Permit . *
CITY OF TIGAR® ELECTRICAL -
RESTRICTED ENE ENERGGY
4 11111( 1 ‘ DEVELOPMENT H BMENT r SERVICES � 639 -4171 DATEESSU 9/5/01 001 =00221
SITE ADDRESS: 08015 SW HUNZIKER ST PARCEL: 2S101BD -00300
SUBDIVISION: ZONING: I -L
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of burglar alarm and access control panel. Job 083 - 00189 -04
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: : X
TOTAL # OF SYSTEMS: 2
Owner: Contractor:
LOSLI, E HOWARD TRUSTEE AND ADT SECURITY SERVICES, INC
SEABROOKE, CAROL ET AL 2815 SW 153RD DR
BY PERFORMANCE CONTRACTING, IN BEAVERTON, OR 97006
CHARLOTTE, NC 28217
Phone: Phone: 503 - 469 -7244
Reg #: LIC 59944
ELE 26- 209CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 9/5/01 $150.00 2720010000 Elect'l Final
5PCT CTR 9/5/01 $12.00 2720010000
Total $162.00
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. gh OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987. / _
A/
Issued by , � / .Z4 Permittee Signature ij 'j
OWNER INSTALLATION ONLY TT
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: d)1 g l / a DATE:
LICENSE NO: -- 1p -.WI G LL
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
09/04/2001 09:09 FAX 5034697110 ADT SECURITY a001/001
- Electrical Permit Appl' ation - l
6 •
Date received: q/610 / Pert no, 2 0i 2, / •
y ••� � City_ of Tigard — -- - Project/appl: no :: - - -- -- Expire nit date: 1 _
Cily of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: ,
By: tt R eceil no.:
Phone: (503) 639 - 4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
El 1 & 2 family dwelling or accessory ,I ommercial/industtial ❑ Multi - family ❑ Tenant impror :rent
❑ New construction ❑ Addition/alteration/replacement O Other: p P
JOB SITE INFORMATION '
Job address: go/5 SW Nuvtzt d Bldg. no.: Suite no.: Tax map /tax lot/account no
Lot: I Block: I Subdivision:
Project name: t r • • M , I. _ , Description and location of work on premises :.. a d A : • ' S rphir,
Estimated date of completion/inspection: •
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: r :c- "IS't- 0 1 411111.11111111111111111M
Fee Max
Business name: AI i - " _ ' ' T II ' - • Description Qty. (ea.) Total no. insp
Address: 2815 S.W. 13RD Dr. New residential = per unit Indudes attached garage.
dwelling
City: Be verton, CbRaten0C 6IP:
Phone:j.)ip9 - ZqY I Fax: (//,Cf-- o I E -mail: ttt 4
Each additional t .. �_
CCB no.: -- � I yy I Elec. bus. tic. no: �( (' ( Limited energy, residential ' 2
��
City /me A lic. no.: Limited energy, non- residential __ 2
Sign.i re .supervising ele` ian (re. uired) D�, and/or . . .. ■■ 2
Sup. elec . name (print): ` -• A U License no � � installation,
PROPERTY OWNER . . 00 : less 2
Name (print): 201 amps to 400 • 2
• .t .,tt: 2
Mailing address: 601 t t amps 2
City: I State: I ZIP: Over t 0 amps or volts 2.
Phone: I Fax: I E -mail: t
Owner installation: The installation is being made on property I own Temporary services or
which is not intended for sale, lease, rent, or exchange according to ' ' ion:
2mps or less
ORS 447, 455, 479, 670, 701. 00 ' 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 : . 2
•
ENGINEER Branch circuits - new, alteration, O.
o .
A. Fee for branch circuits with purchase of _ s_ ,
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):
❑ Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps -rating of l &2 ❑ Hazardous location Each sign outline lighting 2
family dwellings ❑ Building over 10.000 square feet four or Signal circuit(s) or a limited energy panel, �+
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2. tS6 1'50 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
Cl Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the alw e:
❑ Egress/lightingplan ❑ Other.
Per inspection
Submit sets of plans with any of the above. . Investigation fee
The above are not applicable to temporary construction service. Other
Nor all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ _ / 5Q. OC
❑ Visa ❑ MasterCard expires if a permit-is not obtained Plan review (at _ %) $
Credit card Dumber: / / within 180 days after it has been State surcharge (8 %) .... $ _ ! 2 . O P _
Expires accepted as complete. TOTAL $ _ 6 2 , ��
Name of cardholder as shown on credit card $ •
Cardholder signature Amount 4: 1-4615 (6IO0/COM)
•
CITY OF TIGAI 24 -Hour
t Inspection Line: (503) 639 -4175
BUILDING p MST
INSPECTION DIVISION Business Line: (503) 639 - 4171
BUP
Received Date Requested `) aNti d AM PM BUP
Location 0 S W v\C Z 1 \e<4, Suite MEC
Contact Person Ph ( ) PLM
Contractor - Ph (,G ) J4c' r)3.1-1 SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access: j
Ftg Drain ELR c- D 1� (M,'1)
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam � �1�, l ,1`l �- M 01\
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation (\ L� V
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm (-I "
Susp'd Ceiling \`
Roof
Other:
Final
PASS PART FAIL
PLUMBING'
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole \p & ,� b1 1 v c1 V f 0 ,� I c l {) �,�,�, 11( c-or),
Storm Drain J ��' ' \ v \ ,
Shower Pan a , ! 6
Other:
Final
PASS PART FAIL
MECHANICAL
Post& Beam
Rough -In
Gas Line
Smoke Dampers
Final
• FAIL
ELECTRICA
Rough -In
UG /Slab
• Voltage
Fire ar
PART FAIL
111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE 111 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA - -2-- Ext
Approach/Sidewalk Inspecto .% /� / �=
Other:
Final DO NOT REMOVE this inspection record rom the job site.
PASS PART FAIL