Permit •
CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
,I ; DEVELOPMENT SERVICES PERMIT #: ELR2003 -00132
13125 SW Hall Blvd., Tigard, OR 97223 (5031 639 -4171 DATE ISSUED: 5/13/03
SITE ADDRESS: 10998 SW 68TH PKWY PARCEL: 1S136AD -06505
SUBDIVISION: WAY LEE ZONING: C -G
BLOCK: LOT: 003 JURISDICTION: TIG
Project Description: Low voltage for 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: ALARM X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
BANK OF SALEM ALLIED SECURITY
PO BOX 847 935 SE ANKANY
SALEM, OR 97308 PORTLAND, OR 97214
Phone: 503 -585 -5290 Phone: 503- 231 -9550
Reg #: ELE 26- 243CLE
LIC 64465
SUP 556LEA
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 5/13/03 $75.00 Elect'l Final
[TAX] 8% State Tax 5/13/03 $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.
Issued by Permittee Signature 1/1
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
05/12/03 08:07 FAX 503 231 9551 ALLIED - ANKENY Ij003
� (
r 07/05/2002, . 11 - ;0; FAX 5035981980 CITY OF TIGARD 1j002
A _
• Electrical Pe 3 ; 1 on
'I' Date sewed: S /g -03 t } Permit no.:r G/ -o 6 / 33-
i
', l !j l City of Tigard gard Project/appl. no.: Ex pi re date:
a
C1q of Tigard Address: 13125 SW Hall Blvd, d, pig r Date issued: By213 I Receipt no.:
Phone: (503) 639 -4171 Case Blotto.: Payment types
Fax: (503) 598 -1960 CITY OF TIGARD _
Land use appro BUILDING DIVISION
TY1'EOF PERMIT
U 1 & 2 family dwelling or accessory t.onuncrcial/hulustrisil ❑ Multi- family O Tenant improvement
O New construction ddition /alteration/replacement O Other: l Partial
JOB SITE INFORMATION
Job address: # -2' riri-. WA, .. Bldg. no.: Suite no.: Tax ma • tax lot/account no.:
• Lot: Block:. Subdivision:
7 r • Pre („ Desarl .don and location of work on • _ .
P roject terms � � � ; . • „1, _ r e_ i 1). . .. �... - • 1! .i�r
Estimated date of connpletion/lnspectlon:
CONTRACTOR APFI;ICATION FEE SCHEDULE
Job no: . D • _ *- - 1 I • . ]Dearer •, n � Tom[ a o.
Business name: i7C /� . _•
e:w : or ctwttl- faan�Y P�
Address: • t�/!I __ - dweillogwt includes a*tcbedgsage.
City:.` 111V,11.7 State: 0 ' EP: e? 7 a1 • Sent= included: 4
Phone_ . ' is, • P' :.� , Q E-mail: 1000 , .. ft. or less
Elec. bus. lac. . • Each added •^ 500 • . ft or ... thereof MINIM
00... L - -- - Limited twerp, residential 2
City/metro llc. no.: • Limitodenesgy.rwn- resideatlal 2
6/4% in c-,- i - - o k 'rasa manufsc*ured home or modular dwelling
Si: .- re of supetvis : electrician -•D Date Servlceand(orfeeder 2
Svp elect mute (p rX ►�► i' a • Bra lla4oa, 1111
I'1tOI'EItTX OWNER 200am sorlets 2
. 20 i t L 2, .i.T .L. Lq.:. OM IIIIIIIII 11 lilllilillllll 2
Name (print): •
(P �: i t^ - r 401 ampeto amps ��� 2
Haling address: • • vii___. i, ,. :>1 tall[ .-'• am.sto 1000amps MIMI 2
Ci : Mg M fate OM ZIP: ' liTal Over 1000 tun • or volts ��
Phone: Fax: E-mail: Reconneatonly
Owner installation: The installation is being made on property I own eYa r' css O1 ' -
which Is not intended for sale, lease, rent, or exchange according to Installation ,a1tmatoa,orrelotanm
o
200 amps or less 2 -
ORS 447, 455, 479, 670: 7O1. 201 amps to 400 amps 2
Owner's signature: Date: 401 to • .. 2
ENGINEER Snatch circuits -new eratioa, .
. ix-extension per
Name: A. Fee for branch circuits with purchase of
Address: service or feeder f- each branch circuit 2
Phone: • Fax: State:
frm UP: Each additio •• brunch circuit • -•�
PLAN REVIEW (Plcace cheek all that apply) Misc. (SeMceor feeder not • •ded)s ■M
O Servioo over 225 amps•nommetcid D health• rt'e facility Each . • . or irrigation circle 2
O service over 320amps- ratitt&ofIda 0 E1azardouslocation Each sign oroutioellghdng 2
family dwellings O Bonding over 10.000 square feet tow or Signal clreuit(s) or a limited energy Panel. I
O System over600 volts nominal ' more residential units inodeatucture alteration, or extension* 2
O Building over duce stories t] Feeders, 400 amps or more 'Description: , I - •
o Occupant land over 99 persons O Manufactured sanctums Or 1W parer ga& additional inspection over the allowable to any of the above:
O 6grcsarlightingplatr D Other. - Perinspection 1 I I i
Submit _sets of planes with any orate above. Ltveatlgadon fee •
The above are liotap • lieoble to : • .. • . construction service. Other '
• credit cards, mill aisdi�a+ for mare l Notice: This permit application Permit fee ................. ... $ . GF�
Na ml jets a vomit is not o btained Plan review (at — %) $
OVisa OMasterCard expires 8 days State J1
within 180 days after It has been I
Credit card somber azPue+ accepted as complete. TOTAL Aga:, - ' ..
Name or esrlbolder as shown on cadre cud S
Cardltcldcr signs= . Arno= 40•4615 (nallcoM)
CITY OF TIGARD 24 -Hour
BUILDING InspectiemLine: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested 7 -Z Z AM PM BUP
Location /0 79g Suite MEC
Contact Person r- Ph (1 4 1 — 1 34 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner etakt A 42 T ELC a — 410 64 7
Footing l
ELC
Foundation
Ftg Drain Access: ELR 3 — OD 3
Crawl Drain
Slab Inspection Notes: sw ezR 3-60/3
Z
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 b C
Post & Beam
Under Slab
Rough -In � G �G )3d .
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole / c53 o& 1 41-7
Storm Drain J
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 yol taa
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PZ221110 PA - T FAIL
SITE - El Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date - O� Inspe Ext
Other:
Final DO NOT REMOVE this inspection recor from a job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Lire: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Receiver / Date Reques ed , /y AM PM BUP
!
Location o f ?( Suite MEC
Contact Person Veti /A-Q Ph ( ) 02'3 % '7 D PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner / / 4 4 4 k 7 ELC
Footing
Foundation ELC
Ftg Drain Access: r mf ELR j ��� /3 2-
Crawl Drain %O'
Slab Inspection Notes SIT
Post & Beam
Shear Anchors 9121
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 R. 03 - r3 6 ?
Service
UG/Slab del //�
r . �/Va g 7/ "
Fire Alarm
Fi • ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
S - Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
DAoach/Sidewalk Da r-
A . Inspect Al.... J. P' Ext
PP
Other:
Final DO NOT REMOVE this Inspection record from the job ite.
PASS PART FAIL
•