Permit 7 T, •
I f , CITY OF T I G A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
` ML A DEVELOPMENT SERVICES PERMIT #: ELR2002 -00080
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/6/02
SITE ADDRESS: 09735 SW SHADY LN PARCEL: 1S135BD-00300
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of access control at main door entry.
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:
TOTAL # OF SYSTEMS:
Owner: Contractor:
HAZEL INTERNATIONAL, INC AND ALLIED SECURITY
HIGASHIYAMA HIGHLANDS CO, LTD 935 SE ANKANY
BY NORRIS + STEVENS REALTORS PORTLAND, OR 97214
PORTLAND, OR 97204
Phone: Phone: 503 - 231 -9550
Reg #: ELE 26- 243CLE
LIC 64465
SUP 556JLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 5/6/02 $75.00 2720020000 Elect'I Final
5PCT CTR 5/6/02 $6.00 2720020000
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 (7),
� 76A) Permittee Signature gh
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: (in a DATE:
LICENSE NO: �J"L
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
•
07/16/01 MON 09:48 FAX 503 598 1960 .ITY OF TIGARD el002
.
;S
v KectricalPermit 1 i cation
Date received: S(p/, le Permit no. 1 5, 9- -Q,)8
: y ;14 Ci of Tigard ly f T Prajocdappl, no.: Expire date:
Address: 13125 SW Hall BB g 1 21 2x2.3. -
City ojTigard Phone: (503) 639 -4171 s Date issued: By Receiptno.:
Fax: (503) 598 -1960 APR �n 0 ? Case file no.: Payment type:
2q •
Land use approval: _
II TYPE OF PERMIT .
I
0.1 & 2 family dwelling or accessory Commt acial/industrial 0 Multi - family ❑ Tenant improvement
O New construction 0 Additicri/alteration/replacement 0 Other. ❑ Partial
III JOB SITE INFORMATION
Job address: 7, < c . ( , t . ) (< $ Y Avis Bldg. no.: Suite no.: Tax map /tax lot/account no.:.
Lot:, 1 B l xk: Subdivision:
Project name: _ Description and location of work on premises: .. -4,. ' ' 6 , , , -
Estimated date of completion/inspection: n1 I . ',, '
Cl NTRACTORAPPLICATIOI ■.' FEE SCHEDULE
Job no: Fee max
Business name: MI , . - de Description Qty. (ea.) Total no. Imp
New residential - single or multi -fam0y per
Address: ::),5 - A+3 ,___,Ii dwellingunit. lnclades'attadted garage.
city: Po r V\ Pn j( -' 61,( ZIP: q") , I LI Service include&
Phone:-SO 152304111131 E -mail: 1000 sq. ft or less • 4
CCB no.: (p /C Elec. bus. lic. no: 6,000 e/(Q3Lp Eaehae fdtdoaal500aq.ftorportionthereof
Limited energy, residential 2
Cl /m [� — L
ty li no. .� / . Limited energy, non- residential 2
. / ,, 7 ( 21/62 Each manufactured home or modular dwelling
ii' r'is , electrician (re.uiired) pate Service and/or feeder 2
Sup. elect , ante (print): V. r Lic ease 00: a i r . —
Services or feeders - inslallattatt,
alteration or relocation:
PROPERTY OWNER 200' amps or less 2
Name (print): Nc V p,e ' f rn - 1— C 0 N.) Ler-i" 201 amps to 400 amps _ 2
401. amps to 600 amps ' 2 •
Mailing address: Of ° S ts: c A Jt 601 amps to 1000 amps 2
City: - it r.,n„ -cdk State: n ZIP: q--iaa-z, Over 1000 amps or volts 2
Phone: 1 Fax: E -mail: Reconnect only 1 -
Owner installation: The installation is being made on iroperty I own Temporary services or feeders- •-
which is not intended for sale, lease, rent, or exchangt: according to hatalladon , alteration, orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Da'- : 40i to 600 amps 2
1 ENGINEER Branch•cfrealls- new, alteration, •
or extension per peel: .
Name: I A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: • (State• • 121p B. Fee for branch circuits withoutpurchase
Phone Fax' E -mail ofaerviceor feeder fee, IIrst branch circuit: 2
a , , Each additional branch circuit:
PLAN R apply) Misc. (Service orfeeder,wtlnc!uded):
O Service over 225amps•.ommerolal O Realth- erefacility Each pump or irrigation circle 2
❑ Service over 320 amps-rating of l&2 0 Hazardeuslacatioi, Each sign or outline lighting 2
family dwellings ❑ Building over 10100 square feet four or Signal drealt(a) or a limited energy panel.
•O System ovcr600 volts nominal more residential eats In ono amebae alteration, or extensions • % 7,* 2
Cl Building over three Merles 0 Feeders. 400 amps or more •Deacdption:
O Occupant load over 99 lretsona CI Manufactured afro :lute or RV path Each additional Inspection over the allowable to any of the above: •
Q Egress/lightingplan CI Other: • Perinspection I - I I - I
Submit _sets of plans with any of the . thous. . • Investigation fee -
. Tice above are lr of applicable to temporary constr action service. Other
N t all jurisdictions accept crclit cards, please call jurisdiction lot more hdo.madon. Notice: This permit'application
Permit fee • $ 75 u
Visa Q MasterCard expires if a permit is not obtained Plan review (at r - %) $ � ' o a
[ Cl( 1 IiU eslit,card mbs 0 a,' 7 . • ` 5 [) , within 180 days after it has been ) .... $
t 1' Vllif ei "'"� accepted as complete, TOTAL State surcharge (8%) $ 71 0 00
of eardho �{ i '` O f q .tip • e_.. 1. / s al it,4 /4 /` S Il . .
Cardhat -• ,,. tem Amount 440 -4615 (6/OO/COM)
•
i
ZOO( j ANaMNV URI'TIV TSS6 TCZ £0S XVd Z1» :CT Z0 /6Z /t'0
CITY OF TIGARD 24 -Hour -.
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested — 7 AM PM BUP
Location • -- ,■•• wt= % v MEC
Contact Person �. . / Ph ( ) . 7 ` � PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC 8 0
Ftg Drain ` � / ELRa/ 7 c — C.0024
Crawl Drain ✓ h - �
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors r('
Ext Sheath/Shear `
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall \ �{ , b a f ,
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
UG /Slab
arm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
' PART FAIL
SITE El Please call for reinspection RE: • Unable to inspect – no access
Fire Supply Line
ADA
D
Approach/Sidewalk a 0 ---2--- Inspecto a Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL