Permit ELECTRICAL PERMIT -
CITY O TIGARD RESTRICTED ENERGY
�� 11 " DEVELOPMENT SERVICES PERMIT #: ELR2003 -00387
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 12/22/03
SITE ADDRESS: 12447 SW 69TH AVE PARCEL: 2S101AA- 09100C
SUBDIVISION: TIGARD CORPORATE CENTER ZONING: MUE
BLOCK: LOT: OOC JURISDICTION: TIG
Project Description: Installation of limited energy for BA/FA combination in cafeteria.
Job No. 083 - 1737101 '
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: BA/FA COMB X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
TIGARD CORPORATE CENTER ADT SECURITY SERVICES, INC
15400 SW MILLIKAN WAY 2815 SW 153RD DR
BEAVERTON, OR 97223 BEAVERTON, OR 97006
Phone: Phone: 503 469 - 7244
Reg #: LIC 59944
ELE 26- 209CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 12/22/03 $75.00 Elect'I Final
[TAX] 8% State Surchart 12/22/03 $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 ollow rule : •opted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 throuc
by 2%0; Permittee Signature ,ii// % 20
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
12/11/2003 09:56 FAX 5034697110 ADT SECURITY 1i21001
Electrical Per i ' a
II� � !f In
Date received: / f p4 Permit no 0 ,
• •.iii -O # : 7
• • ,, I,L ,1 i • ty of Tigard C o1 i X 0 3 Pro jea/appl. no.:
City o�gard Address: 13125 SW Hall Blvd, Ti , g72 Date issued:
Phone_ (503) 639 -4171 � % Rcceiptno.:
Fax: (503) 5981960 CITY OF TIGARD Case file ao.: Payment type:
BUILDING DIVISION
Land use approval:
•
TYPE OF PERMIT
' ❑ 1 & 2 family dwelling or accessory IN Commercialindustrial 0 Multi - family O Tenant improvement
El New constluetion ❑ Addition/alteration/replacement 0 Other. 0 Partial ,
.1011 SITE INFORMATION
Job address: J
4 Bldg. no.: 's Suite no.: Tax map /tax lot/account no.: -
Lot: ay Block Subdivision: .
Project name: M Description and location of work on premises: :A = ► v ,a A
Estimated date of com . letion/napection: -
(()NI -rnit 11PPL1CA Lire SCHEDULE
Job n CA3 - 1 - ?)-7 1 t • ' ' Max
Business name: ,Se uri �F Illesaiption Qtr- (�+.) MAW . no. Imp
� :,� IS Ord Y Newts std�lat- a /ageornwld- etmdyper
/nclades stfaclted guxge.
City; St OR ZIP: 7470 Servirei
PhonPS03 Fax= /.7 E-mail: 1000 eq. 0 - orkss 4
Each addtional 500 ft. or pardon thereof
Cal no.: s9 i,/ J lel eo. h ies. lie. no: 26- Zd9CLF p `"�
Qry /m lic. no.: � CuO1Id gyremdeatist 2
Limited energy, non-residential . 2
iZl I 1 /t7 Fads manufactured home or modular dwelling
Si (Sniper. a electrician (required) ... Para Service 2
snit elotY neate(Print); 460 KRAUS LI ' no: LEA'S" Servtee rastallat1anr
alteration or relocation:
200 amps orless 2
Name (prin ; f)-P C & 201 amps to 4b0 amps 2
Mailing addres5 s: 'o0 " Mr Lt/�C.4iJ AM 401 amps to 600amps . 2
Y 601 amps to I000 amps 2 • City: /512 r ,) - State: ��4 ZIP: z70C0o over woo amps orvotts -- 2
Phone: 1 Fax: 1E-mail: • - •• nnect only 1 '
Owner installation: The installation is being made on property I own ' 1lempornryservieetorfetdets- •
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocadon:
ORS 447, 455, 479, 670, 701. zoo aa 'a ° or leas 2
201 amps to 400 amps 2
Ownei's si re: ' Date: 401 to warn s 2
Breath elr sdrs- new,alteration, .
Name: or extension per panel:
A. Pee for branch circuits with purchase of
Address: s ervice or feederfee, each branch circuit 2 •
City: I State: rzIP: B. pee for branch circuits without purchase
, Phone: Fax• Evmgj): of service or feeder fee. first branch circuit 2 •
Bach additional branch circuit
- 1111 sc. (Service or reedernodIncluded): • . ,
Q Service over 225 amps commenaol 0 Health - care facility Each pump or itrig3rlon circle 2
O Service over 320 amps-rating of1at2 0 Hazardous location Bach sign oroutline 2
family dwellings 0 Building over 10,000squam feet four or Signal circuits) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension' 1 75 15. 2
O Building over three scoria O Feeders. 400 amps or more VescripUOd -
O Ocevpagt load over 99 persona 0 Manufactured struolmrs or RV park Each additional hnpcdJon over the allowable In eiiy of the above •
013grh:ssNghtLhgplan . O t)ttter Perinapection 1 1 1 ..
Submit_ sets of plans with any of the above. . - bwestigation fee t .
The above are not applicable to temporary construction service. Odtor .
Not all Iudadlclloot seem mitt cards, please can Jurisdiction for mono Mformailon Notice: This permit application Permit fee $
- e
O Visa O MaatesCnrd expires if a permit is not obtained Plan review (at _ 9b) $
neat, coot number: --L-1— within 180 days alter it has been State surcharge (8%) .... $ --
awns accepted as complete. TOTAL, $
Nuns of cardholder w ehowo on credit eetd
S
- Cecdhofdef signature wmeum
440-4e le (ti•UO/COt,)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Lifie: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639-4171 MST
�r`°`� - , �/_ BUP
•
Received 4-q 1 / 1 /� Date Requ sr — �M PM BUP
rte
Location ) q l Suite MEC
Contact Person c2 J ttot Yfn ^- Ph ( ) PLM
Contractor a�� �� Ph (-5i23) � O 1 2 2 / SWR
BUILDING Tenant/Owner /S8 ELC
Footing
Foundation ELC
Ftg Drain Access: -(M3 F 7
Crawl Drain
Slab Inspection Notes: -
Shear - SIT
Post & Beam l
Sr S
Ext � al
Ext Sheath/Shear •
Int Sheath/Shear
Framing
Insulation .k`4A , `� I \ r1 } l
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: al I L� = 'IM � —
PASS PART FAIL
MECHANICAL .
Post & Beam
Rough -In
Gas Line
Smoke Dampers
_ Final
- T FAIL
,-112=1.•
Sep-
-
Rough-In
UG/Slab
Low Voltage p
Fire Alarm
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE ri Please call for reinspection RE: Unable to inspect – no access
Fire Supply Line
ADA �f
Approach/Sidewalk Date o2. _ _ Inspector � i Ext
Other:
Final DO NO REMOVE this Inspection recor • om th : • b site.
PASS PART FAIL
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