Permit r
1 ��1' � D ELECTRICAL PERMIT -
CITY OF TI GA RESTRICTED ENERGY
, ik DEVELOPMENT SERVICES PERMIT #: ELR2003 -00369
��IJa 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/8/03
SITE ADDRESS: 09780 SW SHADY LN PARCEL: 1S135BD -01100
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Install /upgrade alarm 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: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
LEWIS, GLORIA M + AMERICAN SECURITY ALARMS
LEWIS, GLORIA M TRUSTEE + 5411 SE MCLOUGHLIN BLVD
LEWIS, ANDREW M ET AL PORTLAND, OR 97202 -4898
PORTLAND, OR 97225
Phone: 503- 244 -1682 Phone: 231 -0303
Reg #: MET 00002798
LIC 58640
ELE 26- 283CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 12/8/03 $75.00 Elect'I Final
[TAX] 8% State 12/8/03 $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 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 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699.
Issued by •b - / i � ` Permittee Signature elk afp.A.
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
- - -- -- - .,,. -- teiuuz
„
ElectricalPermitApplic Il OFFICE USE ONLY
'I'1 City of Tigard , ` Date received; , , / Permit no.: s _ , o ,5 -b?3 (,'
,ti .� 02wirim Expire date:
ay of n7gard Address: 13125 SW Hall Blvd, Tigprrdr.OR 9,7
Phone: (503) 6394171 lift" `� -03 Date � i
Receipt no.: '
Fax: (503) 598 -1960 Case file no.: Payment type:
• Land use approval: CITY OF TIG
isuILDIWC Dl � . •
T1'1'E OF I'LIt111
0 I & 2 family dwelling or accessory 0 Commercial/industrial 0Multi- family 0 Tenant improvement
0 New construction ' Addidon/alteration/replacement 0 Other: 0 Partial
JOB SIT F, INFORMATION
Job address: "' 1 ��
SW �l t), 1(1e . Bldg. no.: Suite no,: Tax map /tax lot/account no.:
Lot: Block: 1 Subdivision:
Project name: •' At , : A - Description and location of work on 'remises: ;d, `,,,, ej , , ; ,
Estimated date of completion/inspection: 1. i� ' —
� N. r; i � �1(� C • g �
(:ONTRACTOR APPLICATION FI ?E SCHEDULE
Job no:
Fan Man
Business name: pmPrit�s ;n SPnurity Alarms ln� _ Description Qty. (ea.) Total • an. ix?
Address: 5411 SF. Mr'T,n t ltn lar _ New residential- Aide - family per
dwellinputit .laeladasattachedgarase.
City: Portland IStateOR ZIP: 97209 sereiceitacluded:
Phone50 23 03031Fax: 1 044E-mail; woo c.. ft. orless 4
CCB no.: 58640 Flee. bus. lie. no: 2(- 2 Each additional 500 sq. R. or portion thereof
Limited energy, residential 2
Ciry /tnetro o.: 279 ; 4 Limited en. : , non-residentioi
° 2
4.-1 l 'C Each manufactured home or modular dwelling
Signer of s wising olootnclm (mquirod) Date Service and/or feeder 2
Sap. c case (print): Ja e D Lis on License n°' Services or feeders- Installation,
PROI•1'it'1"1' OWN1:lt alterationorretocatioos
200 amps or leas 2
Name (print): f'S t s ._A ( 201 amps to 400 amps 2
Mailing address: iron . • .. to 600 ..a 2
601 am.a to 1000 amps
City: ar State: • 4 1 ZIP: aver 1000 amps or volts 2
2
Phone:,z3 k i • I bjs, ax: E -mail: Reconnect only i
Owner installation: The installation is being made on property I own Tempel-sty services nr feeders -
which is not intended for sale, lease, rent, or exchange according to iaslallation ,alleradoo,orrelocatlons
ORS 447, 455, 479, 670, 701. 200 amps or less 2
Owner's sip gum Date: 201 amps l0 400 amps 2
401 to 600 a 2
I.N (:1 NE F R Branch circuits -new, alteration,
Name or es tension per panel:
A. Fee for breach circuits with purchase of
Address: service or fader fec, each bunch 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 ItEVIE% (Please cltevk all 1la:ai :apply) Marc . (Service orfeedernottncluded):
a Service over 22$ nmps.commercial 0 Health -care fliciliry Each pump or irrigation 'circle 2
0 Service over 320 amps - rating of ldt2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signet cirvuit(s) or a limited energy panel,
0 Sweat over 600 volts nominal more residential unite in one urieaure alteration, or extension' ' 75 _ 75." 2
0 Building over three smiles 0 Feeders, 400 amps or mom
Description: •
O Occupant lend over 99 persons Manufactured structures or RV park
0 Egte6iiighdng plan 0 Other: ns p aepeetioa over the aUowablola any o f the above:
- Per inspection n'pection eetlon I I T
Submit sets of plans with any of the above. Imestigotion fee
The above are nut applicable to temporary construction service. Other
NOT all Jurisdiction. accept credit lards a's ple call rusiWktloe fit more Insunastioe. Notice; This permit application Permit fee $ '75 • 00
0 Visa 0 Mastercard expires if a permit is not obtained Plan review (at _ %) 5
Credit card number: / / within 180 days oiler it has been State surcharge (5%) S
Excites accepted as complete. TOTAL S . 00
Name or cardholder u 'hewn On credit card
S
Cardholder i agn
lgna Amount •
• 4404615 (6 /00 /COA3
I 'd 0890' °N 'ONI 1 SW8V1V A1! fl3 S NV3ld31 WdQZ :q COOZ 'C '380
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Busine s Line: (503) 639 -4171 MST
_ BUP
Received 3 - � � P Date Requested AM PM BUP
Location 9 7 V D .7 &_d,v �_ Suite MEC
Contact Person i- 4.11_ a i- ' ` Ph ( SL P4) — 23 / — 0 0 PLM
Contractor .n.(6 _ Ph (.5 24A SWR
BUILDING Tenant/Owner — . . cc_ '] 4,4-i , Q G/ 6' ,. ELC
Footing i
Foundation ELC
Ftg Drain Access: ELR 22-0?) -- 67) 3 t 7 ` Q
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing ` if - a 47/ / °,,e- /va t' j! %,,O -
Insulation •
Drywall Nailing ,
Fi rewal I
Fire Sprinkler i� - - '" .i - -
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
Low Voltage /
FF �� - � L arm
41114011
RT FAIL El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line A
ADA Approach/Sidewalk Date - Inspector /" - L - t------ E xt
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL