Permit CITY OF TIGARD ELECTRICAL PERMIT -
t. RESTRICTED ENERGY
L jl�il DEVELOPMENT SERVICES PERMIT #: ELR2004 -00115
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/29/04
SITE ADDRESS: 15660 SW PACIFIC HWY A -4
PARCEL: 2S110DC -02200
SUBDIVISION: WILLOW BROOK FARM ZONING: C -G
BLOCK: LOT: 011 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:
INSTRUMENTATION: OTHER: BURG ALARM X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
TIGARD, CENTER LP ADT SECURITY SERVICES, INC
9777 WILSHIRE BLVD #609 2815 SW 153RD DR
•
BEVERLY HILL, CA 90212 BEAVERTON, OR 97006
TI:C ENT ER ' Phone: 503 469 - 7244
9777 WILSHIRE BLVD. Reg #: LIC 59944
#609 ELE 26 209CLE
BEVERLY HILLS, CA 90212
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 4/29/04 $75.00 Elect'I Final
[TAX] 8% State Surchari 4/29/04 $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 throuc
Issued b Permittee Si nature
y 9 iL / � ✓
-
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
0
c
FA)Le'b .
Electrical � , ; ; , I . cation
A Date received: - d i Permit no.�
i GOD — ® �l
_. ' . . I � ! City of TigardApp ) gard; LIK� ProJect/appl.n .: Expire date':
City of Tigard
Address: 13125 SW Hall v t 97223
Phone: (503) 639- 417CITY OF TIGARD Date issued: yll Receipt no.:
Fax: (503) 598- 1960gUILDING DIVISION Case tile no.: Payment type:
Land use approval:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory TaI Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration/replacement 0 Other. 0 Partial •
.1011 SITE INFORMATION
Job address: S „ 3,V �� M Bldg. no.: Suite no.: ' ' Tax map /tax lot/account no.: -
Lot: Block: Subdivision:
Project name: i i l Description and location of work on premises: 6 A Ji / ,) `, . /4
Estimated date of com'letionfinspection: 9
CONTRACTOR APPLICATION FEE SCIIEI)LE
Job no: /fralel E. IG,5%y — 0 Pee max
Description I ea Total no. J
Address: New a6rgleoraeold family per
dw dlingtoff .Includesattadredgarage.
m r • .1111.111111.11 State: OR, ZIP: ' • 0 III ServiceincIude& •
Phone. 6 a . Wei Fax= t , g-mail: 1000 sq. ft. or less .4
CCB no.: S/14 Elec. bus. lic. no: 6.'�'C LE Each additional 500 sq. ft. or . onion thereof
City /me • lic. no.: Limited energy, reaidential 2
Limited energy, non- residential 2
1 . t _ _ rf ea : .h manufactured home or modular dwelling
Signatu of supervis g electrician (required) Date Service and/or feeder 2
Sup. elect name (print): EN) K At)S Ucensono: LEA 381 Senlcesorfeeden— installation,
PROPERTY OWNER alterationorreloation:
������� � /, U. � 200 amps or leas
Name (print): _Ail ` �� 211 am' a tb 400 amps 2
' . Mailing address: 401 amps to 600 amps 2
601 amps to 1000 amps • 2.
City: 3 — 'State: [ZIP: Over 1000 amps or volts 2
-
Phone: 6 (, f . I Fax: 1E-mail: • econnect only
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 butaBadon , alteration, orrelocadon:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600am.s 2
ENGINEER Branch clrculb - 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: I State: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E of service or feeder fee, first branch circuit: 2 •
Each additional branch circuit:
PLAN REVIEW (Please check all that appl)) Misc. ($ervlceorfeedernot included): •
O Service over 225 amps - commercial O Health -care facility Each pump or irrigation circle 2
0 Service over 320 amps - rating of 1&2 0 Hazardous location Each sign or outline lighting 2
family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over600 volts nominal more residential units in one structure alteration, or extension' I 2
0 Building over three stones 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons O Manufactured structures or RV park each additional Inspection over the allowable In any of the above:
O Egress/lighting plan 0 Other. - Per inspection
Submit sets of plans with any of the above. Investigation fee I I • I C . I
The above are not applicable to temporary construction service. Other
Not all Jurisdictions accept credit cards, please call Jurisdiction for more lnfonnadoo. Notice: This permit application Permit fee $ '7 s�
0 Visa 0 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 $ R 0
440 -4615 (6/00/COM)
Name of cardholder as shown on credit card
•
Cardholder signature S Amount �—
I
-1
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Busir •ess Line: (503) 639 - 4171 MST
BUP
Received Date Requested 3 AM P BUP
Location Suite 'tom 6 MEC
Contact Person Ph ( ) '/ 6 9- a 4 / 4 / PLM
Contractor • h ( ) SWR
BUILDING Tenant/Owner / iI !Au _' LC
Footing
Foundation ELC
Ftg Drain Access: ELR alxC) 6 D
i/c"
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear �\ V
Framing
Insulation c��Q
Drywall Nailing ' " $L T V �
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
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
PASS PART FAIL
ELECTRICAL
Service
Rough -In
U . -
•w Volta•:'
Fire Alarm
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• SITE Li Please call for reinspection RE: n Unable to inspect — no access
Fire Supply Line c� r� ( !�Q 1-1:d
�
ADA D J 1 -V Ins ector u v 1E) ' Ext
Approach/Sidewalk p
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL