E�' ±�, ❑EgressQightinsplan R park
Job nol: -, ring- 11 Drib site address: , . r b 7 . VA I . o . 01-care facility ['Other:
Submit 2 sets of plans with any of the above.
City /State/ZIP: 'T i �� . (� , I I, a^ � The above are not applic able to temporary mporary construction service.
no. TI 71. ; I L, • T V1 ..
Suite/bldg./apt - ` I • L...1W.if ,, ? ,1 ,�.,.. ' ' ?.. .
'r0 eCtII:#II18: ��� � ` / i �`u� ;i! . h� n!I'�r�4n :�i� '; �iCvl:�7l=� .
• : !• :. •
Ittatipd•n Qty. Fah Total ..r. Cross etreet/direclions to job site: New residential single- or multi- family dwelli 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_ _ 1
Tax map/parcel no -: Limited energy, residential 75.00 2
' ' 1 1t ti - T - .( Limited energy, n residential 75.00 2
1, i`..I 'lih CA'5 lV 'I _ ,; ") .i;;:L 4 i11 1 , kil i ; '..I , ? .�r Lr j,0:, lw ,l�l 1 ii tS�t + I .,IuI IZ ' k'=' Each manufactured or modular _
:.u:�
_ dwelling, service and /or feeder 90.90 2
41
,' . ii & _ 11 1, �' �' / aU Services or feeders installation, alteration, and/or relocation
_ 200 amps or less 80.30 2 _
p r.- N � .1 %; I ii� l j '..� I l i S 7 k 7 . , n 1 L .5R7L l � 1 l, L i�7 F i �r l A II l 1 l q- ��. I .F� J I I 'IFtr."4 1'a, 201 alpS 10 amps 106.85 2
-_. 1. d.�_ ,.. _ I,'. I�l�+ !�.1i�.r�,.rl t>il+t I r•..: { � i R[ iIl�l.r.,ti J\ I� v l yM r � 7 +ajL 1 7 r : ,
-ti1L, ti.l;.l t , r 61 P' �
Name: 401 amps m 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State/ZIP: Reconnect only 66.85 2
Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fax: ( ) relocation
-
Owner installation: This
installation is being made on property _200 amps or less 66.85 I
g p perty 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.
401 amps to 600 amps 133.75 2
Owner signature -
:
r _,_ - _ te :, alteration, or e
irC•:'11F1 7 I r . . Ii . � � 1, f I�, � l a x I I1 , It�O Branch circuits - new '.A p , lt i 1 extension, n, PCr panel
l;,_ rt ,.! , !�:L, 4 : �,..I� •� I si -6), ' t 4f 1ti t {+ i +, +r 1 II��I _ t.1�4,� « le t. I �. A. Fee forcir
.. 1 G c_ a.l..,. ?9r. r _`:1LIC�.1 _I�ii:lp.
Business name: service err boraeeeh feeder fee ea i 6.65 2
bran circuit
Contact name: j , i • 1 � A / B. Fee for b c i rc lrim
without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'l branch circuit 6.65 2
City /Stete/ZIP; Miscellaneous (service or feeder not included)
Phone: (b1)5) . El.. 1ri r Fax: : ( ) or irrigation circle 53.40 2
E Sign or outline lighting 53.40 2
t, : c, I Signal circuit(s) or limited -
1-04 r t::,!� I t,i, ,11� 1 .,-" II! liIt�Oiil
l t'a ? 0;.i;Fli•�i' : 1 I 77 ;.K
}:L. I!.a nl- a.',- I a J_, - ...:.',L ti. , , �h {�inEJ'Lli''iJ energypanel, alteration, or f
Business name: ADT SECURITY SERVICES, INC.
extension. Describe: Page 2 15, IX) 2
rr , i •
Address:
Each additional inspection over allowable In any of the above
Per inspection 62.50
City /Stare/ZIP: (503) 469.7100 Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
_
I�'i�� "Fij!+1Iliiil �I Ed:Ttii:�il�ir,- 'G':i'I ���`'{. ' "� �9 �
CCB Lie.: .4 Electrical Lie.: be 'll1 :._1 S •L.ii a Yi ., m_..roni! ;:.LI Q7L +,', yl` ,.93 i r X 1:4 ; I : •
cm u prv. Lic.: � .
Subtotal
•
Suprv. Electrician signature, required; J- _- ` Plan review (25% of permit fee)
Print name: ` ` ` Date: r ^ State surcharge (8% of permit fee) 6. pp
Authorized signature: �i TOTAL PERMIT FEE g , Dp
The permit oppllcalion expires if a permit is not obtained within 180
Print name: days after it hue been accepted as complete
Date: l • Fee methodology act byrri- County Building Industry Service aoard
•' Number of impeetione per panmit allowed
I-\ U1ld og1Pmil1u ELC-PermjtApp•doe 12/03 • s40.4615710/02/001,1/WEB
`�;ITY OF TIGARD ,.
BUILDING DIVISION PERMIT #: ELR2005 -00145
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 6/6/2005
�,
Phone: (503),639 -4171 ,,,, h��6 t.iyi1is
In Requests (24 Hrs.): (503) 639 -4175 "
INSPECTION WORKSHEET FOR DATE: 6/29/2005 TIME: 7:08AM PAGE: 7
SITE ADDRESS: 12230 SW MAIN ST CLASS OF WORK:
SUBDIVISION: MORINS ADDITION LOT #: TYPE OF USE:
PROJECT NAME: CROWN CARPET
DESCRIPTION: Low voltage/burglar alarm.
OWNER: INTEGRITY INVESTMENTS INC, PHONE #:
CONTRACTOR: ADT SECURITY SERVICES, INC PHONE #: 503
Inspection Request Scheduled For: Date: 6/29/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 010450 -01 503-287 -6783 N
Corrections /Comments/ Instructions:
A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
N Inspector: Date: 2� � � Phone #: (503) 718-