Permit ELECTRICAL PERMIT -
CITY OF TIGARD
RESTRICTED ENERGY
:4A DEVELOPMENT SERVICES PERMIT #: ELR2000 -00274
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/16/2000
SITE ADDRESS: 09744 SW TIGARD ST 100 / U/9770^� / PARCEL: 2S102BA -00501
`
SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. ZONING: I -P
BLOCK: LOT: 060 JURISDICTION: TIG
Project Description: Installation of burglar alarm. z(3 N 0 • cgs. /(spy - 03
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:
SNYDER, DAROLD D SUE A ADT SECURITY SERVICES, INC
12937 WATER GAP RD 2815 SW 153RD DR -
WILLIAMS, OR 97544 BEAVERTON, OR 97006
Phone: Phone: 503469 -7100
Reg #: LIC 0059944
ELE 26- 209CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 11/16/200C $75.00 2720000000 Elect'I Final
5PCT CTR 11/16/200C $6.00 2720000000
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 thro • • OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987. /7
Issued by % Permittee Signature f r /i( — ria_25:25Z,
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
A Electrical Permit App catf on
Date received: /�� /per P ermit no.: �,Q2o04 -
4" � ¢ '� ' � y + l " City of TiQand �• 2`��'
�, ty b N Q \j t. Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171 Nt1'
Fax: (503) 598 -1960 C��NIU Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory &Commercial/industrial ❑ Multi - family 0 Tenant improvement
0 New construction 0 Addition/alteration/replacement 0 Other: 0 Partial
• JOB SITE INFORMATION •
Job address: 0 1—Li '\ Bldg. no.: Suite no.: Tax ma /tax lot/account no.:
Lot: IBlock C (Subdivisi r ' #-,#' S3 --96f— 67 99 3 S'TE /.07)
l�
Project name: 1 pi ti 14 pi (1 1,- (y\ I Description and location of work on premises: ii?)(n (- i l c (4 t a. r/
Estimated date of completion/inspection: tt.;,• rn- a.:170 rN.
CONTRACTOR APPLICATION FEE SCHEDI.LE
job no: • O - t 1.1 "O Fee Max
Business name: �q er / Description Qty. (ea.) Total no. insp
' 1 t�Pr ~" �) �� 1 G New residential - s or multi-family per
Address: Q 9-7,5 c S , ) 5 3 r--0/ V dwelling unit. Includes attached garage.
City: e 'A (j V1- I Statenk, ZIP' f [) j Serviceincluded:
Phone: .t •r �-{ -- (�i-Fax: /„ C/ :/ — ICE-mail: 1000 sq. ft. or less 4
-(- / Each additional 500 sq. ft. or portion thereof
� G, [ Elec. bus. lic. no:
CCB no.: "1 _ Limited energy, residential 2
City /metro lie. no.:�,' �1 ( Limitcdenergy,non- residential 2
' � e f/b" / /(,J,� ,,,,,o-0 Each manufactured home or modular dwelling
Signature of su rvmg electrician (required) Bate Service and/or feeder 2
Services or feeders— installation,
Sup. elect. name (print): • A ti _ License • :- a l p ' ati; 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: • I 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,orrelocation:
200 amps or less 2
20
ORS 447, 455, 479, 670, 701. 201 1 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps - 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: _ service or feeder fee, each branch circuit 2
City: 'State: ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail:
Each additional branch circuit:
Misc. (Service or feeder not included):
O Service over 225 amps - commercial 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps - rating of I &2 O Hazardous location Each signor 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* L 16' 2
O Building over three stories 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan 0 Other. Per inspection
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 credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $ -- 1, :- )
O 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 %) $ r
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
Cardholder signature Amount 440-4615 (6/00 /COM)
Electrical Permit Fees: Limited Energy Fees: .
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
•
/� Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total Ni, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems '
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy - $75.00
Each Manufd Home or Modular • III Garage Door Opener`
Dwelling Service or Feeder ' $90.90 _ 2
Services or Feeders ❑ ' Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2 1111 201 amps to 400 amps $106.85 2 Vacuum Systems
•
' 401 amps to 600 amps $160.60 2 —.
601 amps to 1000 amps $240.60 2 Other
•
Over 1000 amps or volts $454.65 2 _
Reconnect only $66.85 2
• Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration,. or r relocation
200 amps or less $66.85 2 Fee for each system $75.00
201 amps to 400 amps $100.30 2 (SEE OAR 918 - 260 -260)
•
401 amps to 600 amps . $133.75 2
Over 600 amps to 1000 volts, Check Type of Work Involved:
see "b" above.
Branch Circuits ❑ Audio and Stereo Systems
New, alteration or extension per panel 17 a) The fee for branch circuits Boiler Controls
•
with purchase of service or
feeder fee. ❑ Clock Systems
Each branch circuit $6.65 2
b) The fee for branch circuits ❑ Data Telecommunication Installation
without purchase of service
or feeder fee. ❑ Fire Alarm Installation •
First branch circuit $46.85
Each additional branch circuit $6.65 ❑
HVAC
Miscellaneous
•
(Service or feeder not included) ❑ Instrumentation
Each pump or irrigation circle $53.40
•
Each sign or outline lighting $53.40 n Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00
Minor Labels (10) $125.00 ❑ Landscape Irrigation Control
•
Each additional inspection over n Medical •
the allowable in any of the above
Per inspection $62.50 ❑ .
Per hour $62.50 Nurse Calls
In Plant $73.75 _ ., ❑
- • Outdoor Landscape Lighting
Fees:
n Protective Signaling
Enter total of above fees $
8% State Surcharge $
n Other
25% Plan Review Fee Number of Systems
See "Plan Review" section on $
front of application. * No licenses are required. Licenses are required for all other installations
Total Balance Due $ Fees:
El Trust Account # Enter total of above fees $
• 8% State Surcharge $
•
Total Balance Due $
i:\dsts \forms \elc- fees.doc 10/09/00
CITY OF TIGARD BUILDING INSPECTION .DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP '
• Date Requested / z ' 7 o AM PM BLD
Location 0 P 7 (/Lf .5 (it} 77yyver Suite /vo MEC
Contact Person / Ph 5 C• r f 3 PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR EC/ vv G/
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: n SGT
Slab f'l # SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof �l VJG( / — ■G? �Ss
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam 1
Under Slab
Top Out (A//
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
_ TRI
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Fii'fdl
SS PART FAIL
SITE
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 Date') /^ 2
Inspector 4.1• 404,, - xt
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.