Permit A %. CITY OF T I GA R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
i; DEVELOPMENT SERVICES PERMIT #: ELR2001 -00123
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 04/25/2001
SITE ADDRESS: 14945 SW SEQUOIA PKWY 180 PARCEL: 2S112AD -01000
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
, BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of Burglar Alarm. Job #083 - 13396 -01
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPEIIRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: BURG. ALAR X
TOTAL # OF SYSTEMS: 1
Owner: - Contractor:
PACIFIC REALTY ASSOCIATES ADT SECURITY SERVICES, INC
15350 SW SEQUOIA PKWY #300 -WMI 2815 SW 153RD DR
PORTLAND, OR 97224 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 04/25/2001 $6.00 2720010000 Elect'l Final
PRMT CTR 04/25/2001 $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 Permittee Signature 44 �� i _ ! 1 ,�, ' #� - " -
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: _tra_a
_ �'Yl/LLt DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
04/23/2001 15:40 FAX 503 469 7110 ADT SECURITY I121001
. w
Electrical Permit Application
• Datereccived: all m Permit no.: ' •0
/L
City of Tigard •
4 Project/appl.no.: Expire date:
City ofl7gard Address: 13125 SW Hail Blvd, Tigard, OR 97 �Q E• ; , „� �. By Receipt no.:
Phone: (503) 639 -4171 �r il=r
Fax: (503) 598 -1960 • e no.: Payment type:
Land use approval:
II PE OF PERMIT
❑ 1 & 2 family dwelling or accessory omxnercial/industrial O Muni- family 0 Tenant improvement
❑ New construction 0 Addition/alteration/replacement 0 Other. 0 Partial.
JOB SITE INFORMATION
Job address: ,11, f' , J Bldg. no.: Suite no.: : Q Tax map/lax lot/account no.:
Lot: Block Su • • vision: /
Ptoject name: - / .':•rrall Description and location of work on premises: , t. A d 4 : . i
Estimated date of completion/inspection: L,
CONTRACTOR APPLICATION ELL SCHEDULE '
Job no: 117 — , i . Fee Max
� f C (aliht SGrv Description (m.) Total no, hasp
Business name: Qty. ( )
To
Address: 2K15 S.W. f53� 131x. Ncwtesidential- smgleormulti•familyper
dwelling unit. Includes attached garage.
City; Beaverton, C) ' 70OP: Service Included•
Phone:1J p9 - 3 ZJLi Ftur.f/1€4 - 1-lln I E -mail: 1000 sq. ft or less 4
CCB no.: v vie/ I Elec. bus. lie. no: 0� �(t T °°Dy aq ft_ rportion thereof Limited
/i• etro lie. no.: 2
City/•• ty Limited energy, 2
/ 4 • , , Sash manufactured home or modular dwelling
■ S' 1'':t re o' Dervisin e' • clan -) D ata Service and/or feeder - 2
Sup. elect. name (print): w - A L. U Lic ens e no • 1 - d Services erfeeders installation,
' alteration or relocation:
PROPERTY O11'NCR - 200 naps or less 2
Name (print): 201 amps to 400 amps 2
Mailing address: 401 amps to boll amps 2
601 amps to 1000 amps 2 .
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: '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 l
ORS 447, 455.479, 670, 701. s 2
201 amps to 4000 amps 2
Owner's signature: Date: . 401 to 600 am • s 2
ENGINLER Brandidreuits -hew, alteration, •
or extension per panek
Name: A. Fee for branch ciauits with purchase of
Address: Service or feeder fee, cach•branch circuit 2
City: I State: E ZIP: B. Fee for branch circuit s without purchase
Phone: Pax: $.ma of service or feeder fee, first branch circuit: 2 .
• Each additional branch eircuie
PLAN REVIEW (Please cheer: all lira :tpply) MD= (Service or feeder not Included): •
O Scribe over 225 amps - commercial O Health catefacility Bach Pump or irrigation circle • 2
Cl Service over 320 amps -rating of 18z2 0 Hazardous location Each sign or outline lighting 2
. family dwellings 0 Building over 10,000 square feet four or Signal circuit(a) ore limited energy panel.
0 System over 600 volts nominal more residential units in one structure alteration, or extension I "' '13 a
O Building over three stories 0 Feeders, 400 amps or more •Drzeription:
O Occupant load over 99 persons 0 Manufactured =coma or RV park Each additional Inspection aver the allowable In any of the above
O EgresrJlighting plan 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
Permit fee $ "+ j q)
Na an Jurisaiwms accept aedlt cards, please call jtmsdiaion for room mrormlike. Notice: This permit application Pl review (at _rya) $
0 visa O MasterCard expires if a permit•is not obtained
Credit card narn — _ I I within 180 days after it has been State surcharge (8%) $
■ o' accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder;ienatwe Amount 440 -4615 (6000/COM)
•
•
04/23/2001 15:42 FAX 503 469 7110 ADT SECURITY al001 /001
I oi
. i- ..N .
� ElectricalPermitApplicatio 1.,
Date received: Permit no.: •
' ' - ,,J � i I City of Tigard ` Project/appl.no.: Expire date:
ci of - Ti gar d Address: 13125 SW Hall Blvd, Tigard, OR 972 .Date issued: By: I Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
dB Case file no.: Payment type:
Land use approval: •
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory ibtOrrtnili industrial 0 Multi - family C] Tenant improvement
0 New construction 0 Addition/:+ teration/replacement 0 Other. 0 Partial
•
.1013 SITE INFORMATION
Job address: I t , au�((J ,- Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Los Block: Subdrvision: / —
Project name: !2- 7i j / fr 7 Description and location of work on premises: . 0 A i 2 ,
Estimated date of completion /inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: il -- ,�1..: a/ � IA YiIV Ice Max
Business name: t L d IGJ Description Qty. (ea.) Total no. imp
•
Address: 281 S.W. 153" Dr. New residential - single or'muh'- rimily
dwelling' unit. Ineyudcaatlaebedgaraga
City: Reeyj pn, or leas • 4
Cb e97Qq� Service (Waded:
Phone:1)1P4 - 1 Zy Li I Fax yL�V /O E -maJ1: 1000 sq. ft. �4 f (l LP.G. bus. Be. n0' Each additiona1500 sq. ft or portion thereof •
CCB no.:
5Gi y . ��e� T Limited energy, residential 2
City/ . one lie. no.: Limitedenergy.non- residential 2
/ A" / 4. Each manufactured home or modular dwelling
S'J a o'pervisin: i•eq
clan u ' .) Date Service and/or feeder 2
Sup. elect. name (print): ,,, - a ,, &. U License m
Services orfeedcts- installation,
-, ., alteration or relocation-
PROPERTY OWNER 200 amps orless - 2
Name (print): 201 amps to 400 amps 2
Mailing address: 401 amps to 600 maps 2
g 601 amps to 1000 amps 2
City: 'State: [ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E - mail: Reconnect only l
Owner installation: The installation is being made on property I own Temporal) seri cesorfeeders - alte
which is not intended for sale, lease, rent, or exchange according to °p ' rati0p ' OrrelOCstiOp°
20 amps leas 2
ORS 447, 455, 479, 670, 701.
201 1 amps to 400 amps 2
Owner's signature: Date: 401 to G00 amps 2
ENGINEER Btvach circuits - new, alteration, •
• or extension per poet •
Name: A. Fee forbrnnch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I Stec : E- ZIIP bt
: B. Peeforanchcircuitswithoutpurchase
.. Phone: Fax: �J3. of service or feeder fee, lust branch circuit
' • Bach additional branch circuit
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not iacluded): ' .
Cl Semen over 275 amps-commercial 0 Health-care facility Each pump or irrigation circle • 2
0 Service over 320 amps of 1&2 0 Haazardouslocation Each sign or outline lighting 2
. family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) ore limited energy panel,
0 S y s t e m over 600 volts nominal nrofe residential unite in one atructnrc alteration, orextendon` $ $ 2
0 Building over three stories 0 Feeders. 400 amps or mom *Description:
0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
0 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 tentpotsty construction service. Other i
Not all Jurlsdldlom accept credit cards, please call jurisdiction for more informauoa. Notice: This permit application Permit fee $
0 Visa 0 MasterCard expires if a permit•is not obtained Plan review (at — %) $
Circa! ®d mate: 1 1 within 180 days after it has been State surcharge (8 %) .... $
Expires TOTAL as complete. TOTAL S t�
Name of cardholder as shown on credit card
$
Cardholder rlensture Amount 44o4615 (6100/COM)
•