Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
av ;� l� i - 13125 DEVELOPMENT H BMEN O ) 639 -4171 DATE PERMIT #: ISSUED: g/28 ELR2001-00213
SITE ADDRESS: 10101 SW WASHINGTON SQUARE RD PARCEL: 1S135BA -01802
SUBDIVISION: OAKBURG ZONING: C -G
BLOCK: LOT: 025 JURISDICTION: TIG
Project Description: Installation of CCTV.
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: CCTV X
TOTAL # OF SYSTEMS:
Owner: Contractor:
PPR SQUARE TOO LLC ADT SECURITY SERVICES, INC
BY MACERICH COMPANY . 2815 SW 153RD DR
ATTN: JANET FISHER, ASSET MGMT BEAVERTON, OR 97006
SANTA MONICA, CA 90407
Phone: Phone: 503 -469 -7244
Reg #: LIC 59944
ELE 26- 209CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 8/28/01 $75.00 2720010000 Elect'l Final
5PCT CTR 8/28/01 $6.00 2720010000
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 • h OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
• Issued by _ /, i 1 Permittee Signature Gj �/l,��f• t '�
OWNER INSTALLATION ONLY !7
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: 091. G 1,2 ( Yv DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
08/27/2001 16:03 FAX 5034697110 ADT SECUR f1joo1
A
Electrical Permit Application :
Date received: •0 Permit no. f ' > _ 3
:,' :" � City 1ty Of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Dateissued: v� Receil no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
•
Land use approval: .
TYPE OF PEIt%IIT
0 1 & 2 family dwelling or accessory *Commercial/industrial 0 Multi- family 0 Tenant impror ;ment
0 New construction 0 Addition/alteration /replacement 0 Other: 0 Partial
.1011 SITE INFORR1ATlON I
Job address: /NO/ � : - R, Bldg. no.: Suite no.: Tax map/tax lot/account no.
Lot: Block: Subdivision •
Project name: &a.aq 1, o Amer_ . 'Description and location of work on premises:. ' e'72/
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: /. - i : g5'# 1 . Fee Max
Business name: ' r S - unly ' Cl VI.CS - Description Qty. (ca.) Total no. insp
Address: 2515 S.W. 153 Dr. New residendal- single ormultl- family per
y B verton, OR 700 : Senl nelu nctitrdes�chedgaraga
City: a Serrieeirtchrded
Phone:0/4- q 2j.pi Fax: 0g 9-I/ E - mail: 1000 sq. ft. or less • 4
Each additional 500 sq. ft. or portion thereof
CCB no.: _ i yy Elec. bus. lic. i o: -/ -- .
"'lilted energy, residential 2
City /metro . no.: Limited energy, non- residential 2
,a J a . A t / g127/Ol Each manufactured home or modular dwelling
Sign: . supervising electrician (required) D Service end/or feeder 2
Sup. elect. name (print): U License no •
Services or feeders— installation,
alteration or relocation:
200 amps or less • 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: I ZIP: _ Over 1000 amps or volts A 2
Phone: I Fax: ' ,E-mail: Reconnect only t
Owner installation: The installation is being made on property I own Temporary services orfeeders- --
which is not intended for sale, lease, rent, or exchange according to Installation, alteration, orrelocadors
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am s 2
Branch circuits - new, alteration,
— fi — - — - nrnvtnnein rr panri•
- e A. Fee for branch circuits with purchase of _
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
Phone Fax: E service or feeder fee, first branch circuit: 2
• Each additional branch circuit
I'LAN REV1LN' (Please check all that appl)) Misc. (Service or feeder not included): •
0 Service over 225 amps - commercial 0 Health -care facility Each pump or irrigation circle 2
0 Service over 320 amps- rating of 1&2 0 Hazardous location Each sign or outline lighting 2
. family dwellings 0 Building over 10,000 square feet four or Signal circuits) or a limited energy panel,
0 System over 600 volts nominal more residential units in one structure alteration, orextensione 1 - 35 2
0 Building over three stories 0 Feeders, 400 amps or more 'Description:
0 Occupant load over 99 persons 0 Manufactured structures or RV part Each additional Inspection over the allowable In any of the ab, re:
0 Egreas/lightingplan . 0 Other. Per inspection • I I I l
. Submit _ sets of plans with any of the above. Investigation tee
The above are not applicable to temporary construction service. Other
Not all Jurisdictions accept ciedlt cards. please call jreisdlcdon for more information. Notice: This permit application Permit fee $ _ - v - 4" j 43
D Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $ _
Credit card number: I / within 180 days after it has been State surcharge (8 %) $ _
H accepted as complete. TOTAL $ _ 'G I
Name of cardholder as shown oo credit card
$ •
Cardholder signature Amount • 0 (6100/COM)
•
CITY OF TIGARD 24 -Hour
MIMING Inspection Line: (503) 639 -4175 r
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested a` AM PM BUP
Location / 0 1 C) I 1 - S • R 0 Suite MEC
Contact Person Ph ( ) 4 {6 , ' ''7 a► S " PLM
Contractor Ph ( ) _ SWR
BUILDING Tenant/Owner 6 ELC
Footing Footing 696
,/ ELC
Foundation Access: � � _ v� oZ
Ftg Drain ELR 3
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fire wall C•V
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 3 D) .00 a k? - Nss
Storm Drain
Shower Pan
Other:
Final � O CO 1 . } 9' P A t �
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line •
Smoke Dampers
Final -
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire e A
SS PART FAIL SS fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Ei Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line �,� /
ADA GSA
Approach/Sidewalk Date � e9,/ '- <,) . � Inspector � -4. C
Ext
Other:
Final DO NOT REMOVE this inspection reco fro a Job site.
PASS PART FAIL