Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
1 DEVELOPMENT SERVICES PERMIT ELR2001 -00224
+L ..� II ., ` 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/10/01
SITE %ADDRESS: 11999 SW PACIFIC HWY PARCEL: 1S135DD -05106
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of CCTV.
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: CCTV X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WEIREX CO INC + ADT SECURITY SERVICES, INC
CCC PROPERTY MANAGEMENT LLC 2815 SW 153RD DR
14001 WILLAMINA CREEK RD BEAVERTON, OR 97006
WILLAMINA, OR 97369
Phone: Phone: 503 - 469 -7244
Reg #: LIC 59944
ELE 26- 209CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
5PCT CTR 9/10/01 $6.00 2720010000 Elect'l Final
PRMT CTR 9/10/01 $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 Permittee Signature Olh Gr;. .
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: 5`0
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
09/06/2001 14:07 FAX 5034697110 AD '••=..•ITY 0 001
_ . ,., A Electrical Permit A I , . tion �
Date received: a Permit no.: 0 .., / , y / C' •
• „' I � '' City of Tigard ECE��ED , pp
R Pro'ect/a 1. no.: Expire date:
City of Tigard Address: 13125 SW H. : r+ ... d, OR 97223 Date issued: 13
Phone: (503) 639 -417 1 ' u i Y Reedy . no.:
Fax: (503) 598 -1960 / 6 SU Case file no.: Payment type:
MENT
Land use approva ' . . t , , , %ITI
DEVELO
TYPE OF PERi11IT
CI 1 & 2 family dwelling or accessory IPC ,mmerciallindustrial 0 Multi - family ❑ Tenant impro'• :ment
❑ New construction 0 Addition/alteration /replacement CI Other: U Partial
JOB SITE INFURIATION _ I
Job address: / SW 1 4 q / i�, RA, r' Bldg. no.: Suite no.: Tax map /tax lot/account no.
Lot: Block: co,C
ubdivision:
Project name: r,l d.E' A eri ' I Description and location of work on premises:. l; :C77/
Estimated date of completion/inspection: •
CONTRACTOR APPLICATION FEE SCHEDULE I •
Job no: ADT ►�+ Q Fee Max
Ph 1
Business name: i! Security SCIV1l:C5 Description Qty. (ea) Total no. Insp
• Address: 2515 J.W. 13 Dr. dwelling residential -single or malli-family per
dwelling writ. Includes attached garage.
City: Be verton, ORa ' 70(6: Service included:
Phone:./ j,pQ- 72C/i./ 'Fax-m E -mail: 1000 sq. ft. or less - 4
r Each additional 500 sq. ft. or portion thereof •
CCB no.: 5jg4 4I I Elec. bus. tic. no: 49 (L/ •
7 Limited e nergy, residential 2
City /metro Ii . no.: Limited energy, non- residential 2
•
//‘/0/ Each manufactured home or modular dwelling
Signature of supervising ele • ician (re uired) Date / Service and/or feeder 2 •
elect name (print): Servicesorfeeders— installation,
Sup. (P ) (✓ L License alteration or relocation:
200 amps or less • 2
Name (print): 201 amps to 400 amps _ 2
Mailing address: ' 401 amps to 600 amps • • 2
601 amps to 1000 amps 2
City: ( State: I ZIP: Over 1000 amps or volts , . 2
Phone: I Fax: E -mail: Reconnectcinly : - 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 installation, alteration, orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or les 2
• 201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am s 2
--1 Branch circuits - new, alteration,
N iTte' ._ ._ . ____.._... _ _____ .__ __ _/fir exrpnefnn por ranP1_ . _____ _. _ _ ._._ .._ __ ..__. _
A. fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E-mail: of service or feeder fee, first branch circuit: 2 .
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps - commercial 0 Health -care facility Each pump or irrigation circle • 2
O Service over 320 amps - rating of 1&2 O Hazardous location _ Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
OSystemovereoo volts nominal more residential units in one structure alteration, or extension' 1 _ 2
O Building over three stories 0Feeders,400ampsormore *Description:
O Occupant load over 99 persons O Manufactured structures or RV park Each additional Inspection over the allowable in any of the alp ve:
O Egress/lightingplan . 0 Other: Per inspection I I I I
Submit _ sets of plans with any of the above. . Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more infonuation. Notice: This permit application Permit fee $:1)
o Visa Cl MasterCard expires if a permit is not obtained Plan review (at _ %) $ _. .
Credit card number: / / within 180 days after it has been State surcharge (8 %) $ _,�
Expires accepted as complete. TOTAL $ _.
■ Name of cardholder as shown on credit card
$ •
Cardholder signature Amount 10-4615 (6DD0/COM)
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hcr.,ur Inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP
Date Requested p /d _.36 AM PM BLD
Location , / 99 Suite MEC
Contact Person Ph Zit; V 70 7 PLM
•
Contractor Ph SWR
BUILDING Tenant/Owner A ELC
Retaining Wall G' Do Z
9 ELR � �
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm CC-711
Susp'd Ceiling
Roof c
Misc:
Final
PASS PART FAIL �/
PLUMBING �nSte(4) 7 p/e
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
ELECTRICAL
•
Service
Rough In
UG /Slab
Low Voltage
Fi - • larm
F'- '
f : PART FAIL
S E
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 /(372 U/ Inspector b Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.