Permit CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 - 00206
- ° � 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/26/2005
PARCEL: 1S135DD-03301
SITE ADDRESS: 11945 SW PACIFIC HWY 250 ZONING: C - G
SUBDIVISION: HOFFARBER TRACTS NO.1 LOT: 002 JURISDICTION: TIG
Project Description: 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:
TIGARD PROPERTIES INC ADT SECURITY SERVICES, INC
8320 NE HWY 99 2815 SW 153RD DR
VANCOUVER, WA 98668 BEAVERTON, OR 97006
Phone: 360 -574 -6255 Phone: 503- 469 -7244
Reg #: LIC 59944
ELE 26- 209CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 7/26/2005 $75.00
[TAX] 8% State Surcha 7/26/2005 $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 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: '7 ► ' Permittee Signature: j,-e- Ct N
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.
07/26/2005 09:01 FAX 5034697110 ADT SECURITY 8001
E.- lc trical Permit AppliC r FOR OFFICE USE ONLY
City of Tigard Received 03 1 Permit No.6L, ' /D
13125 SW Hall Blvd., Tigard, OR 97223 -
Phone: 503.639.4171 Fax 503.598.1960 JUL 2 6 2 ) - j Ian' Other Permit •
Inspection line: 503.639,4175 J .. `i late Ready/By I ® Sc e page 2 for
Internet www.Ci.tigard,or.us N otified/MerhoO:
TY OF TIGARD Supplemental Information
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N'ew construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other ❑Service over 225 amps, comm'l ['Hazardous location
•I,j I s�� nv o- `; L °il^i' +q: tin :;I� l J .. L I7 i �.__ ❑Service over 320 amps - rating ❑Duildng over 10,000 N. ft.,
1IF ; 1 t i1 ^- 7jut�I �,Ialj pru , tl i ; I 1 i i , F: ' 1 M u I I r J !0� I�( il PI JF, -i ! t:f of 1- and 2- ■ : a,.1 1.. ± �:- �1'G�SL:^ f '�",il;,f.J1r_.. _.i! -,,,r < �IV<<_n�ki 18H i11.7!., v Iletl. family dwellings 4 or more new residential
❑ 1- and 2- family dwelling • ommercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
CI Multi famrly El Master builder Other. ❑Building over three stories ❑Feeders 400 amps or more
❑ ❑Occupant load over 99 persons ❑Manufactured structures or
l�;/+ , ' 1,3i ^' 1 i f i7 "q i r,5',V, :'a i S ^ i I '� i ' 1,'-71 a y � i .` it 1. ; i 1
ii br;i' !. 1 i Iii: 1 it v�a r � 1111:t4.a� l lx ;. 11i ti •'+ il�i� I a • f l ?..� ..� .s� I �.� Tr;" . J�O ilrYtli..t.'t { ❑Egresailighting plan RV park
Job
no.: D site address: - ['Health-care facility ❑Other:
u . dd . La -� - I L. T - ' Submit 2 acts of plans with any of the above.
City / State/ZIP: - Ti Q ' D r 9 ell The above are not applicable t0 to
� Dr app temporary construction service.
1
Suite/bldg./apt no.: 1(i 1a l Ir 1f�,0.�l1 f�:f 1 1a'J¢: ..J a � , �' d'l1 ;
;; f A - I Project name: /w &. _. ' " &- ■ pwerionea Qty. Fee. Total , ••
Cross street/directions to job site New residential Single- or multi- family dwelling unit.
!
l/� (‘ \ Includes attached garage. / `� Y r ( A) � Q C_A l - \ c , ` Hli \J 1,000 sq• ft, or less 145,15 4
Subdivision: Lot no.: ( Ea add'1500 sq. & or portion 33,40 1
Tax map/parcel no.: Limited energy, residential 75.00 2
c, rlrr ;,I :: lS r;: j,. ? ^ „p? `;4i” 4: ___ a^ - • .;� ,:•: a .P: •,,� ,, • •ra , - v . Limited energy, non - residential 75.0() 2
li•'''-I +, r d i! �.L+' tr C7 : 41'I ' +d 3 •y I p �'Cti''1', ln� il',�•.PFT ' ,I I � 1 -g 1 I �r[,'Sc j r
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/1 Il A f /I Q dwellin se rvice and/or feeder 90.90 2
• Ld.f �71"I [A f 1 I 1 1//t/1 Services or feeders installation, alteration, and/or relocation
� J 200 amps or less 80.30 2
4 1 17,1 - p 9 t,' • d � i 1 ',1 I �1ii; � l i i P-7, 1 d .
� V' 'i 'r 1 I - 1.i 1
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r,' �
G_� 1. l l .l� 1 011 ;717,,"P 201 ara115 t0 400 am 106.85 2
1 J21..2_ L�z�3 ,..L . �fi : f �� � it,r .l,].: .1 -1
,. -'1, A - i;l l, �f� • 401 amps to 600 amps 160.60 2
Name:
601 amps to 1,000 amps 240.60 _ 2
Address: • Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fax, ( ) relocation
200 amps or less 66.85 1
Owner installation: This installation is being made on property 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: Date: -
,1 r Branch circuits - new, alteration, or e x t ension, per panel
,fJoJ 1'14' gl,` I r i I... 'e rc . r J :". ris•, L.1 i r.5 L 7 L ., , 1
,f 1 loll r - r`{ f�ir'fti I� 1 tt L r A. Fee for branch circuits with
;
..af . L; _ ._ll..r_ ::::r ; F_... , c.._ _ L 1_L .,L. L ., .: r, _: j j -r ,;. I 7, - , i k_ • _ L . i ,: ,. W service or feeder fee, each
Business name: • branch circuit 6 2
B. Fee for branch circuits
Contact name: without service or feeder fee,
Address: each branch circuit 46.55 2
Each add'1 branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) I FaX :: ( ) Pump or irrigation circle 53.40 . 1 2
1 Sign or outline lighting 53.40 2
` E -mail: _ _ Signal circuits) or limited -
j 1 7. !.c���l!':Zi6 ;i i,i'. i. �� 1 {'' vii�I Lf li��tti7 ,r' a 11 I ��' �_ u_ r c...il en
_ )I { i J li tll I J Iii ,Lt` (� ,I egy pmlel, altera[itm, ar
extension. Describe: I Page 2 - 15, ct 2
Business name; ADT SECURITY SERVICES, INC.
Address: 2816 5.W. 153rd DR, Each additional Inspection over allowable in any of the above
BFAVFRTON OR 87QI16 Per inspection 62.50
City/State/ZIP: (503) 469-7100 Investigation per hour (1 hr min) _ 62.50
_ Phone: ( ) I Fax; C.1L�J) 1 0 — . — 1 I Industrial plant per hour 73.75
CCB L1C.: 51C/11414 �leCttlCa ti ll._ e1 �4: ii; lL' �if,d3�.(= f�l• f3•.'. �. 1�'3:..-: I7�! t; 1, l` �t, ifil7tr.6�L�A�•.'f.1 -" /1�4_..
I Lie.: .7rb ck� uprv. Lic.: / � Subtotal
,: Suprv. Electrician signature, required: "` Plan review (25% of permit fee)
/bCi , /.lA
Print name: )/p I� �/f S j )axe: l/2J)D)
_ TOTAL PERMIT FEE gi. pp
Authorized signature: Thy permit application expires If a permit is not obtained within 180
days after it has been accepted as complete
Pritnt name:
Dam v Fee methodology set by lrr County Building Industry Service Board
l •• Number of impatiens per permit allowed.
T\BwtalnalPe mi l :Lc-Pemi IApp.doc 12/03 41046I5T(10/02/COM/WBa
r
C OF TIGARD,_
BUIL DIVISION PERMIT #: ELR2005 -00206
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/26/2005
Phone: (503) 639 -4171 44. ��,
Inspection Requests (24 Fps : (503) 639 -4175
INSPECTION WORKSHEET FO DATE: 9/14/2005 TIME: 7:09AM PAGE: 80
SITE ADDRESS: 11945 SW PACI -% HWY 250 CLASS OF WORK:
SUBDIVISION: HOFFARBER TRA' LS NO.1 LOT #: 002 TYPE OF USE:
PROJECT NAME: JO - ANN FABRICS
DESCRIPTION: Burglar Alarm.
OWNER: TIGARD PROPERTIES INi , PHONE #: 360 -574 -6255
CONTRACTOR: ADT SECURITY SERVICES, `k„ PHONE #: 503 - 469-7244
Inspection Request Scheduled For: D'61e: 9/14/2005 Pour Time:
Code Inspect '':es -": Confi # Contact # Message
135 Low ';ts Itage V /wf'L 015618- 503-469-7212 N
I orr cti s /Comments /Ins _.--';, ,
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: • til Date: 9'" l - 2 - Phone #: (503) 718-
,