Permit t,, $ ,� i„
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C I T T Y OF TIG TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
` COMMUNITY DEVELOPMENT PERMIT #: ELR2006 - 00282
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/20/2006
PARCEL: 2S102AD -02200
SITE ADDRESS: 08900 SW BURNHAM ST F007 ZONING: CBD
SUBDIVISION: BURNHAM TRACTS LOT: 006 JURISDICTION: TIG
Project Description: INTERACTIVE MEDICAL. Protective Signaling. Job #206651 - 1.
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:
BURNHAM BUSINESS + STORAGE LLC ADT SECURITY SERVICES, INC
9500 SW BARBUR BLVD STE 300 2815 SW 153RD DR
PORTLAND, OR 97219 BEAVERTON, OR 97006
Phone: Contact #: PRI 503- 469 -7100
FAX 503- 469 -7110
FEES Reg #: ELE 26- 209CLE
LIC 59944
Description Date Amount
[ELPRMT] ELR Permit 11/20/200€ $75.00
[TAX] 8% State Surcha 11/20/200€ $6.00 REQUIRED ITEMS AND REPORTS
. 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 or 1.800.332.2344.
Issued By: - 77:), "...).„,\ Permittee Signature: S' Q f i
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 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Nov 20 06 08:20a Stephanie Pate 503.469 p.1
a
11 ..
Eiectricai Permit . FOR OFFICE 'USE. ON LY. • • . .
,
C ity of Tigard 1)
NI ' -
Received ; 1,7 As ,
Dnrc/7 / f _
1317_`5 SW Hll a Blvd., Tigard, OR. 972 ll 1 a
9t 1.1;ia irovic,,,
phone: 503.0394171 Fax: 503.59S 1 `; 60 (1%1 2, 0 1.4 ,
Daceiliv: Other PATInit:
Inspection Line; 503,639.4175 ‘\1U ,,
v ..k Dale Ku:Wyatt-, Jurt.,T- ' t Svc Pitau 2 for
. ' ethliiM
(MC Met! W WW .0 i . li gii id 0 1. 'US f 110 t% . . ' '
,.... 0 N V IS
04 Notirtedf:Oeshodi
-
• , Supplemental litforrnatIon
• . 7 ,„—,— . ..
• '
, ' • ' • TYMP,DOggi< ' •.
• •• . • ' PLAN REVIEW
• --
0 New constructiOn S Addition/alteration/replacement . Please chuck all that apply:
Li Servit,se over 22.5 amps. cornrn'l ['Hazardous location
0 Dernoliiion •al Other: OServi
, ce over 320 amps - rating OBLIildnE, ova I 0,000 Sq IL,
_._,. .
.. . . CATF,;GORY. OF .: : .'. . ''; . • .: ' .. . .' Or I- and 2-fami]y dwellings 4 or more new residential
O 1- and 2-f mm
2-tun lv dwe lili1 Coercial/industrial 0 Access 0 System ever 600 volts
ory building nominal units in ono stniinure
0Building ovix throe stories El Feeders, 400 amps or mote
0 Multi-camilv D Master builder 1.2 Other: ['Occupant load OW' 99 persons 0 NI anufactured structurc-i or
JOB SITE AND LOCATION • • " .' . ..
- ' - 0 Egross/liOntae, plan RV park
[30ther:
0 I•leilith-CMC facility
Job no.: c ?(:)6' ‘o'sr , Sub site address; ,gf 0 e) s w ge../,..e,2/ , y 4 /72 .5 7 Stibnii1 2,_ Sag of plans with any of the above.
City/StatelZIP: it e. 6 • q7,? ca-3 The above are not. applicable. to temporary construction NCTV13e.
! . , • .. PEE* SCIIEDUIY,
Suit /bldg./apt. no.: 7 7 Project 0101 e , ;■;;C.67 d. (.... ..
./.---/--(_.e..) Description
Cro street/directions to jet) site' ' (_ &.„,, , New residential single- or yotilti.family dwelling unit,
. includes attached garage.
1,000 sq. ft. or less 145,1•5 4
,--
Ea. atlit'1500 sq. ft. or portion 33.40 1
Subdivision; Lot no,:
1,imited energy, rusidential 75.00 2
Tax map43arecl no.: Unmcd enertv, non-IeNitlenlial 75.00 2
. . — -.-...
. • . :1)ESCIZIPTION: OF WORN; ' : . •• ' ' r .i.' . Itch manullicturixl or modular
dviellin7. service andiof feeder .,.. 90.90 , 2
Services or feeders installation, alteration, And/or relocation
....- - . -.. ..... ,
200 amps or 1(0.30 2
...
• 201 amps to 400 amps 106,85 2
,
0 PROPERTY OWNER , . . p...igNA NT • , .."
— ' 401 amps to 600 amps 16 0.60 2
Name: <'01 amps to 1.000 amps 240,60 2,
_
Adctross; Over 1,000 amps or volts 454.65
Reconnect only 66,85 4
City/state/ZIP; Temporary services or feederS iOstallation, alteration. and/or
_ - relocation
Phone: ( ) f.',:tx: ( ) 200 amps of le:ss
_-- .... -
Owner installation: This installation is being triaillJn properry that 1 o which is not 201 amps 10 400 amps 100,30 2.
intended for salc, lease, rent, or exchange, according to ORS 4447.449, 670, and 70!. 401 amps to 600 amps 133.75 2
Owner signature: Date; Branch circuits -• new, alteration, or extenkon, per panel
.
. • • 0. ArrucAN(:: • . . a .,. coNtAci . vtusoN ., . :. . A, Fee thr branch circuits with
. -- serviec or fceder fee, each
C I. 2
Business name: 4 branch el rcoit
name: -
-
13, Pet for branch clivuits
Contact'
without SCH.e.e. OT rthfiier fee,
1irst branch circuit ,•
Address: —
Each adtl'l branch circuit 6L5
—2 j
—
City/State/ZJP: Miscellaneous (service or lilt de not Included)
—
Phone I Pump or irrigation circle 53,40
-
: (5-03 ) 37-- 6 g 0 Fax: , ( )
Sign or outline lighting 53.40 .... -s
- - ...
13-mail: - ' Signal cireuit(s) or limited-
co
• CONTRACTOR '. • energy panel, alteration, or i 2 iS
' ..--- • • • ,. extension. Describe: Page 4 2
Business name; AOT Security Services
-„ -:-
Address 2 81 S W 153" Di Each additional inspection over atiOWable in any of the abo 'e
: 5 . —
•,. • -. Per inspection 82.50
City/Stew/ZIP: Beaverton OR 97006 Investigation pet hour G ::11: min) 62.50
-
Phone: (503) 469-7100
. ,
Fax; (503) 469-7114
• Industrial plant per hoot 7375
.._-
• • • :•.: ELECTRICAL PERMIT FEES'' • . • .'
• • •
I --
Cal 1.5c.: 59944 Electrical Lie.; 26-209CLE : Suprv. Lie.: LEA389 Subtotal 15' °--`-'
-
Suprv. EleCtriCian t-lignature, required 4 ..., 74,-,1ezez,./ Platt review (25% Of permit fee)
_,•
Print mime: keit., 4rit [ Date: 7/ 0 e6 State ma alter:nit re0 6. 0 °
TOTAL PERMIT FEE *V 6 ' °
Authorized sigriature:, , / , 6 4..0 4:2 „../ This pt•rmit uppliCAOCtil expires If a permit ii nut obtained 154141111 It10
• thin After it has been accepted AS complete
Print name: Al ; .. A/ 1 1 6:4 vs' I Date: n' Fee nleilso.;toiogy set by Tri-COA111',.e 11Ailtl•Its lads-toy s..,,,i, 11,,,rd
- - •• NtlAthAr tir inKpOeClOnS per pennii Allowod.
i ',1;61,3,,, q.C.-Permit.App.thn ;2(C3 s— -----!cao-ar,tf,r(itta2,1:0MAtIa
CITY OF TIGAFID _ BUILDING DIVISION DIVISION
PERMIT #: ELR2006-00282
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/20/2006 I
Phone: (503) 639-4171 .,:i tilii
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 12114/2006 TIME: 7:02AM PAGE: 54
SITE ADDRESS: 08900 SW BURNHAM STIL':_007C.f CLASS OF WORK:
SUBDIVISION: BURNHAM TRACTS LOT #: 006 TYPE OF USE:
PROJECT NAME: rINTERAGTFVEMEDICAL
DESCRIPTION: 'INTERACTIVE MEDICAL. Protective Signaling. Job #206651-1.
OWNER: BURNHAM BUSINESS + STORAGE LLC, PHONE #:
CONTRACTOR: ADT SECURITY SERVICES, INC PHONE #: 503.469-7100
Inspection Request Scheduled For: Date: 12/14/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 041046-01 503-469-7100 N
Corrections/Comments/Instructions:
•
A :ASS 1 PARTIAL APPROVAL 0 CANCEL fl NO ACCESS
fl FAIL pi CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: Q -... 7 '-- ' b Le . Date: 1 11 Phone #: (503) 718-2-
A-4---.—