Permit C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
iftotrevi DEVELOPMENT SERVICES PERMIT #: ELR2005 -00450
,.� !! DATE ISSUED: 12!29/2005
13125 SW Hall Blvd., Tigard, OR 97223 5 03 - 639 -4171
PARCEL: 1S134AA-01800
SITE ADDRESS: 10260 SW NIMBUS AVE M10 ZONING: I -P
SUBDIVISION: SCHOLLS BUSINESS CENTER LOT: 002 JURISDICTION: TIG
Project Description: Buglar 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:
ROBINSON, CONSTANCE A + ADT SECURITY SERVICES, INC
ROBINSON, LYNN + BELL, KAY ET 2815 SW 153RD DR
BY INSIGNIA COMMERCIAL GROUP BEAVERTON, OR 97006
BEAVERTON, OR 97008
Phone: Contact #: PRI 503- 469 - 7100
FAX 503- 469 -7110
FEES Reg #: LIC 59944
ELE 26- 209CLE
Description Date Amount
[ELPRMT] ELR Permit 12/29/200E $75.00
[TAX] 8% State Surchar 12/29/200E $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 95 - -001 -0100. You may ob :'n copies of these rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: .410 � ' Permittee Signature: �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 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.
12/27/2005 16:47 FAX 5034697110 ADT SECURITY 1Z1001
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Electrical Permi _1, Z∎ . 1� FOR OFFICE USE ON LY
City of Tigard . _ q v n ( , g. itNo
w' Petm, :,� —OD i
13125 SW Hall Blvd., Tigard, OR 972 - x ( � Plan Review
• Inspection Lane: 503.639.4175 . 03.398!1 ' OF ' ' J S O ^ , 4 , Ili Dat R : : Other Pe�mie
4tii Nod G e wmethod' I S Sppee ease a for
lnrormaaon
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New construction ❑ Addition/alteration/replacement Please check all that apply!
❑ Demolition ❑ Other: ❑service over 225 amps, comml ❑ Hazardous location
1 r �?-,� :,�ntr ; r *� -1e l��t�_ -y: -f� e ; u ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft_,
� :� � .1; - , 1 . .' 1 1: ; I ✓ el Ju j 1 7 5 :, !Ile Il ( i,7 ,7 Z .� 1 I) 1111' 111 r
3� " .'� L ' $ of I. and 2-family dwellings 4 or more new residential
tL :t4::a rin l� __� ,!�ci,ta,.Ilr. ,«libJ: 1! y
❑ 1- and 2-family dwelling % Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
El Multi- family ❑ Master builder ❑ Other ❑Bwldmg over three stories ['Feeders. 400 amps or more
❑Occupant load over 99 persons ['Manufactured structures or
1 F ;, '+Q n 1 - ` 1 .� 1 1 ldi I — "=-,T � , .C l � 11 I .!- �S � -t �.t I 1 'r I,. �';I!i
t f ~ ∎� 1 !1I '� N7,.. I li t IJ ,d r �_tr:".r/21r, 4 ' 2 ' ; ' .. /'� i,r' > j -Ir �� . � 1r 11 ;1�i,.)� . I � IL, :1 1 �' 11q :,. ❑E gr e s s / li g htlll g p l® RV park
❑Health -care facility ❑Other.
lob no .J:WynRao ;,, Job site address: l 0 00 an Mt i l Ml iS � Submit 2 sets of plans with any of the above.
City/State/ZIP: �i y� De CQ3 , The above arc not applicable to temporary construction service.
• t/' ( Iy ,r•�I�:. ate.— z'c��y
y� 1 l ltr!r �'` I i;7 r l, .1 :7 y' {71 . t i r -
Sul ldg. /apt. no. 1 -ib Project name s, „ ''�ydl � L _.. s .�1�'f.l.,lL� , ' ';• ft
Description Qty. Bee ut
To
Cross street/directions tolob 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.:
t>t M" 1 r T " Tr Ft I �: L �',477.., pt a — jrL'tT0.'� , f I j,' ',51.3.
11Irllted CIICr�y, non- rrbidential 75.00 2 P.
,, �.1`,i :1 .It's ' :� - I • I � .: \� i t. I .i : I i I :.1i 166 ..;" '' Sid wd I E ach manufactured of m odular
dwelling, service and/or feeder 90.90 2
S' '' , i4 4 . It I Services or feeders Installation, alteration, and/or relocation
• 200 amps or less _ 80.30 2
.fin' f "i� "- 1 ,4- 0J-i+?4i .rust. �•-Lr :417i,7't t ; r Pi t I� 201 amps to 400 amps 106.85 2
•.1JPw Ib 1.,-� J!=6.b 4E,Z,:2 !Ilia 1 4 —' , l�1 '; f" : ' 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 45445 2
Reconnect only 66.85 2
City /StBte/ZIP: Temporary services or feeders ta alteration, and/or
Phone: ( ) I Fax: ( ) relocation 00 ni s
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, ttmt, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: L 7g Branch circuits - new, alteration, or extension, per panel
L I,t" 1 1R _I a }" f .57 2 i s .� 1 ' I . ' - :. `4-"� 1' ra -7 e � t �'�` ';7, 1r " A. for branch circuits with
h 1 sl' 'i! I�� `, 1: / .! ..7 ;.,1 s ;� •� 1 �, Yfe v: a . i.: 7; '_ i41� -Li 1 A Fee service or feeder fee, each
Business name: branch circuit 6,65 2
',lib A DY
B. Fee for branch circuits
name: without service feeder e or feeder fee,
each branch circuit 46,85 2
Address: Each add'l branch circuit — 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( .— '5 I Day I Pump or irrigation circle 53.40 2
Fox:: ( )
Sign of outline lighting 53.40 2 `
E-mail: y Signal circuit(s) or limited-
,�gU ^< 9..1iI1 itF' 111; , Fly i F71 can +tl.r �1 L( 4 1�I . '' ' ..1. �5 l ! i 9 7�!, energy panel, alteration, or
Business name: extension. Describe: � Page 2 15, it 2
ADT SECURITY SERVICES, INC.
Address: 4511. 153rd DR . Each additional inspection over allowa in any of the above
RFAVFgrnk OR 9 Per inspection 62.50
City /State/ZIP: (503) 469.7100 Investigation per hour (1 hr min) 62.50
Phone: ( ) I Fax: ( ) Industrial plant 73,75
I Y I t ^I r V Y b 7 'L 4 i Pi'
CCB Lic.: 51°144 I Electrical Lic.: log us y )uprv. Lic_: 9 IAA
• Suprv. Electrician signature, required: /1A review (25% of permit fee)
\
Print name: eo I /� � Date: Ia4 -1\05 State surcharge (8% of permit fee)
J_ 1 1 TO'I'N. PERMIT FEE 81.00
Authorized signature: This permit application expires it a permit ill not obtained within 180
days aver it has been incepted so complele
Print name: Date: - Fee methodology set by Th - County Building Industry y Service Board
Number of inspections per permit allowed
wn,.;w:..ay....o.,m r_v.w..s a... .r.. ,,mv n I .a . . — . / 11 , 440.4etratarowcoM/wEa
CITY OF TIGARD
1 BUILDING DIVISION PERMIT #:iR2.4305', 00LIR)
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 preN ^il
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS NI N O5 CLASS OF WORK:
1
SUBDIVISION: 102 S LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: \)(z.4:6 NL `- PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description � Confim # Contact # Message
A t
9 � .
Corrections /Comments /Instructions:
ir)Gt do cr'30
*PASS PARTIAL APGAL ❑ CANCEL ANO ACCESS
OR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: N y] L_‘ Date: V ( 1 t\ L Phone #: (503) 718-