Permit CITYOFTIGARD RESTRICTED ENERGY
� DEVELOPMENT H B E ) 639 -4171 DATE ESSU 2R 0001 -00030
PARCEL: 2S 112 DA -01400
SITE ADDRESS: 15350 SW SEQUOIA PKWY 100
SUBDIVISION: PP1996 -048 ZONING: I -P
BLOCK: LOT: 002 JURISDICTION: TIG
Project Description: Installation of restricted energy system for burglar alarm. Job No. 083 - 13172 -01
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:
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: 503469 -7100
Reg #: LIC 0059944
ELE 26- 209CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
5PCT CTR 2/7/01 $6.00 2720010000 Elect'I Final
PRMT CTR 2/7/01 $75.00 2720010000
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Muniapal 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 yo to foil* rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0 -0010 throug OAR 952 - 001 -0080. You may obtain copies of these rules or direct question to OUNC at (503)
246- 87.
Issu y 041Z44144r Permittee Signature ,/f _ . /,_ .i.' / / i s ,
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
-
Ath Electrical Permit Application
Date received: R 11 O/ Permit no.: gy ,2,01.40,
uy� >� l
. i City of Tigard r v'�
V Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tig 9 7223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171 .• TA
Fax: (503) 598 -1960 0 Case file no.: Payment type:
Land use approval: C�8
\C j o)C41 14 °
TYPE OF PEIU%IIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other: 0 Partial .
JOB SITE INFORMATION - �..
Job address: b / d BB ldg. no.: Suite no.: te, Tax map /tax lot/account no.:
Lot: Block: Subdivision: r
Project namecky{ C N 41-441.3. I Description and location of work on premises: h/J.
Estimated date of completion/inspection: •
--- -- CONTRACTOR APPLICATION _ __._. _. __ ..._..... ..FEE SCHEDULE . -._: _ .-
Job no: ` . �l If �— (J Fee Max
•
Business name: �\ 1 Description Qty. (ea.) Total no. insp
Address: 2815 S.W. 1 Dr. New residential -single ormutti- familyper
dwelling unit. Includes attached garage.
City: ' R vertAn, Cb te970(1 servicehteluded
Phone — 7 Fax: -�-� ( C) I E -mail: 1000 sq. ft. or less • 4
CCB no.: Elec. bus. lic. no'.•,)��• ey3 (/ Each additional 500 sq. ft or portion thereof •
C. Limited energy, residential 2
Ci , ,44metro lic. no - Limited energy, non- residential 2
Jr` fA • A / Each manufactured home or modular dwelling
S ature of supe ising elec clan (required) Date Service and/or feeder 2
Sup. elect name (print) - a i A Licensenp 3,% Services or feeders — installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: [State: I ZIP: Over 1000 amps or volts 2
Phone: I 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, or relocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - 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 -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):
•
0 Service over 225 amps - commercial 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps - rating of 1 &2 0 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,
O System over 600 volts nominal more residential units in one structure alteration, or extension* 1 2
0 Building over three stories 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or 1W park Each additional inspection over the allowable In any of the above:
0 Egress/lighting plan 0 Other. Per inspection I I I . 1
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 audit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $ `l-!)W
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 TOTAL as complete. TOTAL $ '
Name of cardholder as shown on credit card
$ •
Cardholder signature Amount 440-4615 (6/00/COM)
J ,C.)TX OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
Y BUP
Date Requested dZ Z '0 AM PM BLD
Location / 3) 54, -S f � ("-• -o/ ("-• ,,r / l vi Suite ( MEC
Contact Person 5/✓' 6 Ph Z, 0, 72 1/4/ PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR 0i
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 - 1
Roof
Misc:
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
p SS pA T FAIL
ELECTRI
ervice
Rough In
UG /Slab
Low Voltage
Fir(Alarm]
F'• .
'PART 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
Other i Date 2 Zs Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.