Permit ELECTRICAL PERMIT
CITY OF TIGAR®
RESTRICTED ENERGY
*1049,01I - 13125 DEVELOPMENT / I Tigard, SERVICES ) 639 -4171 DATE ISSUED: 002 -00031
ED: 3/5 02
SITE ADDRESS: 09619 SW WASHINGTON SQUARE RD L -4 PARCEL: 1 S126C0 -01107
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Burglar alarm add ons.
•
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: : X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PPR WASHINGTON SQUARE LLC ADT SECURITY SERVICES, INC
P.O.BOX 21545 2815 SW 153RD DR
SEATTLE, WA 98111 BEAVERTON, OR 97006
Phone: Phone: 503- 469 -7244
Reg #: LIC 59944
•
ELE 26- 209CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 3/5/02 $75.00 2720020000 Elect'l Final
5PCT CTR 3/5/02 $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.
by / Permittee Signature �C
Issued b — � , 014-0
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: CIM(1 l 6( -j•= 2, 0 _ DATE:
LICENSE NO: 3'39
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
03/01/2002 10:50 FAX 5034697110 ADT SECURITY Z001
- i tG
,� Electrical Permit Application
„ • Datereceived: 3/. O Ti- Permit no.: , a
��DD� G ►<J!7 /
j ' ,;ji City of Tigard VE D Roject/appl.no.:
Expire date:
Add ress: 1312 S W Hall BjvB, r
City ofTigard Date issued: Bis)5Q2 f Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 - 1960 MAR 0 1 2002 Case file no. Payment type:
Land use approval: n/ oy .I1
- TYPE OF PERMIT .
❑ I & 2 family dwelling or accessory Sli Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction 0 Addition /alteration/replacement ❑ Other: ❑ Partial -
JOB SITE INFORMATION
Job address: 19 - 0 I Sit) As 6, Sy r . Bldg. no.: Suite no.: jy Tax map /tax lot/account no.:
Lot: Block: Subdiv : /
Project name: !, E LT:,..:1111M Description and location of work on premises: L. . , far — / r
Estimated date of eom 'lotion/inspection:
CONTRACTOR APPLICATION FEE SCIIEDILE '
Job no: 023- 1 2. 1 4 I -Qt
Business name: Description Fee dlsnt
Addtess:� lr Y New resldadial -�eormultt- fatnilyper
(ea.) Total no.iutsp
�S dwelling unk indudesattachedgarage
Cit y: Ete,�rtlG_Je, I stale! OR.I �:- 97004 3etviceincluded: ,
•
Phone . 1 4 41.7100 FaxS3. 4 Email: 10004 ft_ or less d
CCB n0.:� Q Elec. bus. lie. no: ��.�C' ��
Each additional 500 sq. ft or portion thereof
City/metro lie. no.:
I ' un i ted energy, residential 2
Limited energy, son rrsidendal 2
3'01 - D 2 Each manufactured home or modular dwelling
:stn
tn.re 0 upervising electrician (required) Date Service and/orfeeder 2
Sup- rlectname(prinQ: .- License te. ■ Services orfeedera- installation,
" L ' • �' alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 4ls ^ fp,G +. A d 4aok A rY D yo 201 amps to 400 amps 2
Mailing address: - 401 amps to 600 amps • 2
601 amps l0 1000 amps 2
Ci ty' I S tate: ZIP: Over moo amps or volts 2
Phone: y IS -et t- ni 0 1 Pax: E -mail: Reconnectonly 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, or relocation:
ORS 447, 455, 479, 670, 701. 200 amps or leas 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am, • 2
ENGINEER Branch circuits -new, alteration,
Name: or extension per panel:
A. Fee for branch circuits with purchase of
Address: service orfeederfee. each branch circuit 2
City: State: IZIP: B. Fes for branch circuits without purchase
Phone Fax: E of service or feeder fee, first branch circuit 2
Each additional branch circuit
Misc. (Service or (ceder not included):
O Senrioe over 225 amps- a:ammercial O Health -care facility Each pump or irrigation circle 2
❑ Service over 320 steps - rating of 1 &2 0 Hazardouslocntion Each sign outline lighting 2 -
family dwellings ❑ Building over 10,000 square feet four or Signal circuil(s) or a limited energy panel,
❑ System over600 volts nominal more residential units in one structure alteration. or extensions 1 75 75 2
0 Iuilding overthmestories ❑ Feeders, 400 amps or more
*Description:
0 Occupant load over 99 persons O Manufactured structures or RV park Each additional Inspection over the allowable In any of the above:
Cl Egress/lightingplan 0 Other
Per inspection
Submit ` sets of plans vrith any of the above. Investigation fee I I i
The above are not applicable to temporary construction service. Other
Not all Jusisdietions accept credit cards, plea= call jurisdiction for more information. Notice_ This permit application Permit fee $ '15 .co
0 Visa Cl MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit Cord number I / within 180 days alter it has been State surcharge (8%) $ • •
Expires accepted as complete. TOTAL $
Name o7 cardholder as shown on cmelt curd
- $
Cardholder signature Amount 440.4615 (6J00/OOM)
CITY OF TIGARD 24 -Hour
BUILDING N. r- Inspection Line: (503) 639 -4175
•
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
• BUP
Received Date Requested 3 — / AM PM BUP
Location / 6 /6/ L )1? --S - kJ) Suite MEC
Contact Person mil �l��_ Ph ( ) 4746 7 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC -
Footing g — P 3 / C> ELC
Foundation Access:
Ftg Drain ELR 2- -"Giro 3/
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 m C
UG/Slab ° � C.)3 - - i t/0
ire Alarm
PASS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
D Please call for reinspection RE: Unable to inspect – no access
Fire Supply Line
ADA Date o 2-- In eCtor .tom . r __ Ext
Approach/Sidewalk P
Other:
Final DO NOT REMOVE this Inspection record from the ob site. -
PASS PART FAIL