Permit (�* ELECTRICAL PERMIT -
CITY TIGARD RESTRICTED ENERGY
,• 111 DEVELOPMENT SERVICES PERMIT #: ELR2004 -00064
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/15/04
SITE ADDRESS: 09802 SW SHADY LN PARCEL: 1S135BD -01200
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of security system.
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:
FORBES, DONALD CAROLYN NW SOUND AND SECURITY
BURDICK, DONALD LINDA 10300 NE MARX ST
434 RIDGEWAY RD PORTLAND, OR 97220
LAKE OSWEGO, OR 97034
Phone: Phone: 503 254 - 2811
Reg #: LIC 112538
ELE 34- 423CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 3/15/04 $75.00 Elect'I Final
[TAX] 8% State Surchart 3/15/04 $6.00
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 • • •- _ • says of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
yo s follow rules as • sted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc
A io
sued by .. j Wfb LL s 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
03/15/2004 12:08 5032542818 PAGE 01
Electrical Pern#t Application
— Date received: ` :. _ cit of Tigard E C E I V E V Projetynppl.no,: _ an* dares
CLpol�gmd Md1C55 13125 SW Hall Blvd. Tigrn OR- Dare Awed: 1' .
Phone: (503) 6394171 MAR 15 2004 � `�`'�
Pax: (503) 598-1960 PRymcnt type:
Land use approval: CITY OF TIGARD
a a OM •
I II. i.11• I'LKUii•
O 1 & 2 family dwelling or accessory gCommetaiat/indu■ trial 0 Mu1ti•faraily Q Tenant improvement
la New eoobm moon D Addition /altetat)oarepleeem•nt 0 Other. • ❑ Pitttial
.I(_)i;ril1'INJ01.1 \t \IION
Job address: i / 4 ! <. , Bldg. no.: Suite no.: Tax olapItax lot/account no,:
IMMIIIIIII Block: .;, :
' act name: , MIME Desalptioo and location of wont an .remises: .'f : ��!�,�
Estimated date of Completion!' , t ' oe: J i
CONTI? lI 1012 1PP1 • \I ION ' . 1:Ei_ s(.111_111 I I
Job not �NSI 1M1ata1 ER
Tie less theme .+ .7 . , I . i... .. !T7a+ g!�� 1_ - ,
Address: . 2, OD G. r 8t . • an : - � Kr III
fetellli�tetit .>lee»�:rp�
• , • • , . State: • ' MP: ,, ,2, Std iceitetoatedi
Phone:. _Z + ; i • ^ i } ` :r • _ .. ft. of lea : •
ii ii ci si: no.: _ . edtfidona1500 ... Rot • • • on thereof �_w
Liroirod dtsoC
entagp,nyia1 EMIMII_ 2
City/mean lie. no.: , _,,e,IB --_, A7 / p A t ierdtotl , nert.ruitkndal MIME. MI 2
_ itvr Each h�uLtCtured home aretoduler dwelling ■■�
... - dry' , - aired) Data Service and/or feeder 2
Mom mow (priep: s , • . , . ...•. t . , �; s�►+ieee - iesra g „ •
abated= �
Sup.
1'Itt!;•GIt Sob amps at less 1111111
Name (glint): 201 amps to amps 11E111111111 Ma
Mailing address:
cal ouch, to 600 •.
601 em
City: State: ZIP; p` to 1000 • • a 11.1111=11.1.1 2
ow. moo • or volts 1♦.11l♦
Phone Fax: E -mail: r•111111111111 1
Owner installation; The installation is being made on ptupetty I own 1kaiporary neevienn er defers -
which is not intended for sale, lease. rent. or exchange according to lastal61bn.slterRetta orrekmatime 1 447, 455. 479, 670, 701. 200 cos or leas 2
owners 01 Ampere 400 a , s �_�
:. - --.. Dat A 01 to ...drape
I\ G I N I h 1{ Brooch at,* • ant alterstiaa,
or "tend" Per 1511115111.11 A. Fee forbr circuits with purehan0 of
Address: stroke or feeder fee, each brattch circuit
City: State: ZIP: B. Pea for brooch eireatte without porehae
PhOtte: Pax: E-mail: et
'mimeo!' fee*, frog first bnndt drottit � 2
• • EMI otitlitionW brooch eireele w'�
1`1 12} }Ali \1` (I•Ic:�.■• ncech :Ill that :,PP1, 1 MGC. ..rri0eerfledre
eotleCBtEedr ���
O• Sertrlcettver2 25 aenpe•canabenelal to Frghh-cerefaeltity Each - . orini ti on circle 2
0 Senily 7ompa•rotinRoflR1 Dl rdmln Each Wei roroatlieli mha4
family M� 0 8Qildieg over 1010 .0bDagvmlbe:e four or MOW 4 KOilft ) oralindtMinergy good,
O Systemovar600 votisnmrtinal mate reaidentlat . Otte iteu:rpte eleeradon,oteeterryion•
O Building overdo= menu Q Feeders, d00 mares or more • t - • • • an: _ _ _
O Occupant load over 99 means G mottractertd strums= or RV ppint . a _ . . --- --
Fbeh MOWN IMptalen orer tso elfowabte 8t set of floe diem _ --
Q Egrmttlllglntegpltut U Otteet• Pr tinepaeden
Babbitt arts of ptsa.,IV1tlI say of the tebetre. Invent • elan flee
The eib•e cafe sou *lleabk to temporary mtmtrndion anima- Gahm
not rot Jevudreetam =apt mot cords.Orme eon 1 ease tar mud itramwetae, Notice: This permit. application Permit tee $ ts- •
jF(Ym O _ _ _ _ l expires if a permit is not obtained PI an tnvlcw (at _ 96) $
�.. tiTri gni within 180 clays after h hero been State stttt httfge (8%) $
accepted -- 19.1 -
•'-r r i , thrum' �, : , pted as oompielr. TOTAL S
Af./ A_ $ (I. Do
410.415 aikt3C0M)
•
7nrttA,
CITY OF TIGARD 24 -Hour - -
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received ' \ � ' Date Requested 3 1 40 ' O� AM PM BUP
Location cl . 9 )ti Sikta'S • Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner N S UBs ELC
Footing
Foundation ELC
Access:
Ftg Drain
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
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/ • 4 C.NICV1
ow Volta
\ Fire A arm
Fi 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
ASS PART FAIL
SITE E Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA kp t �
3 — 1 L 0 1 G "� 1 1 O � -
Approach/Sidewalk Date Inspector F7ct
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL