Permit C I T" ®F T G A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
h DEVELOPMENT H B�EN r S0 R 9 2 (503) OR 97223 639 -4171 DATE ISSUED: 1 8/04 4 -00021
AA -41
SITE ADDRESS: 16055 SW 74TH AVE PARCEL: 2S113AB -00800
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: JOB NO. 083 - 17499 -01
BURGLAR 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: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
DUNCAN, JOHN A AND ADT SECURITY SERVICES, INC
JANICE LEE 2815 SW 153RD DR
7060 SW PALMER WAY BEAVERTON, OR 97006
BEAVERTON, OR 97007
Phone: Phone: 503 469 - 7244
Reg #: LIC 59944
ELE 26- 209CLE
FEES Required Inspections
Description Date Amount Ceiling Cover
[TAX] 8% State Surchar€ 1/28/04 $6.00 Wall Cover
Elect'I Final
[ELPRMT] ELR Permit 1/28/04 $75.00
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 throuc
Issued by J 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
01/28/2 -n04 11:31 FAX 5034697110 ADT SECURITY 21001
• ]Electrical l'ermitA I 1 li q aDb -ov a
e11.�;i���� City of it . - 1 Dateteaeived: Permit no.: ----- - __
1 Project/appl. no.: Expire
City of Tigard Address: 13125 SW H d g, �(4k 97223 d ate:
Phone: (503) 639 -4171 Date issued: By: Receipt no.:
•
Fax: (503) 598-1960 cm oF TIGARD Case file no Payment type:
al. �
Land use apprt VEERING
TYPE OF PERMIT
•
1 1 & 2 family dwelling or accessory ISl Conunereial/industrial CI Multi- family ❑ Tenant improvement
Cl New construction ❑ Addition/alteration/replacement 0 Other ❑ peal -
.10R SITE INFORMATION -
Job address: ,p' JO • 1\ L Bldg. no.: Suite no.: .. Tax map /tax lot/account o.:
Lot: Block: Subdivision:
Project name: ,1L►�l {�� .
�ligraataL ,,g "eription and location of work on premises: inr � �' r
Estimated date of nom r Iction/inspection:
•
C N APPLICATION FEE SCHEDULE
Job no: 111 — aril •
Business name: 1 l x
. by r D escr i ption no. 4w .
Addrest: 1 • • t, I
New tr�daliGrl-single arm • p
City: _ a v State: 41/e, ZLP:" • dwellilegtar dr9attaclledgarage .
() . Serrieeindudem •
Phones. 0."1 t ;�Q ,
� Fax. ' 1000 sq. R or]esa 4 •
CCB no.: �C4��f 4 ' Elec, bus. UUc. no: _ . at Each tional500sq, It orportion thereof mum "
! Limited - ME_
min
2
City/me • tic, no -: / energy, residential
� Limited energy, nonersidential, _Mr 2
' r "Ell � y - uohmatwfacnrred home or modular dwelling
Signa. of auperi g electrician required) Date ■� Service 11111.1
Sup, elect. [tame (pant): 2MMEIMIIMIll Li env: LEA 389 ServIeea erfeedera— Installation,
PROPERTY OWNER alteration 11 III
�
200 amps or less
Name (mint): a1' ( .. 4_24 main ZIP 01.4._ 11 amps to 4 t ' amps �� 2
Mailing address: 401 am .610 600 amps ' IIIIIIIIM _ . 2
City: State; ZIP: 601 amps to 1000 amp: � � • 2.
Over 1000 amps or volts MI_ 2
Phone: 6., — , je Fax: E -mail: Reconneetonl _11111111MIMIN
Owner installation: The installation is being made on property I own Teinporary servicesorfeeeders- •"
which is not intended for sale, lease, rent, Or exchange according to Installation, alteration, or relocation:
ORS 447, 455, 479, 670, 701. 200 amps orless 2
Owner's signature: 201 amps to 400 amps II
D ate: 401 to 600 aro .s ii
ENGINEER Branchctrelts_ new, lteration,
Name: or extension ppllet:
Address: A. Fee for brah dreuia wth purchae of
servce or feeder foe, each branch circuit
City: State: ZIP: B. Fee for branch circuits without purchase
"Phone: Fax: E-mail; of service or feeder fee, first branch circuit: �.� 2
Each additional branch circuit/
PLAN RE IEW(Please cheek :111 that apply) Misc. (Service orfeeder not Included): . '
0 Service over 225 amps - commercial 0 Health - cane facility Each pump Of irrigation circle 2
O service over320amps-rating oft &2 . A Hazardous location Each sign or outline lightig 2
fantlly dwellings 0 Building over 10,000 square feet four or Signal circuil (s)ora limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, orextension• 1 7S 75- 2
❑ Building over three stories ❑ Feeders, 400 amps or more •
Occupant load over 99 n:on; D�� � lion:
O Occu
P pc 0 Manufactured structures or RV park eh additional
0 Egress/lighting plan 0 Other hJSpoctlon ovals the allowable In any of the ohms
Pcr inspection . j
Submit _ _ sets of plans with any of the ribose. Investigation fee
The above are not uppllcable to temporary construction service. Other
Not all Jurisdictions accept credit cards, prase cell Judadledon for more lefotmanoe Notice: This permit application Permit fee
0 Visa Q MasterCard expires if a permit is not obtained Plan review (at _ %) $
Co dit card .number / / within 180 days after it has been State surcharge (8%) ..,, $ •
Expires as complete. TOTAL..- $ , O
• Nome of cardholder ss shown on credit cord -
Cardholder signalum Amount
44i5 (4100/( ply()
Case Activity Listing 11/17/2004
1:05:22PM
TIDEMARK Case #: ELR2004-00021
COMPUTER SYSTEMS, INC.
'"ovei de Ic g gia,qui:;.:"Igta.
a " • t Dat ° "3z: 11104,1,,,,P):§
D te p e• $t�
� "" �a tiibn �. ��.
ELRC001 Application Received 1/27/2004 None DONE FAX 1/28/2004
JMT
ELRC700 Ceiling Cover None 1/28/2004
JMT
ELRC720 Wall Cover - None 1/28/2004
JMT
ELRC799 Elect'1 Final 3/9/2004 None PASS HS 3/10/2004
HFY
ELRC500 (F) Issue permit 1/28/2004 None DONE JMT 1/28/2004
JMT
ELRC800 Case Finaled 3/10/2004 None DONE HFY 3/10/2004
HFY
Page 1 of 1 CaseActivity..rpt