Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
I b '� DEVELOPMENT SERVICES PERMIT #: ELR1999 -00155
^` " r l ll 13125 SW Hall Blvd., Tigard, OR 97223 (5031 � / DATE ISSUED: 6/22/99
W
SITE ADDRESS: 11920 SW PACIFIC HY PARCEL: 2S102AA -00200
SUBDIVISION: TIGARD HIGHWAY TRACTS ZONING: CBD
BLOCK: LOT: 013 JURISDICTION: TIG
Project Description: Installation of protective signaling. Job No. 083 - 03059 -02
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: v HVAC: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
SANDRA L. BARNES ADT SECURITY SERVICES, INC
C/O TUMAY CORPORATION 703 NE HANCOCK
11920 SW PACIFIC HWY PORTLAND, OR 97212
TIGARD, OR 97223
Phone: Phone: 503 - 284 -3265
Reg #: LAC 005994
ELE 26209CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT DEB 6/22/99 $60.00 99- 316315 Elect'I Final
5PCT DEB 6/22/99 $3.00. 99- 316315
Total $63.00
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
require • ; • • follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -'4)1 -0010 t' •ugh OAR 952 - 001 -0080. You may obtain copies of these rules or direct questio s to OUNC at (503) _
246-i 987. �
Issue: by � '� ( �OCGI,�N�. Permittee Signature , ,(/y1�,4j v// ._p , t ,
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: , )0 Q 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 APPLICATI • Rec'd bPDado /iit4%.4Y
13125 ( SW HALL BLVD �D6 9 �8� - 1� 3037_,- am ! Date Rec'd:
TI OR 97223 / PRINT OR TYPE
V - 503 -639 -4171 X3O4JUN 2 1 199' , �
Q ,a-ogd Permit #: (LA /999-00/
F - 503 - 598 -1960 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd:
CDMMIINITY DEVEI OPMFNT WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
� Q/J Restricted Energy Fee $60.00
(FOR ALL SYSTEMS)
JOB Street Address Ste #
ADDRESS / /qA0 614)r Check Type of Work Involved:
C /State ig 7a � Phong Y,- 3d // ❑ Audio and Stereo Systems
N v 7 (D ❑ Burglar Alarm
OWNER Mailing Address ❑ Garage Door Opener
City/State Zip Phone # ❑ Heating, Ventilation and Air Conditioning System*
Name
❑ Vacuum Systems*
ADT SECURITY SERVICES, INC.
•
703 NE HANCOCK ❑ Other
CONTRACTOR Mailing Address PORTLAND, OR 97212
(503) 284.3265 TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a City/State Zip Phone # Fee for each system $60.00
copy of all licenses (SEE OAR 918 - 260 -260)
are required if Oregon Contr. Brd Lic. # Exp. Date
/
expired in C.O.T. �7'7" T Check Type of Work Involved:
data base). Electrical Contr. Lic # / Exp. Date
�rD / A ❑ Audio and Stereo Systems
C.O.T. or Metro Lic. # Exp. Date
❑ Boiler Controls
Owners Name
❑ Clock Systems
OWNER - Mailing Address
APPLICANT ❑ 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. ❑ • 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 ❑ 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;
Protective Signaling
5. Assume responsibility for calling for a final inspection when all of the
corrections are completed. ❑ Other
Permits are non - transferable an. • .n-• - fundable and expire if work is not
started within 180 days of is . - nce •r if work is suspended for 180 days. Number of Systems
The person signing • p - - it must be the applicant or a person • No licenses are required. Licenses are required for all other installations
authorized to bin. ••p' -nt.
� 7' FEES:
Signa ire ENTER FEES
5% SURCHARGE (.05 X TOTAL ABOVE) $ J ,
Authority if other than Applicant TOTAL / $ / 3 ,
i:\dsts \forms\resele.doc 3/98 1 '5I 1 I
7/25/99 Activities for Case #: ELR1999 -00155
6:20:07 PM
Assigned Hold Updated •
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRC001 APPlication Received 6/21/99 DEB MAIL No Hold DEB 6/22/99
ELRC003. Permit Created 6/22/99 DEB DONE No Hold DEB 6/22/99 •
ELRC725 Low Voltage Inspection. 6/22/99 DEB No Hold DEB 6/22/99
ELRC799 Elect! Final 6/22/99 6/22/99. 7/14/99 CD FAIL No Hold AKJ 7/14/99 no access
ELRC500 (F) Issue permit 6/22/99 DEB DONE No Hold DEB 6/22/99
ELRC799 Elect'I Final 7/15/99 7/15/99 7/15/99 CD PASS No Hold AKJ 7/15/99
ELRC800 Case finaled 7/15/99 AKJ DONE No Hold AKJ 7/15/99
•
•
•
•
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
G q,ken 3 %C0 BUP
Date Requested �1 S / AM PM x BLD
Location t 20 g4-& �' Suite MEC
Contact Person TO Ph �g'7 -,� j PLM
Contractor U Ph SWR
BUILDING en Owner e,u.2,1s ELC �j p�
Retaining Wall ELR I � q -1 D1 S 5
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: NAD� nee"- Slab SIT
Post & Beam
Ext Sheath /Shear I AA"11 I 3 0t)
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling E.L
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
PASS PART FAIL
<LECTR1J
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
PART FAIL
SITE
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
Other Date 7/:_fl 9 Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.