Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT #: ELR1999 - 00107
" ..��! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/30/99
SITE ADDRESS: 11573 SW PACIFIC HWY PARCEL: 1S136DB-00201
SUBDIVISION: ZONING: C -
BLOCK: LOT: JURISDICTION: TIG
Project Description: Protective signaling
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:
WILMINGTON TRUST CO ADT SECURITY SERVICES, INC
BY FRED MEYER INC 703 NE HANCOCK
3800 SE 22ND AVE PORTLAND, OR 97212
PORTLAND, OR 97242
Phone: Phone: 503 - 284 - 3265
Reg #: LAC 005994
ELE 26- 209CLE
FEES Required Inspections
Type By Date Amount Receipt •Eleet - r;n 1 tat) VC VC 1
PRMT BON 4/28/99 $40.00 99- 314929 Elect'l Final
5PCT BON 4/28/99 $2.00 99- 314929
Total $42.00
ORIGINAL
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 tar Permittee Signature t(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: 1 U k DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APP L A I ED Rec'd by: 41..
13125 SW HALL BLVD c
0/ Date Red: - - °I
TIGARD OR 97223 �a - / / �C✓6 — 0 PRINT OR TYPE APR 2 �gg�
Weill
V - 503 - 639 -4171 X304 Y/� Permit #:� 2 _ �01D r]
F - 503 - 684 -7297 P LETE OR ILLEGIBLE APPUtiniaig VELOPMENT Cust.Call'd:
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee $40.00
7c 4 1 (FOR ALL SYSTEMS)
JOB Street Address j� Ste Check Type of Work Involved:
ADDRESS //.5 5 "`� ( it. ' y�� 3 3
City/St n a 7 �� P h9 ❑ Audio and Stereo Systems
Na4 PFEfl )) '�cJJ (,p
l Ys "� ❑ Burglar Alarm
l D d ,< .6 r7 Door Opener*
OWNER Mailin Addres n
� `° ❑ Heating, Ventilation and Air Conditioning System*
City /State I Zip l Phone #
Name I ❑ Vacuum Systems*
A ❑ Other
CONTRACTOR Mailing
D,. M.E. Nomad TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a City /Stateerni t ig] Phone # Fee for each system $40.00
copy of all licenses 503 - � � (SEE OAR 918 - 260 -260)
are required if Ore g n C n r Lic. # Ex � t
expired in C.O.T. f Check Type of Work Involved:
data base). Electy l , c. # E ❑
.� f Audio and Stereo Systems
C.O.T. or Metro Lic. # Ex Date
0 Boiler Controls
Owner's Name
❑ Clock Systems
OWNER - Mailing Address
APPLICANT 0 Data Telecommunication Installation
City /State Zip Phone # ❑
Fire Alarm Installation
This permit is issued under OAE 918 - 320 -370. This applicant agrees to
make only restricted energy installations (100 volt amps or less) under this ❑ HVAC
permit and to do the following:
❑ Instrumentation
1. Only use electrical licensed persons to do installations where required.
Certain residential and other transactions are exempt from licensing. 0 Intercom and Paging Systems
These have asterisks( *). All others need licensing;
❑ Landscape Irrigation Control*
2. Call for inspections when installation under this permit are ready for
inspection at 503- 639 -4175; ❑ Medical
3. Purchase separate permits for all installations that are not ready for an l i Nurse Calls
inspection when the inspector is out to inspect under this permit;
4. Assume responsibility for assuring that all corrections required by the ❑ Outdoor Landscape Lighting*
inspector are done, and;
IX Protective Signaling
5. Assume responsibility for calling for a final inspection when all of the
corrections are completed. ❑ Other
Permits are non - transferable and non - refundable and expire if work is not
started within 180 days of issuance or if work is suspended for 180 days. Number of Systems
The person signing for this permit must be the applicant or a person * No licenses are required. Licenses are required for all other installations
authorized to bind the applicant.
-FEES: c).-4"-1.---- / ENTER FEES $ '`R/ DO
Si nature
5% SURCHARGE (.05 X TOTAL ABOVE) $ 0 "
Authority if other than Applicant TOTAL $ 1 1D - t b
is \dsts\resele.doc 7/97
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6/30/99 Activities for Case #: ELR1999 -00107
1:21:44 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRC001 Application Received 4/28/99 BON DONE No Hold BON 4/28/99
ELRC003 Permit Created 4/28/99 BON DONE No Hold BON 4/28/99
ELRC730 Elect'l Service 4/28/99 4/28/99 No Hold BON 4/28/99
ELRC799 Elect'I Final 4/28/99 4/28/99 No Hold BON 4/28/99
ELRC001 Application Received 4/28/99 BON RECD No Hold BON 4/30/99
ELRC003 Permit Created 4/30/99 BON DONE No Hold BON 4/30/99
ELRC725 Low Voltage Inspection 4/30/99 BON No Hold BON 4/30/99
ELRC799 Elect'I Final 4/30/99 4/30/99 6/7/99 CD PASS No Hold AKJ 6/7/99
ELRC500 (F) Issue permit 4/30/99 BON DONE No Hold BON 4/30/99
ELRC800 Case finaled 6/7/99 AKJ DONE No Hold AKJ 6/7/99
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
rr __ q BUP
Date Requested l.t�' l 1 AM PM BLD
Location (l c 1 P4 LI 4-h A 9 ( Suite MEC
Contact Person int (4 , L , I Lt ako, Ph U - St/ ;2 PLM
Contractor Ph SWR
BUILDING n T wner Pekes ELC
Retaining Wall ELR i g q q -- 0 7
Footing Access:
Foundation FPS
/�
Ftg Drain S
' ` 1 6 " Jm L_ SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler _ ` r .� dr'
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
A FAIL
LECTRI T L
Service
Rough In
UG /Slab
Low Voltage
Fir- Alarm
e 00 PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk /7/Y Other Date rev Inspector l/ ,r�� Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.