Permit vt
CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
*alp DEVELOPMENT SERVICES PERMIT #: ELR2001 -00011
� � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 01/17/2001
SITE ADDRESS: 12394 SW SCHOLLS FERRY RD PARCEL: 1S134BC-00900
SUBDIVISION: PP1993 -058 ZONING: C -G
BLOCK: LOT: 003 JURISDICTION: TIG
Project Description: Install 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:
THOMPSON, DENNIS C AND ADT SECURITY SERVICES, INC
DAVIDSON, WILLIAM G 2815 SW 153RD DR
12475 SW MAIN ST BEAVERTON, OR 97006
TIGARD, OR 97223
Phone: Phone: 503469 -7100
Reg #: LIC 0059944
ELE 26- 209CLE
FEES Required Inspections
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 01/17/2001 $75.00 2720010000 Wall Cover
Elect'l Final
5PCT CTR 01/17/2001 $6.00 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 �
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
. . ., w
41
Electrical Permit Applicat •
E Datereceived: Permit no: ,, a - be/
1.I f City of Tigard RE E ProjecUappl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 , ,nQ; Date issued: By: Receipt no.:
°�
Phone: (503) 639 -4171 AM i
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: CO""Nlii pEVc�Ol tu�t��
TYPE OF PERMIT
ii■
0 1 & 2 family dwelling or accessory ' ommercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction Y Addition/alteration /replacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: / qI ` J r; / FP rr t, y p4 Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision: (f
Project name: Q x\S ,1. 14, I Description and location of work on premises: tou W
Estimated date of completion/inspection:
_... _ . — - ,,. C fIi`I'T CA'OR-A-P1'11 'IOIS- --.-'--- ,.-- -- - - - ---- - -FEE SCHEDU;E -....� — -
Job no: 0�)5.- bly L Fee Max
Business name: A�1 ur acrvIces Description Qty. (ea.) Total no. insp
Address: 2815 S.W. 153 Dr. New residential - single or multi- family per
dwelling unit. Includes attached garage.
City: Reav r Dlt$t97o()q ZIP: Service included:
Phone:141,q- -- 7 1 I Fax: - u Q I E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.:°SG�( Elec. bus. lic. no: Limited energy, residential 2
Cit /metro lic no.: (1 — L� Limited energy, non - residential 2
A � I i I I /' v 4 Each manufactured home or modular dwelling
t gn ure of su rv ismg electrician (required) Qd a t e Service and/or feeder 2
Sup. elect. name (print): , 1, A , ,..._ License n.: oy Services or feeders - installation,
alteration or relocation:
- -- PROPERTY OWNER • - 200 amps or less 2
r-.1.71.74 us , f x ,p l O � u �� 201 amps to 400 amps 2
1t( 401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone5CIp Fax: I E -mail: Reconnect 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 installation, alteration, orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: 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
of service or feeder fee, first branch circuit: 2
Phone: Fax: E-mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc .(Serviceorfeedernotincluded):
❑ Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps - rating of l &2 ❑ Hazardous location Each signor outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* \ _
2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable In any of the above:
0 Egress/lightingplan ❑ Other. Per inspection
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other ob
Not all jurisdictions accept credit cards, please call jurisdiction for more informat Notice: This permit application Permit fee $ -15.
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ q �
Credit card number: / / within 180 days after it has been State surcharge (8 %) $ U' t DO
• Expires accepted as complete. TOTAL $ 81 ■ a O
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6/00 /COM)
..
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
/� Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
•
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manuf d Home or Modular ❑ Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less $80.30 2 ❑
201 amps to 400 amps $106.85 2 Vacuum Systems
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation
200 amps or less $66.85 2 Fee for each system $75.00
201 amps to 400 amps $100.30 2 (SEE OAR 918 - 260 -260)
401 amps to 600 amps $133.75 2 .
Over 600 amps to 1000 volts, Check Type of Work Involved: p
see "b" above. ❑
Audio and Stereo Systems
Branch Circuits
New, alteration or extension per panel
a) The fee for branch circuits Boiler Controls
with purchase of service or
feeder fee. ❑ Clock Systems
Each branch circuit $6.65 2
b) The fee for branch circuits ❑ Data Telecommunication Installation
without purchase of service
or feeder fee. ❑ Fire Alarm Installation
First branch circuit . $46.85
Each additional branch circuit $6.65 ❑
HVAC
Miscellaneous
(Service or feeder not included) ❑ Instrumentation
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 n Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00
Minor Labels (10) $125.00 ❑ Landscape Irrigation Control*
Each additional inspection over ❑ Medical
the allowable in any of the above
Per inspection $62.50 ❑
Per hour $62.50 Nurse Calls
In Plant $73.75
Outdoor Landscape Lighting
Fees:
❑ Protective Signaling
Enter total of above fees $
n Other
8% State Surcharge $
Number of Systems
25% Plan Review Fee
See "Plan Review" section on $
front of application. * No licenses are required. Licenses are required for all other installations
Total Balance Due $ Fees: •
C3 Trust Account # Enter total of above fees $
8% State Surcharge $
Total Balance Due $
i:\dsts \forms \elc- fees.doc 10/09/00
Q'TY TIGARD BUILDING INSPECTION DIVISION MST �' M
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested c2 - ) AM PM BLD
Location / 37 / .s X90 /6 /V Suite MEC
Contact Person Ph 5' Q 77t PLM
Contractor Aar Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR a7D 9 / - G U o I 1
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
Susp'd Ceiling
Roof
Final 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
'ELECTRIC
ervi
Rough In
UG /Slab
Low Voltage
Fire Alarm
A T FAIL
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 Date /-5 4 Inspector I ector EXt
Other p
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.