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Permit CITY TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT . i �, l t� DEVELOPMENT SE RVICES PERMIT #: ELR2005 - 00268 �:� li 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/8/2005 PARCEL: 1S127DD-00100 SITE ADDRESS: 09730 SW CASCADE AVE ZONING: C - SUBDIVISION: LOT: JURISDICTION: TIG Project Description: Fire alarm system. Job #083 - 02190 - 22. 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: X OUTDOOR LANDSC LITE: OTHER: : HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: • TOTAL # OF SYSTEMS: 1 Owner: Contractor: T MICHAEL + ASSOCIATES LTD ADT SECURITY SERVICES, INC ATTN: JOHN WEGMAN 2815 SW 153RD DR 9200 E MINERAL AVE, SUITE 200 BEAVERTON, OR 97006 ENGLEWOOD, CO 80112 Phone: • Phone: 503- 469 -7244 Reg #: LIC 59944 ELE 26- 209CLE FEES Description Date Amount REQUIRED ITEMS AND REPORTS [ELPRMT] ELR Permit 9/8/2005 $75.00 [TAX] 8% State Surcha 9/8/2005 $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: ' j, ' / 643 . 2 . Permittee Signature: - c- 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. • 09/08/2005 08:38 FAX 5034697110 ADT SECURITY 0 001/002 .Electrical Permit Application FOR OFFICE USE ONLY . . • ., City - of Tigard P LAC E tI V E © Received 9 Permit No. ` �U - f , N. 13125 SW Hall Blvd., Tigard, OR 97223 Plan U 0 Om1;0 Date /B view Phone: 503.639.4171 Fax: '503.598.1960 �i� ��t, O � � i �� 11 , {Nh i nf � ' i f \ Date/B Other Permit: Inspection Line: 503.639.4175 oAk . e Date Ready/By: lin a See Page 2 for Interne: www.ci.tigard.or.us Notified/Method: Supplemental Information �s;'9'^i } �+�i tv t ) 7 tai T 6 +S Tr, ,i J.v •.y SS` ul ny . ir' r . •1 n+� t f r•) m,: A 3 , • i +I !' 4y�1 " PV- ;4 "rti,h' • ki • x r .. M1 t , fit , id , a �,� t ' s ' � , li h d 5 y3t ii V'' 4 I f C ri� : � A40741. ,,,,*, S'ik•i:: • " '1 ,.. Eg1 A ,� lig: - sted5� . 1 itc :,.r.11i r,L, ,.� gli f xc l + t / S i '; ,. A t'- ') . ; :+ ts: w i t a•'•' - yi U, ^ .:�4 ��:;.,.c {ud•d1�d P�.�.iJJ�?�fet���` � It` � . , � . New construction ❑ Adiirtionateratiori%replacement Please check all that apply: ❑ Demolition ❑Other: Service over225 amps, comm'l ['Hazardous location a , sl � r t � rn�Tr ,�^� 5, j r,7 �}�( , � ,,,�,� ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft -, • ,i..t �,:_ 1t- .t'tr! ' li; AID y J_ I iP trims 1•, .0 i t Jk, .a � a >t:...- 3rt'®,c '� ei : 0 11 ,i` :l ' , ir„ ti 7 .t i = 4 f 3 � l � ,I; of 1- and 2- family dwellings 4 or more new residential ❑ 1 and 2 family dwelling Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑Building over three stones ['Feeders, 400 amps or more El Multi 0 Master builder ❑Other £ o , ; N ,;, { ❑Occupant load over 99 persons ['Manufactured structures or l: l� >iT�. „uh r I 0:• ft B91 i W ;', °i u (! ,' ; y''•'r i` "K f l lg Fl - i w , . ��_ ti�?t ,, d da zlsf S•`rti.�t.1t'r ❑Egress/lightingplan RV park t , ❑Health -care facility ❑Other: ' Job no.: (,m aal 9D ,, ob site address: I I w �+ C i 1' Submit 2 sets of plans with any of the above. �. City/State /ZIP: po,� I. O t��=� L The above are not applicable to temporary construction service. Suite/bldg. /apt - no.: Projectname: lA ,0 �V �d�2t � il�t� ' i�4�t ` , , a t �,�t 'e d J ", � ; :,._,.,. Description Qty. Fee. Total .. Cross street/directions to job site: New residential single - or multi family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no.: Ea. add'l 500 sq, ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map /parcel no.: _ ; Limited energy, non - residential 75.00 2 ! LL �Fk,frs,_ 1i. i ,, �s � i J j . '1, '71't! s + h i M F ' y"4T4li? ' r ., fi e ,,_r . ,N,. -. k, f v`;,. o de2 ,,g _ r� 1 ?., Ivan' iidt .,1: nr .fLt . l Each manufactured or modular T ' / i dwelling, service and /or feeder 90.90 2 LV' I `-li 1 At Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 Tx4s hr r il g � i 'l t ++ ( p 3 ' 4 d iiiti ^ � a i 1 � i g p o V, , + V 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: 601 amps to 1,000 amps 240.60 2 Address: • Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State /ZIP: Temporary services or feeders installation, alteration, and/or relocation ( ) Phone: ( ) Fax: 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 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 circuits - new, alteration, or extension, per panel s 1g ;.; t .I ', * x ` � i ul:.� O i 11t 1 l i r � t ) # 7 l� t at tier ) , ; 1 1 1 r it l'' ` .- ti4 r . N J s * ft A . Fee for branch circuits with - '• " ""�'�'" s '"`.1 K-' service or feeder fee, each Business name: branch circuit 6.65 2 t pot B. Fee for branch circuits n = e su r \\ Contact name: � 'x\ s A wihout service or feeder fee, 101 each branch circuit 46.85 2 Address: Each add'I branch circuit 6.65 _ 2 City /State/ZIP: Miscellaneous (service or feeder not included) Phone: (() 6316_. 9M Fax: : ( ) Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E-mail: :! _ // Signal circuit(s) or limited - sr 7 f irff k ('w- f +,1 +`1 t �'11R!!t ln1 'vlt 11taEV IIA'.Ji1�31a.,6°Il`i�`�h�yl•. llg!`�y} Y�{, } e� :.�. `P a. energy Panel, alteration, or extension. Describe: I Page 2 15.Db 2 Business name: ADT SECURITY SERVICES, INC. Address: 231b .W.153rdDR. Each additional inspection over allowable in any of the above ItVFRTf)N, (1R 970f1R Per inspection 62.50 City /State /ZIP: (503) 469 - 7100 Investigation per hour (r hr min) 62.50 Phone: ( ) Fax: ( ) Industrial plant per hour _ 73.75 ai v?i'�.�.°l ;il''!ti. * : : :11k 4v ,.t 4,! l� l?i• 4hAikk'); .,1�'+R,G,"r1? ; ; '- ''. r'�,e'L,� y ` . L ' CCB Lic.: 59 gL44_1 Electrical Lie.: , . ••ii e lf✓ uprv. Lie.: g Subtotal Suprv• Electrician signature, required: _ • Plan review (25% of permit fee) Print name: '4 k/ U Date: • b State surcharge (8% of permit fee) U. M fff��� TOTAL PERMIT FEE $1.00 Authorized signature: This permit application expires If a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board "* Number of inspections per permit allowed. istnuilding\ Fertnits \ELC- PcrmitApp.docl12/03 . 7 _ I 440.4615T(10 /02/COM/WEB 09/08/2005 08:39 FAX 5034697110 ADT SECURITY 2t1002/002 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: 1 a.''?,'�y;;,,y 6'� b'rrl h�l it 7 %i� t tC,�'�4)., wt 5 '1,'`© 1 '��t rt' ��.�,� i "'r7E't V!_�:c.�'..._� .... �cs.,�.r.r ��vietn �. ��:.'tx��� �'If1�ti� t �tF",[i Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* - El Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning ,System* ❑ Vacuum Systems* ❑ Other: C v(� o f ic y 'q ''T k � t t rs h A t ti << h`a. �r l,11 r'`+�irtl yvlE�iW 5 t � „ '4,d i I:f v „ar�-�.- y i �:: J's t,iu.:.itt tr i ' • ; t r•�i. Fee for each commercial system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling Other fr'A Total number of commercial systems: *No licenses are required. Licenses are required for all other installations is�8uilding \Permits\ELC-PemtitApp.doc 04/03 c CITY OF TIGARD . ,• BUILDING DIVISION PERMIT #: ELR2005"00268 13125 SW. Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/8/2005 Phone: (503) 639 -4171 AA tlnry�ii i- Inspection Requests (24 Hrs.): (503) 639 -4175 �_' ''II.. - ,_` INSPECTION WORKSHEET FOR DATE: 9/16/2005 TIME: 7:01AM PAGE: 92 SITE ADDRESS: 09730 SW CASCADE AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: SHANE CO DESCRIPTION: Fire alarm system. Job #0B3- 02190 -22. OWNER: T MICHAEL + ASSOCIATES LTD, PHONE #: CONTRACTOR: ADT SECURITY SERVICES, INC PHONE #: 5034169 -7244 Inspection Request Scheduled For: Date: 9/1012005 Pour Time: Code # / Inspection Description Confirm # Contact # Message 135 V Low voltage 015839 -02 503 - 595.7900 N Corrections /Comments/ Instructions: ‘*'.....r‘‘A__1\) • ,. ii PASS fl PARTIAL APPROVAL n CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector:, Date: , — 1 6 — Phone #: (503) 718 -