Permit • CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
011 DEVELOPMENT SERVICES PERMIT #: ELR2004 -00054
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/4/04
SITE ADDRESS: 13009 SW 68TH PKWY A PARCEL: 2S101 DA -00105
SUBDIVISION: HOMESTEAD VILLAGE ZONING: MUE
BLOCK: LOT: JURISDICTION: TIG
Project Description: JOB NO. 724 -01 -26858 CCTV, (1) CAMERA/MONITOR
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: 1
Owner: Contractor:
HOMESTEAD VILLAGE INC HONEYWELL INC
ATTN: PROPERTY TAX DEPT 15495 SW SEQUOIA
7777 MARKET CENTER AVE STE 100
EL PASO, TX 79912 PORTLAND, OR 97224
Phone: Phone: F - 968 - 3398
Reg #: S08- 330041LEA
LIC 150191
ELE 26- 207CLE APP. SAYS CI
FEES Required Inspections
Description Date Amount Ceiling Cover
[ELPRMT] ELR Permit 3/4/04 $75.00 Wall Cover
Elect'I Final
[TAX] 8% State 3/4/04 $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 _
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
MAR -2004 15:06 HONEYWELL 503 968 3398 P.02/02
. - _ Eleel nCal i ' et nu . Applhealion at - ...: • -. 3 0 .
. ._ - � Penno a.
City of 1 - ig CEIVED .____ uappl.no,: Expircdotc�jla��( -�dZJ
,tf�tt li -
5 SW Hall Blvd, T ard. OR 9722 Dale issued: ksy � keccipt nn.:
Cny r.1'1'trm(' Addles 1312. S 1' Y -
Phone: (503) 839-4171 MAR 2 2004 Case file nu.: Pavement type.
Fax: (503) 598 -1y6U
CITY OF TIGARD
Land use approv: t
0 Multi -family 0 Tenant improvement I
0 1 X 2 family dwelling or accessory 'Commcrcia1industrial _ 0 Penial tl
U New construction 0 Addition/alteration/replacement 0 Other:
SOB SILLIN FORMATiON .
Joh address: DI. & , Cyan j B1dp. no. (Suite no.: 'Tax map/tax Iot/accounl no.:
Lot: Block: SutxlivIsla U
v , ID i' 'Minn and location of work on premises:
Ptojcct name. X11 I��L1..�. �it�l►]l�L��
Estimated dale ol completion/inspection: W Ij - -- 1,� 5���plA.l
CONTRACTOR APPIACA 1N.�
• p o. os
Job no: � � �i�l +moo lk"criMi°" insp
$usincs< name: HONEYWELL lNew reaideer1W •wrgk or mupl.t ally pet
Address: 15495 SW Sequoia PkWy,*1 dw iling an% lloselntlea attacised garage.
t ate:CR Service included:
Phonc503- 968 =3304 Fax: 968 -33
ZIP: 97224 4
City: pr r l ]and S felon sq. h. or (rte*
968-33N. E-mail: Each additional 500sq. ft. or portion thereof EOM
CCB no.: I 0 I ti i Elec. bus. lie. no: 26- 207G1: P j,;mited energy, residential _ ill MN illi.1
M.
City/metro - 4 619 Limited energy, non-residential Fl Each manolacrured hoar or modular dwelling RE
r aw/ ��^ 2
— S
Date Service and/or f eeder
n rune of sufr ervisinF elu 'trician (required) Sery inslollation, ill
up lFCt: nanii (p►tnr)= 'S a ehouSC _- alteration or re location: 2
11%01140V Ott1' ER 100 amps. or lea. .1111111/1 201 amps to 400 am •
Name (print): 001 amps to 600 amps �__ 2
Mailing address: 601 amps to 1000 amp* _
City: State: 21P: over 1000 amps or volts MI _ . -
Reconnect only
Phone: Wax: E -mail: • 'temporary services of teedert - 1111
Owrtcs installation: The installation is being made on property 1 own a l )afion,atteralion,
which is not intended for salt, least, rent. or exchange according to 200 nmpsut {ear
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps
Date; 401 to 600 amp*
Owner's sigftalure: b circuits •nee, alteration, • Ll�GiNLI I et extension pro panel:
• Name: A. Fee tar branch circuits with purchase of
Address:
Fervice en feedeI (cc, each branch circuit
ll. Fee for branch eireuita without purchase
City: Stale: ZIP: 11.
service or feeder fcc, rrrsr branch circuit: III
Phone: Fax: F.-mail: Each additional branch circuit:
_ .
"IAN ItE%ILV'( hue dick till that apply) misc. (Senice feeder uor include ): 2
O Senn= ova 225 antpa•commercial 0 Health-eare facility
Each pump or irtiFation circle 2
0 Senile over 320 stops- raring of 1 &2 0 B u aardov* location sign M aniline Iit:htin► etion Signal circuit(a) of a limited energy panel. 1 �1C 2
Wilily dwdlinK: ID Buildu over l ( ow syuare fe tow or ! 1J
O System over M)0 volts nominal more residential units in one ttrocruTt alteration, of es tension'
❑ Building over three stories ❑ Feetiern.400 an s or more Description_ -- .
D occupant Mad ova 99 Percoru
0 Manutacwred swcrutea or RV part ryrh additional inspection over the allowable in any ol the above:
1--L 1
❑ Eyrass/lightingplan 0 Otl,at: —. - Fa Inspection _
nve ation fee
Subroif _„ seta n! plans with any o f the above. - I plhrs -
The oboe. ate not applicable to temf►uratry construction service. it Permit fee
Nnticc: p,�rmii applicati°n Plan review tat _ %) g
` is jurisdictions tempi moo cards• trlcase d1 juritAic+ijurisdiction ra more udonnntien. expires if a permit is not obtained ('0
O Viva �T vtast d n within 180 ria� s abet Hiss }seen Stair. Surcharge (8%) .... g. _ ...— to
C.rcdircare • urgers: ha Ill • V ly 'L P,pu accepted ds complete. 1'OTAJ. $ • 11_______
_
o • — • - s S1.
r �..'t card � aao-aolS r awo+caH
NAM of r hoi F rr Amount
TOTAL P.02
Case Activity Listing 11/17i2004
10:42:07AM
T I D E M A R K Case #: ELR2004 -00054
COMPUTER SYSTEMS. INC.
Assigned Done Updated
Activity Description Date 1 Date 2 Date 3 Hold Disp To By By Notes
ELRC001 Application Received 3/4/2004 None DONE FAX 3/4/2004
JMT
ELRC003 Permit Created 3/4/2004 None DONE JMT 3/4/2004
JMT
ELRC700 Ceiling Cover None 3/4/2004
JMT
ELRC720 Wall Cover None 3/4/2004
JMT
ELRC799 Elect'1 Final 3/15/2004 None PASS GN 3/15/2004
RLB
ELRC500 (F) Issue permit 3/4/2004 None DONE JMT 3/4/2004
JMT
ELRC800 Case Finaled 10/18/2004 None DONE RB 10/18/2004
RB
0
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