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Permit CItY O F T I G A R D ELECTRICAL PERMIT - RESTRICTED ENERGY aw r DEVELOPMENT SERVICES PERMIT #: ELR2002 -00122 '� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/10/02 SITE ADDRESS: 11765 SW PACIFIC HY PARCEL: IS136CC -00100 W SUBDIVISION: ZONING: C -P BLOCK: LOT: JURISDICTION: TIG Project Description: Alarm Panel conversion. 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: BARASCH, STEPHEN ADT SECURITY SERVICES, INC BY WORLDWIDE REAL ESTATE 2815 SW 153RD DR GENERAL MOTORS CORP BEAVERTON, OR 97006 DETROIT, MI 48202 Phone: Phone: 503 - 469 -7244 Reg #: LIC 59944 ELE 26- 209CLE FEES Required Inspections Type By Date Amount Receipt Low Voltage Inspection PRMT CTR 7/10/02 $75.00 2720020000 Elect'I Final 5PCT CTR 7/10/02 $6.00 2720020000 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 . �� � 1C& Permittee Signature ' 7ti a42#4'0.01 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: P6 C L� Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day 07/02/2002 15:28 FAX 5034697110 ADT SECURITY a001 - - . El Date received: - /O- O Z Permit no.: � ; of Tigard — -� °` -L ., 1 0 Projed/apptno.: Expire date: City ogard Address: 13125 SW Hall Blvd, Tigard, +ORk 2 2 Phone: (503) 639 -4171 ` Date honed: By: 1312:11 Rcceiprno ` Fax: (503) 598 -1960 � v' 1 * Case filo no.: Payment type: Land use approval: �. � J3 ��‘ X 6 7 O 1 & 2 family dwelling or accessory IC CogarciaUindustdai 0 Multi - family 0 Tenant improvement O New construction CI Addition/alteration/repIacement 0 Other 0 Partial - JOB SITE INFORMATION Yob address: // 765 5( Aw n - fir //ivy Bldg. no.: Suite no.: Tax map/tax lot/accountno.: Lot: Block: Subdivision: / Project name: &ALE .E. idariodent I Description and location of work on premises: [r _ o , VUF y Az.,4 P1t1 i>tifL Estimated date of completion/inspection: . CONTRACTOR APPLICATION FEE SCHEDULE ' Job no: OZ• 126 73 L_O 2 Fee Max Business name: Arn- ,see ra! fI Dest�ptlo ,te a) Total no T int Address: 22 IS 314 'Sd r - NewresIde d -single oronm- ramnyper dwel l: gmat.Ltdudesatadvedgarage. Cit Sesimertalk state: Opt' ZIP:* 97006 Senlalndaded: Phoneteetpii 41'7 /001 Fait Sal E-mail: - 1000 sq. ft. Dries • 4 CCB no.: erg 4 I Elec. bus. lie. no: Z6.2 9t LE L e dditi°rta15 a sq ft. or portion thereof Li en rr8deatisl l 2 City / m • • i e. no.: limited :, , non•resldeatial 2 B ade m anuratiod home or modular dwelling .. ?• oz. OZ g Si F. : , ' of supery , g - eetricion (required) Date • Service and/or feeder 2 Sup. ect.name X8 9 Services or feeders - fustallatlon, P (ant} KRAVt License alteration orreloation: PROPERTY OWNER 200 amps orless 2 Name (print): l ' 201 amps to 400 amps 2 - — Mailing address: • 401 amps to 600 amps • 2 • 601 amps to 1000 amps . 2 Cie: I State: 1 l 21P: Over 1000 amps omits 2 Phone: I Fax: [E-mail: ' Reconncctonly 1 Owner installation: The installation is being made on property I own Temporary services or feeders - • which is not intended for sale, lease, rent, or exchange according to ' hO°,a1 on, 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 amps 2 ENGINEER lirench 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: State: ZI: S. Fee for branch circuits without purchase Phone: Fax: p 1. of service or feeder fee, first branch circuit: 2 . • Each additional branch circuit PLAN REVIEW (Please cheek :ill that apply) Masts Oar,iceor feeder not Included): • O Service over 225 amps D Health - care facility Each pump or irrigation circle 2 O Services over 320 amps - rating of Ida 0 Hazardous location Each signor outline lighting 2 - family dwellings 0 Building over 10,000 equate fear four or Signal dreuil(s) or a limited energy panel, O System over 600 volts nominal more residential units in one structure alteration. or extension* I 7575 2 O1ganding over three stories O Feeders, 400 amps or more *Description; a Occupant loud over 99 persons 0 Manufactured structures or RV park Each additional Inspection over the allowable In soy of the ahove: O Egress/lightingplan O Other Per inspection I 1 • 1 .. I Submit _ sets of plans with any of the above. investigation fee The above are not applicable to temporary construction service. Other Permit fee $ 7S a all Judt Not a dlcdoos matte ern* cards, please call jurisdiction foe more information. Notice: This permit application O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $ Credit � number a O I / within 180 days after it has been State surcharge (8%) $ 6 -_ • Name of cardh cord older as shown on credit d Expires accepted as complete. TOTAL $ a Cardholder sienature Amount 0404615 (6/(1WCOM) CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION- Business Line: (503) 639 -4171 MST - BUP Received D^at�e / Requested / s' AM PM BUP • Location l ! 2 5 �" ��- / .0 f f p �J� Suite MEC y Contact Person A 1 -°11/A Ph ( 544) �-' �? ✓ PLM Contractor Fl. D : 1' Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR r Z c 2 L c t �Z Crawl Drain Slab Inspection Notes: _ SIT Post & Beam ' ? �/�' �Z l Ext Shear Sheath/Shear th / Srs Shear C � r/ , / S 'g TN) Ext eah/ V Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING — Post & Beam Under Slab Rough -In IPf 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 PART FAIL _ Service Rough -In UG /Slab Low Voltage Fire Alarm 111 PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date T Inspect) Mr Ext Other: Final DO NOT REMOVE this inspection record rom the ' b site. PASS PART FAIL