Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
���� DEVELOPMENT SERVICES PERMIT #: ELR2005 -00026
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/7/2005
SITE ADDRESS: 14100 SW 72ND AVE PARCEL: 2S112AA -01000
SUBDIVISION: PP1992 -007 ZONING: I -H
BLOCK: LOT: 001 JURISDICTION: TIG
Project Description: Alarm addition. Job # 083 - 15899.
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: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WILLIAMS CONTROLS INDUSTRIES INC ADT SECURITY SERVICES, INC
14100 SW 72ND AVE 2815 SW 153RD DR
TIGARD, OR 97224 BEAVERTON, OR 97006
Phone: Phone: 503 469 - 7244
Reg #: L$O3- 46959114
ELE 26- 209CLE
FEES Required Inspections
Description Date Amount Low voltage
[ELPRMT] ELR Permit 2/7/2005 $75.00 Electrical final
[TAX] 8% State Surchart 2/7/2005 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010
through OAR 952- 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Issued by `�� Permittee Signature
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
02/07/2005 12:29 FAX 5034697110 ADT SECURITY el001
' ElectiicbPer A .pp ' E1VEV soli (mien. USE ONLY
7 Ci of Tin and Received . - r
13125 SW Hall Blvd Tigard, OR 97223 p O 2 p I I G Port No : 6 /...1.:,„24041- v 1, e
' Phone: 503.639.4171 Fa$: 503.598.1960 C • D '' "s:. •, Other Permit
` I .
`'I '' Date/13
Inspection Ire 503.639.4175 f1 . • .f .iice ° `•1 J gp� B See Page 2 for
Internet www,ci•Ligard W ns 1SY pfr , S10 " - NotlfedMMetbod: Supplemental information
.. .[ I ;,1 1 1 , ` "i , I 1 tI F, (, ' ✓ r 11 Li,� I �
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❑ New construction ri ; Ad•'; . , :1teration/replace lent Please check all that apply:
0 Demolition CI Ooh ❑Service over 225 amps, comm'L ❑Hazardous location
❑Service over 320 s - ratio Buildn over 10,000
".. , -- , :. , , r 1'. ' .iV l 1 ■ I 1 1,1 1 1 .P. ,Ii d 1 Ih : I J r k : i (., - ,, Of 1- and 2- f dwellings 4 or more new residential
• ❑ 1- and 2-family dwelling ['Cornnlerciallindlutriall 0 Accessory building ❑System over 600 voile normal units in one structure
OBuilding over three El Multi-family I , ❑ Master bur7der - 0 Other: �,,�,pan
persons structures or
' . 1 „ ° 1 i "_"'1' I , " .. 1 i ' 1,1 c,..4' . 2 , .. Q u'+gh�g 1 teed over an � l�Ma pl ctmea
'es amps or more
Job no.: M JO/ a I Job site address: /y/ o 14.4 1; Ave ❑Health re facility ❑other.
1 , Submit j� sets of plans with any of the above.
City/State/ZIP: f,�„e ->r� a p17 y The above am not applicable to temporary construction service.
Suite/bl dg./apt no.: f / : .... . , . ... - ,
� Project / /L4AMf Gv�1r��s � ".. , ; , = :. _ . .; = � ,i:` ' - i l� ' i. - i: : i: � �:- 61`:i=��:�i; �:,�, .?.,.. ...
.•;,
« .
nccrlptl® Qty. sae, 1 Total I
Cross street/directions to job site • New residential single- or multi-family dwelling unit.
Includes attached garages
1,000 sq. ft. or lens 145.15 4
Subdivision: • I Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: j _ Limited energy, residenlial 75.00 2
-,- .. _ ...:....... : .. Limited energy, nom- rcsldential 75.00 2
' � &acts msrtufscttuod to modular
dwelling, service and/or feeder 90.90 2
/14%17 _diprti r r Series or feeders Installation, alteration and/or relocation
200 amps or leas 80.30 2
:,:. . r I , s to 400 106.85 2
1 1 I; I I r 1 l" 4 201 amps —.- - - 160.60 2
Nam - JH /zG lol 601 amps to 1,000 snips 240.60. 2 .
Address: Over 1,000 amps or volts 454.65 2
City/stateJZIP: Reconnect only 66.85 2
Temporary services or feeders installation, alteration, and/or
-
Phone: (c ? ) err -I p` 7(, I Fax: ( )
200 a
2n fen
200 stops or less 66.85 1 I 1
Owner installation: This installation is being made on property that I own which is not 201 amps to coo IIIilpa 10030 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch tirsuita - new, alteration, or extension, per panel
- • A Fee for branch circtrits with
service or feeder fee, each
}
..... ,. .. ,:... ,._.. _ .. 6.65 2
Business name: branch circuit
B. Fee fbr branch circuits
Contact name: without service or feeder fee, 4615 2
• Address: each branch circuit
Each add'1 branch circuit 6.65 __] 2
City /State/ZIP: Miscdlaneoua (service or feeder not included)
Phone: ( ) I F es; ; ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53 -40 2
E -mail: Signal circuit(s) or lim ted-
il e_i , , , 4 I � , : J � , ' 1.41 * 4 ` r . , ' . '",, f 1 ,' � li1 i , eriergy el, alterrtlon, or extension. 2
h I 1 1 1 rl1 I extens Describe: Page
Business name: ADT SECURITY SERVICES, INC.
Address: 2875 S.W. t5sr'd DR. Each additional Inspection over allowable in any of the above
RAJ RTelly !1R 9700,1 Per inspection 62.50
City/State/ZIP: (503) 469.7100 Investigation per hour (1 la net) 62.50
Phone: ( ) Fax: ( ) industrial plant per hour 73.75
• !.' ,I a 1'' t I ,�'5 ,-,-7-77-'77 w: l-- i1l (I) i I 1 , - -. .. r
il.t 1._._. I mo. .I.....}� .. �..�
CC13 Lie.: 59 0 14 Electrical Lic.: ,, a et uprv. Lic.: - -• , ' Subtotal
Suprv. Electrician signature, required; j /. ��� ; . Plan review (25% of permit fee)
P Ile t-, Date: State surcharge (8% of pemtit fee)
Print name:
1��1 �'A.u� °�/
TOTAL Y)r Tt1V1Y7 Yt')c)r
Authorized signature: Thlt permit application expires If a permlr is not obtained within 180
days after It dam been accepted m complete
Print name: Date: - Fee methodology sec by Tri•County Building Industry service Board
� , •• Number of b i peetions per permit allowed.
oNsodineorm'ta1E.c•PematApp,dec I,2/03 410-4e137110/0zJCO /WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line:_(503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Ave- 3-14, AM PM BUP
Location /4 / OO '7a ' e- Suite MEC
Contact Person 8e az-j Ph ( ) L IG9 — 734 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: LR SOS - OO Oa.ce,
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
RT FAIL
LECTRICA
ervice
Rough -In
UG/SI. •
• , Volta..
Fire Alarm
rl•Y-.1�-
I CED PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Please call for reinspection RE: ❑ Unable to inspect – no access
Fire Supply Line
ADA Date? / Inspector Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this Inspection record fr m the job site.
PASS PART FAIL