Permit A CITY OF T I G A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
Y
DEVELOPMENT SERVICES PERMIT #: ELR2001
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 07/19/2001
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: DATAITELE 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 Low Voltage Inspection
PRMT CTR 07/19/2001 $75.00 2720010000 Elect'I Final
5PCT CTR 07/19/2001 $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 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
Issued by _n %/ L . . � _dr Permittee Signature ( 7), 7
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: /)/ 6; DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
07/17/2001 15:12 FAX 5034697110 ADT SECURITY 11001 /001
. •
Electrical Permit App
:
A , ; - 1 Date received: i Permit no. i .. /
a 1 411 City of Tigard � _, Project/appl. no.: Expire date:
City ofTigarai Address: 13125 SW Hall Blvd, Tigard, OR 9722 Date issued: By: ReceiF no.:
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 1 ommercial/industrial 0 Multi - family 0 Tenant improv ment
0 New construction 0 Addition /alteration/replacement CI Other: 0 Partial
JOB SITE INFORMATION
Job address: / 5 '1(' s(.4_) //‘ L A . Bldg. no.: Suite no.: Tax map /tax lot/account no.
Lot: I Block: 'Subdivision:
Project name: '&,, L o f AkszniA. !Description and location of work on premises: 16 k ¥ oi- rv'
Estimated date of completion/inspection: t
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: 083 -J Q Fee Max
Business name: ADT Security Sc vices Description Qty. (ea.) i fatal no. insp
Address: 2815 S.W. 153 1)r. New residential - single or multi - family per
dwelling unit Includes attached garage.
City: Be verton, C)Rat97006 Serviceincluded:
Phone:4ljpq- 72 [/(,
11 Li I Fax; -- // I E-mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: 0jL/ei I Elec. bus, lic. no: ,.,7/o Ott (tom
Limited energy, residential 2
City/me ,. lic. no.: - Limited energy, non - residential 2
- A , w . k A- ..- <i _ 717/0 / Each manufactured home or modular dwelling
Sig + ■ re of supe 1 ng electrician (required) Date Service and/or feeder 2
-
Sup. elect name (print): ' - A , Pt (A License no I d W Services or feeders - installation,
alteration or relocation:
PROPERTY C'7.'. at 200 amps or less 2
Name (print): 'r {t>te.: Kth A tai lr;/,. a3 -275- /gar 201 amps to 400 amps 2
Mailing address: 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: [State: I ZIP Over 1000 amps or volts - 2
Phone: 'Fax: I E -mail: Reconnect only i
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to Installation, alteration, orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: • Date: 401 to 600 am s 2
Brunch circuits - new, alteration,
or extension per panel:
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
Phone: Fax: E -mail:
of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
Misc. (Service or feeder not included):
O Service over 225 amps - commercial O Health-care facility Each pump or irrigation circle 2
O Service over 320 amps- rating of 1&2 O Hazardous location Bach sign or outline lighting 2
family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* 1 1 5 - l .2
O Building over three stories O 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 ab re:
O Egress/lightngplan . O 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
Not all jurisdictions accept meat cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ _ i <j
O Visa O MasterCard expires if a permitis not obtained Plan review (at _ %) $ _
Credit card number: 1 j within 180 days after it has been State surcharge (8%) $ _ _ , ��
■ Expires accepted as complete. TOTAL $ _ . C I ``'
Name of cardholder as shown on credit card
Cardholder signature Amount ■i 0-4615 (5/00 /COM)
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
C� BUP
Date Requested /CI e9"' l AM PM BLD
Location ) G /Ds / )6, ? '``? -- Suite MEC
Contact Person at 4:71(c 2 j PLM
Contractor Ph SWR
,
BUILDING Tenn/Owner ELC
Retaining Wall ` c— S ELR ' ` G C 1 9 3
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
2— (I Cc�[�1/�
Firewall —
Fire Sprinkler — sMPi.r
Fire Alarm
Susp'd Ceiling Cif P / / 7t" C2) �j c� /� 27
Roof I
Misc: / _ . -' . _
Final
PASS PART FAIL "/ / r/ E t ��C- � x c�-Z cVC
PLUMBING CF //° - -- C 7Y7 cs ? ( f U C-J ;
Post & Beam
Under Slab p
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
( 7 1 ) Smoke Dampers
Final ?�
PASS PART FAIL l 7
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage 1 \, ( t ..7//
Fire Alarm
\if
4 ' PART FAIL EXPIRED
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] 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 / / � n / p
Other Date ` �( D Inspector � ( Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST •
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested - ( AM PM BLD
Location l � l !� S // , (- Suite MEC �
Contact Person 4 ��,�,_� Ph 7 9 7 .J7 / PLM
Contractor //' 3 Ph //�� SWR
BUILDING Tenant/Owner 8'�a tl -+�m ELC
Retaining Wall ELR c; ) - .6/ De.) Y
Footing Access: 301)/ cl,3
Foundation •
Ftg Drain
Crawl Drain Inspection Notes:
Slab
Post & Beam - Ca /
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall D e C/ tc"
Fire Sprinkler / /' _ �— '�
Fire Alarm a
Susp'd Ceiling � e �� [ P • —
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Pos
r S labm
U J� re
Top lab /
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
Rrra=>
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next is section. 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 Date � Inspector s _ ice. • E x
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
BUP - Building Permit ELC - Electrical Permit
Inspection Description Date Passed By Inspection Description Date Passed By
Footing /Setback Underground cover
Foundation walls Wall cover
Footing drain Ceiling cover
Waterproof bsmt walls Electrical rough -in
Slab Electrical service
Crawl drain Electrical final
Underfloor insulation
Post/beam structural
Shear walls /anchors _ ELR - Restricted Energy Permit
Roof nailing 4 Inspection Description Date Passed By
Firewall Low voltage
Tilt -up panel Electrical final 9 - 2 O,' 4640
Masonry /Reinforcement
Framing
MFG - Structure set -up MEC - Mechanical Permit
Insulation
Inspection Description Date Passed By
Drywall nailing
Post/beam mechanical
Suspended ceiling
Gas line
Engineered soils
Welding Lab Final Mechanical rough -in
Concrete Lab Final Fire damper
Duct work
Bolting Lab Final —
— Smoke detector
Structural observation Mechanical final
Fireproofing Lab Final --
Final inspection
PLM - Plumbing Permit
BUP — Fire Protection System Permit Inspection Description Date Passed By
Plumbing underslab
Inspection Description Date Passed By Crawl drain
Sprinkler underfloor /slab Post/beam plumbing
Sprinkler rough -in Plumbing top -out
Sprinkler final RP /backflow preventer
Fire alarm final _ Rain drain
Storm drain
Water service
SIT - Site Permit Sanitary sewer
Inspection Description Date Passed By Culvert/catch basin
Footings Pump /fill septic tank
Foundation walls Plumbing final
Sprinkler supply lines
Sprinkler underfloor /slab
Catch basin /Manhole SVVR - Sewer Permit
Engineered soils Il Inspection Description Date Passed By
Engineering acceptance Sanitary sewer
Final inspection Final inspection
Inspection Record - BUP, PLM, SWR, ELC, ELR, MEC, SIT Permits
is \dsts \ forms \InspRecordBUP.doc 04 /17/01
CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
44* =; DEVELOPMENT SERVICES PERMIT #: ELR2001 -00193
--° 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 07/19/2001
PARCEL: 2S 110CD -00107
SITE ADDRESS: 15905 SW 116TH AVE
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 Low Voltage Inspection
PRMT CTR 07/19/2001 $75.00 2720010000 Elect'l Final ,
5PCT CTR 07/19/2001 $6.00 2720010000
Total $81.00 ,y
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes d rib
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 II
952 - 001 -0010 thro h OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 - 1987.
Issued by " , ,� J, L /L Permittee Signature (i 0��,y, CO
OWNER INSTALLATION ONLY ono
The installation is being made on property I own which is not intended for sale. lease, or rent.
OWNER'S SIGNATURE: DATE: VII
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: J)/ /LG DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day