Permit •
- ELECTRICAL PERMIT -
CITY TIGARD RESTRICTED ENERGY
,iC DEVELOPMENT SERVICES PERMIT #: ELR2001 -00126
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 04/30/2001
SITE ADDRESS: 11945 SW PACIFIC HY 209 PARCEL: 1S135DD-03301
W
SUBDIVISION: HOFFARBER TRACTS NO.1 ZONING: C -G
BLOCK: LOT: 002 JURISDICTION: TIG
Project Description: Burglar alarm installation. Job #083 - 11395 -05
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: BURG.ALARM X
TOTAL # OF SYSTEMS:
Owner: Contractor:
TIGARD PROPERTIES INC ADT SECURITY SERVICES, INC
2106 SE OCHOCO ST 2815 SW 153RD DR
MILWAUKIE, OR 97222 v 0 I 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
5PCT CTR 04/30/2001 $6.00 2720010000 Elects' Final
PRMT CTR 04/30/2001 $75.00 2720010000
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility. Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
Issued by , (��e. t � Cam_ :7,. j Permittee Signature t (.19/01/42-1/4/!2'7
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale. lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
04/27/2001 14:44 FAX 503 469 7110 ADT SECURITY 3;/6 awn
Electrical PermitApplication •
s
,. ;�.,,,,�;, e �ln>,� Datercceived: .,27 0/ Permit no.: [�a10U; -1o
I1� City of Tigard ED Projeet/appl.no.: / 12.51
City of Tigard Address: 13125 SW Hall Blvd, OR 7223
Phone: (503) 639 -4171 Date issued: By: Receipt no.:
Fax: (503) 598 -1960 APR 2 7 2001 Case tile no.: Payment type:
Land use approval:
EN
TYPE OF PE1t111IT
❑ 1 & 2 family dwelling or accessory 12f Commercial/industrial 0 Multi - family 0 Tenant improvement
0 New construction O Addition/aiterarion/replacement 0 Other. — 0 Partial
JOl$ SITE INFORMATION
lob address: i J'V fS S ICJ , rfi 4 `a 0g Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision: ti
Project name: ,i__ , • ' r b, G Description and location of work on•premises: a . a , , • 1
Estimated date of completion/inspecdon: -
( :ONTRA(1 OR APPLICATION FEE SCHEDULE
Job no: On. 1139$-05 -
Fee Max °
c-uri � �eyU/ Deamptron Qty. (en.) Total no insp
Business name: ADT Se
Address: 2$/- 30. /53 NewresidmlSal. leormult;- single
City: j��w (.4 cm Statc:(J� ZIP: d�O1emdt.Indodssamdtedgarage.
Phone :$03 L I 4 4 - .7 -2 Fax: el (q' 7 /(Q I E-mail: 1000 t1 or less 4
CCB no_: S I 1 g c m I Elec. bus. tic. n o : 6 - E' additional 500 s9- or portion thereof ,;
2 1 ��� Limited energy. residential
City /metro lie. no.: 2
Limited energy. non-residential 2
Each manufactured home or modular dwelling
i Sjnature of supervising electrician (required) Data smoke andlorfeeder 2
( I! Sup. elect n
��,,) name (prim): • License no: Ser+i� feeders — installation,
d alhaagonorrelttapon;
JJ ry � 200 amps or less 2
� ( pant): Co)4411C T . ilif. DWG 201 amps to 400 amps 2
Mailing address: _ 401 amps to 600 amps -
601 amps to 1000 2
City: :State: Z>;P: Over 1000 amps or volts � 2 � .
Phone:S6r 637 4 I Pax: 1E-mail: Reconne only I 2
Owner installation: The installation is being made on property I own Temponayseaylmes feeders - 1
which is not intended forsale, lease, root, or exchange according W insdladoo , alteration. orrelocation:
ORS 447.455, 479. 670, 701. 200 amps or less 2
Owner's signature: Date: 201 atoms to 400 amps 2
401 to 600 amps 2
Bt anehidttuita. new, alteration, --
Name: • or e:teusion per panel
Name , A. Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 2
City: !State: I ZIP: B. Fee for branch circuits widtout purchase
Phone: Fax: E . `� of service or feeder fee, first branch circuit 2 •
PLAN REVIEW (i'Ica a check all that apply) Misc.
PP ) Mise . (Service or feeder not induded):
O Service over22S amps-commercial Cl Heahhcvofacility Each pump or irrigation circle 2
O Service over 320 amps - rating oft &2 Cl Hatardous location Each sign or outline lighting 2
family dwellings 1:1 Building over 10,000 u auefenf ouro r Signal System over 600 voila nominal mom sttucruR alteration. ! o o r i e s) or a limited energy panel, I ' .
trsidentialunitsinotuuation.oexleasion• 2
O Building over three stories 0 Feeders, 400 amps or more
0 Occupant load ova 99 persons '• structures 0 Manufactured structur or RV park a a ch adduti
0 Egress/lighting ress/lighting plan 0 Other EaaT Iaapoetioo over the allowable In any oFdte abut
Submit sets of plans with any of the above. . Inv esti ggatio itu on I 1 1
nvn Fee
The above are not applicable to temporary construction service. Other
Nor su'jmiacklioas reaps casdit cards, please call ptdadied= for more infonnntim. Notice: This ermit Permit fee J
0 visa .OMaate,Card P application $ � �'
expires if a permit is not obtained Plan review (ax , %) $
Credit card number: / / within l80 days niter it has been Stale surcharge (896) $ • –
Expires accepted as complete. T emit f $
Note or cardholder as shown on credit Card P
Cardholder riesature s Amoral
7 4404615 (6.400ICOM)