Permit CITY OF TI G A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
°O�1' �:I DEVELOPMENT SERVICES PERMIT #: ELR2002 -00136
,l- =f I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/26/02
SITE ADDRESS: 09300 SW WASHINGTON SQUARE RD PARCEL: 1S126C0 -01403
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Job No. 083 - 04681 -0
Burglar /Fire 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: X OUTDOOR LANDSC LITE:
OTHER: • HVAC: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
MAY DEPT STORES COMPANY, THE ADT SECURITY SERVICES, INC
ATTN: PROPERTY TAX DEPT 2815 SW 153RD DR
611 OLIVE STREET BEAVERTON, OR 97006
ST LOUIS, MO 63101
Phone: Phone: 503 - 469 -7244
Reg #: LAC 59944
ELE 26- 209CLE
FEES Required Inspections
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 7/26/02 $75.00 2720020000 Wall Cover
Elect'I Final
5PCT CTR 7/26/02 $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 'c..€/Vyj��2�cX-- Permittee Signature __‘yf Je.e.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
4 Electrical Permit application
Datcreoeived: Permit no.:
:�1 1� r
g_. ,LI City of Tigard � � _ V 260; '�i��
_ . - Projeci/appl.no.: Ex pire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receipt
Phone: (503) 639 -4171 _
Fax: (503) 598 -1960 JUL 2 3 2002 Case filcno.: Payment type:
Land use approval: Cif 1 W' i i WIRD
If 1®Tt,(Y 1'1wO q
TYPE OF I'1RMlr
0 1 & 2 family dwelling or accessory 7111 Commercial/industrial ❑ Multi - family ❑ Tenant improvement
Cl New construction 0 Addition/alteration/replacement ❑ Other ❑ Partial •
JOB SITE INFORMATION
Job address: q300 $1.1) IA1 �tn)r, - r6u) PD. Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: • Description and location of wort on premises: Q r RE /Qµ/1/4_
Estimated date of completion /inspection: •
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: 0 81 6 V' 0 Fee ' Max
Business name: lrt
Description Qty. (ea.) Total . no. harp
Address: '�$ P 153rd New te n dtnlal- singleormulti•famlb%per
acv Begwer a� S t a te: O pt ZIP: 470o scr- atttcheagara�e, -
Pl1oae .14 omo Faxj. �•7 1<mail: 1000 sq. ft_ or less 4
CCB no.: 5'1/4,4 I Elec. bus. lic. no: 26. 1 CLE additional5 00sq.ILorportionthereof
City /metro 1 _ no - l energy, residmrial �� 2
Limited energy, non - residential _ 2
___ — Z 3 .0 Z Each maim ro m ed home or modular dwelling
Signature f su.ervising ectrician required) Date Service and/orfeeder a
Sop. elect. an= (print): mirleAus )i cenieno: 5w 39-L j Sec.lees orfeeders— installation,
PROPERTY OWNER Al
200 ampsorless 2
Name (print): 201 amps to 400 amps 2
Mailing address: - ' 401 amps to 600 amps - 2
601 amps to 1000 amps 2,
City: [State: jZIP: Over 1000 amps or volts 2
Phone: 503 &�•3 I I1:: 1 mail: Rec oattcctoni 1
Owner installation: The installation is being made on property I own Tempotary services or feeders - •
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation:
ORS 447, 455, 479, 670, 701. zoo amps or less 2
201 amps to 400 amps 2
Owners signature: • Date: — 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
Name: or extension per panel2
A Fee for branch eircuiu with purchase of
Address: service or feeder fee, each branch circuit 2
City: IState: IZIP: B. Fee for brands circuits without purchase
Phone: Fax E of service or feeder fee, first branch circuit: 2 ,
Bach additional branch circuit.-
PLAN REVIEW (Please check all that apply) Misc.(Serviee or feeder not Included):
❑ Service over 225 ampa.conunercisl CI healthcare facility Each pump or irrigation circle 2
O Service over 320 amps - rating of 1 &2 0 Hazardous location Bach signor outline lighting 2 -
family dwellings 0 Building over 10,000 square feet four or Signal cireuit(s) or a limited energy panel, w�
❑ System over 600 volts nom r
inal more residential units in alteration, or extension' I 7S r 2
O Building over three stories ❑ Feeders, 400 amps ormore *Description:
❑ Occupant load over 99 persons ❑ Mannfactnred structures or RV park Each adtitionstl
CI Egressfighting plan 0 O inspection over the allowable In any of the shoe:
Per inspection I I • I J
Submit sets orphans with any of the above. • lavestigation fee c
The above are not applicable to temporary construction service. • . Other
Not all jarisdir tirn etxxpt creme cords, please can Marcum, for unae infotmatloa Notice: This permit application Permit fcc $ ' 7C .CO
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at ` %) $
credit Card number / / within 180 days after it has been State surcharge (8%) $ • •
Name of mummer ea shown en crag card •
Expires accepted its complete. TOTAL $ R . O
Cardholder algnaurre — A mount
i 440-4615 (6/00/COM)
T LLI2I1133S „WV OTTL696CO5 %V.3 9C :9T Z001.!CZ %LO
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 118 AM PM BUP
Location g30 W - 5 2 - D' Suite MEC
Contact Person Ph ( ) 1 1 1 ( o 7 -7 3-q f PLM
Contractor L->9 , P ( • ) 6 ,a O -33/1 SWR
BUILDING Tenant/Owner C ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR AD d2- ( 36
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
/\
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
q:1\1 Fire Alarm
1/ cc
Susp'd Ceiling ( �"
Roof
Other: r- 3
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
taw Voltage
lar
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS SITE Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date 3 - - 0 Z Inspect . • Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL