Permit ELECTRICAL PERMIT -
CITY OF TIGARD RESTRICTED ENERGY
l; DEVELOPMENT H B Tigard, ) 639 -4171 DATE ISSUED: E%6/03 3 -00341
SITE ADDRESS: 07150 SW SANDBURG ST PARCEL: 2S101 DG 03900
SUBDIVISION: SALEM FREEWAY SUBDIVISION ZONING: C -P
BLOCK: LOT: 004 JURISDICTION: TIG
Project Description: Low voltage for burglar alarm.
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:
PROGRESSIVE CASUALTY ADT SECURITY SERVICES, INC
INSURANCE COMPANY 2815 SW 153RD DR
6300 WILSON MILLS RD BEAVERTON, OR 97006
MAYFIELD VILLAGE, OH 44143
Phone: Phone: 503 469 - 7244
Reg #: L1C 59944
ELE 26- 209CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 11/6/03 $75.00 Elect'I Final
[TAX] 8% State 11/6/03 $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. ' J /
Issued by AVe A��� ,� f/`i Permittee Signature , e
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
11/06/2003 08:00 FAX 5034697110 ADT SECURITY • 1jj001
. '4 'p89 /7� &
Electrical P ' •
e rlYllt r l I , ,1 ►:,1
r _ I�Anite>,�
Decroceivod, /l 4, 0. Pernik ./O - -D/3 /
' . ', I:' I! City of Tigard E ® ProjecwappL no. Expire date
Ciryof7igard Address: 13125 SW Ball Blvd, :rl
Phone: (5p3) 639 171 Date issued: M Receiptno.:
Pax: (503) 598 -1960 NOV b 2003 Case file no.: Payment type:
Land use approval: CITY or TIGARD
T'i I-L Ca' PEliul
A & 2 family dwelling or accessory TA Commercial/industrial 0 Multi- family 0 Tenant improvement
ew construction 0 Addition/alteration/replacement O Other O Partial
Job address:7 /5 5 A0/5/..042:4. r - Bldg. no.: . Suite no.: Tax map/tax lot/account no.: -
Lot: l Block: Subdivision: .
Project name:120a2G ya //h/? IDescription and location of work on premises: j /240 1
Estimated date of coin • letion/ napection: �' 11
CONTRA( FOR ,\l' PIA (Al ION FEE SCIIl=n1
Job no: Fee . Mu
'Business name: A n- Accori f it 1 donO° Qty- .(e 'natal moans,
Address: 1 • '"' Tknresldmtmt-a eorewtfl•Gmfb Pcr
City: Eteivyt riho State: Olk ZIP: S Wrlataaltadredearage
�aQO sdtialo�rdad -
Phone 6 1 • 1 Fax • 0.7 email: . moo sq. ft. or less 4
CCB no.: s i,74 Elec. bus. lic. no: z6.2:0? e LE — E id°n't Sop sq. R. or portion thereof
tlmited energy
residential 2 •
City/me lie. no.: {
/ n
/ / Limited malty, non-residential . 2
& ? j . penh fucturedhomeor modular dwelllog'
Signs of supery g electrician (required) Date / $ervlco ond/orfeeder • 2
Sup. elect mune(print: r KRA License no: LEA38 Services or feeders— testallatlon,.
alteration orteloabicre
200 slaps or less t 2
Name (print Ad/l�/r (i'� km iV Au LL 201 amps to 400 amps 2
• Mailing address: . 1 40l tomato 600 rasps • 2
' 601 amps to 1000 amps • 2 -
City' . I State: I ZIP: ovalo00 orvolr: '
2
Phone: 470 - ax: 113-ail: Recoaneaenly I
Owne installation: The installation is being made on property I own ! 'Ilempotrrry .• • w
which is not intended for sale, lease, rent, or exchange according to installation, alteration, or reloarion_ •
ORS 447, 455, 479, 670, 701. 200 amps or leas 2
201 amps to 400 amps 2
Owner's signature: Date: - 401 to 600 . , • s 2
ENGIjNF.I' 17 Bra/tch'tirmitt- eew,alleration, •
Name: or extension per puce:
- - A. Pee for branch circuits with purchase of
Address: service or feeder flee, each branch circuit 2
City: Stale: ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E-mail; of service or feeder fee, first brand► drool r: 2
Eeeh add;Gonet blanch circuit:
1'l,AN 1UI VIL,' %' (!'lease OWL ;ill that apply) Mc. (Service or feeder not lnctaded): • .. - ,
ci Service over 225 a mps•oommerri al O Health -cero facility Each pump or irrigation circle - 2
Cl Service over 320 amps-rating of I &2 0 Hazardous location Each signor outline lighting_ 2 •
family dwellings Cl Building over 10,000 square feet fbur or Signal citeult(s) ore limited energy panel,
Cl System over 600 veIls nominal more residential units in oneetructure alteration, or extension• I 75 75 2
Cl Building over three stories Cl Feeders. 400 amps or more *Description:
Cl Occupant load over 99 persons 0 Manufactured struemtee or 1W part[ 'lath additional inspection over the allowable In any of the above
O Bgress/lightingplan . 0 Other:
Per inspection
Submit _ sets orphans with any of the above, . lavestigetlon fee I _ I I i . • � —
The above are not apppcabie to temporary construction service. Other .
Not all jurisdictions accept credit cards, please call jurisdiction rhr mote hcfonead Notice: This permit application Permit fee $ '? .
O Visa O MasterCard expires if a permit is not obtained Plan review (at •,_ %) $
credit o. been rd number: / 1 within 180 days after it has b State surcharge (8%) ..,. $
Name of cardholder as Shown an credit cud
cr expel accepted as complete. TOTAL $ O
Cardholder nI netttre S Aepeuat
_ --�� //-q 440-4615 (6R10rCOM)
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