Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT #: ELR1999 -00237
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/08/1999
SITE ADDRESS: 15575 SW SEQUOIA PKWY PARCEL: 2S112DD -01600
SUBDIVISION: ZONING: I -P
• BLOCK: LOT: JURISDICTION: TIG
Project Description: Install protective signaling.
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:
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 ORIGI I\14L
Reg #: LIC 005994
g ELE 26209CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT KJP 10/08/199E $60.00 99- 318950 Elect'I Final
5PCT KJP 10/08/199E $4.80 99- 318950
Total $64.80
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 YYla
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 -- )'I /4 DATE: (O/e/99
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
. • d
CITY OF TIGARD STRICTED ENERGY ELECTRICAL APPLICATION Rec'd by: le, 13125 SW HALL BLVD RECEIVES pp 22 Date Rec'd: / 0/7I f f
TIG, RD dR 97223 PRINT OR TYPE OOJ- 17 r O /
V - 503- 639 -4171 X3040CT 0 7 1999 tp/ f Permit #: GM- tf i -�,
F - 503 - 598 -1960 INCOMPLETE OR ILLEGIBLE A P P L TION Cust.Call'd:
COMMUNITY DEVELOPMENT WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
• Restricted Energy Fee $60.00
I('' (FOR ALL SYSTEMS)
JOB Street Address Ste #
ADDRESS J557 S 4) 5 eetvQi,q PKw Check Type of Work Involved:
Ci tate Zi P hone # ❑ Audio and Stereo Systems
o a Ti� 3 707,01,/ p —go
Name ❑ Burglar Alarm
4,12 To itof egLUL,4L. ❑
OWNER M s Garage Door Opener'
C / State E Zip Phone # ❑ Heating, Ventilation and Air Conditioning System*
Name El Vacuum Systems*
ADT SECURITY SERVICES, INC. ❑ Other
28 S.W 153rd DR.
CONTRACTOR Mailing Ad N, dress – , OR 97006
503) TYPE OF WORK INVOLVED - COMMERCIAL ONLY
(Prior to issuance a City/State Zp Phone # Fee for each system $60.00
copy of all licenses (SEE OAR 918 - 260 -260)
are required if Oreg9n ))r.frd Lic. # ytati •
•
expired in C.O.T. J `f Check Type of Work Involved:
data base). Elec I Contr ic. # E
aQ / ❑ Audio and Stereo Systems
C.O.T. or Metro Lic. # Ex Date
❑ Boiler Controls
Owner's Name
❑ Clock Systems .
OWNER - Mailing Address
APPLICANT ❑ Data Telecommunication Installation
City /State Zip Phone # ❑ Fire Alarm Installation
This permit is issued under OAE 918 - 320 -370. This applicant agrees to
make only restricted energy installations (100 volt amps or less) under this ❑ HVAC
permit and to do the following:
❑ Instrumentation
1. Only use electrical licensed persons to do installations where required.
Certain residential and other transactions are exempt from licensing. ❑ • Intercom and Paging Systems
These have asterisks( *). All others need licensing;
❑ Landscape Irrigation Control*
2. Call for inspections when installation under this permit are ready for
inspection at 503 - 6394175; ❑ Medical
3. Purchase separate permits for all installations that are not ready for an ❑ Nurse Calls
inspection when the inspector is out to inspect under this permit;
4. Assume responsibility for assuring that all corrections required by the ❑ Outdoor Landscape Lighting'
inspector are done, and;
Protective Signaling
5. Assume responsibility for calling for a final inspection when all of the
corrections are completed. ❑ Other
Permits are non - transferable and non - refundable and expire if work is not
started within 180 days of issuance or if work is suspended for 180 days. Number of Systems
The person signing for this permit must be the applicant or a person • No licenses are required. Licenses are required for all other installations
auth 'zed to •nd the a plicant.
t 677 FEES:
Si ature ENTER FQQQ
E S $
I�CdRGE (.05 X TOTAL ABOVE) $ O � t/ 1
_q_._&
Authority if other than Applicant TOTAL $ / •
is \dsts \forms\resele.doc 3/98
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
/ ,l BUP
Date Requested /c `!.C/ AM PM BLD
Location / S /F-) Suite � MEC
Contact Person As 1L/A. L / . i Ar Ph PLM
Contractor i Pt' 6 74 I ( SWR
BUILDING Tenant/Owner ELC
• Retaining Wall ELR ( 99 ()Qc� 37
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 - - - A - - =
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
PASS PART FAIL
ELECTRICAL
Service
Rough In
;:a
Fir- Arta)
• S 'ART FAIL
ITE
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 D
Other Date ?7 Inspector ,cam Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
02/17/2000 Activities for Case #: ELR1999 -00237
3:36:55 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRC001 Application Received 10/08/1999 KJP RECD No Hold KJP 10/08/1999
ELRC003 Permit Created 10/08/1999 KJP DONE No Hold KJP 10/08/1999
ELRC725 Low Voltage Inspection 10/08/1999 KJP No Hold KJP 10/08/1999
ELRC799 Elect'I Final 10/08/1999 10/08/1999 BP PASS No Hold JMT 11/10/1999
ELRC500 (F) Issue permit 10/08/1999 KJP DONE No Hold KJP 10/08/1999
ELRA800 Case finaled 11/10/1999 JMT DONE No Hold JMT 11/10/1999
•
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