Permit ELECTRICAL PERMIT -
CITY TIGARD RESTRICTED ENERGY
fly DEVELOPMENT SERVICES PERMIT #: ELR2001 -00257
=--' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/17/01
SITE ADDRESS: 15905 SW 116TH AVE PARCEL: 2S110CD -00107
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT: JURISDICTION: KIN
Project Description: Installation of 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:
INSTRUMENTATION: OTHER: BURG ALARM X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
NORTH SHORE CORP, THE ADT SECURITY SERVICES, INC
BY BANK OF AMERICA OREGON 2815 SW 153RD DR
PO BOX 6400 -UNIT #2814 BEAVERTON, OR 97006
PORTLAND, OR 97228
Phone: Phone: 503- 469 -7244
Reg #: LIC 59944
ELE 26- 209CLE
FEES Required Inspections
Type By Date Amount Receipt Elect'I Final
PRMT CTR 10/17/01 $75.00 2720010000
5PCT CTR 10/17/01 $6.00 2720010000
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 thr• •h OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987. A f
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. ELECN: DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
10/12/2001 16:12 FAX 5034697110 ADT SECURITY Fj001
•
Electrical Permit Application
, Date received: 1I, to /U \ Permit no.: i , 00
�,,1.r.''1h', City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By :f) I Receipt
Phone: (503) 639 -4171
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 'C { ommercial/industrial U Multi - family 0 Tenant improvement
0 New construction ❑ Addition/alteration/replacement 0 Other: Cl Partial
JOB SITE INFORMATION
Job address: / 5/ O S 54.) //6 5 - Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: ] Block: j Subdivision:
Project name: p e Lp Description and location of work on premises:.. ,_ jk i 1 a
Estimated date of completion/inspection: • v
CONTRACTOR APPLICATION FEE SCIIEDLLE
Job no: 0 :4 - /O , : 7 ; / . 2 . . Fee Max
• e unly aerv1GGs Description Qty. (ea) Total no. insp
Business name: New residential - single ormuld- fandlyper
Address: 2 315 S.W. 153 Dr. dwelling unit. Includes attached garage.
City: B verton, Cb tat970gg�: Service included:
Phone:U/A- '7ZIjL( � Fax. y4'q - 9 - //U E - mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: -Ai3/1/4,/ I Elec. bus. lie. no: fQ r } e, Limited energy, residential 2
Limited non - residential 2
Ci / etro lie. no.: ) manufactured home or modular dwelling 4. "/ /0 . �� - O! Each manufact
nature o sup i ng el (rewired) Date
Service and/or feeder 2
Services or [seders - installation,
Sup. elect name (print): h. , — License no U I - -d✓ alteration or relocation: L.
PROPERTY OWNER 200 amps or less 2
201 amps to 400 amps 2
Name (print): 401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Fax: I E -mail:
Phone: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
.
installation, alteration, or relocation:
which is not intended for sale, lease, rent, or exchange according to 200 amps or less 2
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am s 2
Branchcircuits - new, alteration, -
or-extettsion par panpt-
Name:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2 -
City: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
irrigation circle 2
irri
h pump or g
q Service over 225 amps - commercial ❑Health -care facility Each 2
0 Service over 320 amps - rating of 1&2 0 Hazardous location Each sign or outline lighting
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, I
O System over 600 volts nominal more residential units in one structure alteration, or extension* i 2
U Building over three stories U Feeders, 400 amps or more *Description:
0 Occupant load over 99 persons O Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
U Egress/lighting plan U Other. Per inspection I I I I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other _
Permit fee $ -- e43
Not all jurisdictions accept [edit catch, please call jurisdiction for more information. Notice: This permit application
Cl Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number; I / within 180 days after it has been State surcharge (8 %) $
■ 13x accepted as complete. TOTAL $
Name of cardholder as shown on credit card
Cardholder signature Amount 440 (6/00/COM)
CITY OF TIGARD BUILDING INSPECTION DIVISION
X 24 -Hour Inspection Line: 639 -4175 Business Line: 639 - 4171 MST
BUP
Date Requested /;- -( 7 AM PM BLD
Location / g S /At) '0-12,_ Suite MEC
4
Contact Person Ph e2_ R 7c PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR v2D7)/ S7
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing 4 - e i '.4 1 • / • u
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
40 _
'I` PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ I Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Dat / — — 0/ Ins �► _ I - - -• Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.