Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
ik DEVELOPMENT SERVICES PERMIT #: ELR2003 -00285
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/22/03
SITE ADDRESS: 11420 SW PACIFIC HWY PARCEL: 1S136AD -06200
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of limited energy for CCTV. Job No: 083 - 10222 -02
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: CCTV X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WY EAST PROPERTIES LTD ADT SECURITY SERVICES, INC
330 SW DIVISION PL 2815 SW 153RD DR
PORTLAND, OR 97202 BEAVERTON, OR 97006
Phone: Phone: 503 469 - 7244
Reg #: LIC 59944
ELE 26- 209CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 9/22/03 $75.00 Elect'I Final
[TAX] 8% State Tax 9/22/03 $6.00 '
Total $81.00
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a (. 1 1 6)
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
starte ,_within -480 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
y onto follow rule . dopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 throuc
Issued by t _ A∎1 iL■ Permittee Signature JUL I (0-1..../
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 639 -4175 by 7:00 P.M. for an inspection needed the next business day
09/18/2003 11:17 FAX 5034697110 ADT SECURITY 0001/001
a ,, . _
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Electrical PermitApplication
Mk r e c e i ed: ' / p 05 Lermit no.: f 8
� '►��. Ca o f 1 i I E D -,,,
City ofTigard Address: 13125SW v , g OR 97223 T/
pho ne: (5 03) 6 39 -4 171
Date issued: B- : - Receiptno.:
Fax (5 03) 59 -1 960 SEP 18 2003 Cane Zile n0. Payment type
Land use approval: CITY or TICAfD
- - T11'Is OF PERMIT
O I & 2 family dwelling or accessory Commercial/industrial 0 Multi- family Cl Tenant improvement
❑ New construction CI Addition /alteration/replacement CI Other. ❑ Partial
JOB SITE INFOR\1,1TIO N
Job address: 20 i ' I. Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot Block: Subdivision: ,
Project name: Ai r; g 11 P - • "ption anti location of work on premises: CC,,,
CON l itr1C' Olt APPLICATION FEE SCHEDULE '
Job no: •1. -- II . . '" AV tttry. .(ea.) Total
Business name: .1, /,r p PEI
Address: 28 FS Sul j 3r fl
City: - - mfr A st QJt ZIP • . Q . Serdeelndadert •
Phone -`. 69-7100 Fax .- mail: 1000 : 4
CCB no.: Sge, 4 _ Elec. bus. tic. no: 2.6-21W LE - M
no.: 2
City /me . • tic, n
0 9.1 I V 03 ch moneocnord borne or modular dwelling II
Si :1 P elearician (required] Dote
Sup. ekes name (plot): CA) Kla aus u oente no: LEA 3 :
PROPERTY OWNER 200 amps orb= 2
Name (print): ..Iill f _ -- ,' 1 1._. , l • ei 201 mops , , amps nu 2
ad• dress: f,Uy 1,f51 ' ! 4 ' % 4 , , I ME M • 2
/� �Q 2.
City: TLS S ta • : fit_ - • „ 1 1 11" amps er vlAis _NMI 2
Phone - r7q (p Fax: E-mail: Reconnect only 1
Owner installation: The installation is being made on property I own TemPonlOrsenicei
installation, alteration, or relocation:
which is not intended for sale, lease, rent, or exchange according to
ORS 447, 455, 479, 670, 701. amps or less 2
201 nmps to 400 ems 2
Owner's signature: _ Date: 401
EN C 1 t\' l; L Ii, Brandt circuits- new, alteration,
or extension per peek
Name: A. Fee for branch circuits with purdlose of
Address: service or feeder [cc, each branch circuit 2
City: State: • H. otservio r feed e er fee. rstbranch cirre �
Phalle: Fag: pry. ofeerveoleadfee ,firstcira,it
' ruirth additional branch eirpuit
PLAN 11, V1L1V (Please cheek :iii that apply) Bose . (Service ar feeder not todnded): •
O Service over 225 amps•commervial O Healthcare facility Each pump or irrigation circle - 2
O Service over MO amps-rating oft &2 O Hazardous locauon Bach sign or oudine lighting 2
renliby dwellings 0 Building over 10,000 square feet four or Steel citwit(s) ar a limited energy panel. ' I ��
CI System' over 600 volts nominal more residential unita in oMeaeruCtore alteration, or extension 2
CI Building overtlueea:ories 0 Feeders, 400 amps mo •
� *Description:
O Occupant load over 99 poisons Cl Manufactured a uctams or RV pant Ed1 additional Inspection over the allowable In any of the alma •
❑ Egrcaarlig hung plan 0 Other:
Per inspection
I • I . I
Submit _ sets of plans with any of the above. • tavesdgatioa fee c
he above are not applicable to temporary construction service. Other
Not all *Malone adept credit cards, please eaf)urtidlction for more adores Notice: This permit application Permit fee $ ''
O Visa O MasterCard expires if a permit is not obtained Plan review (at %) • $
Credit Cord number: / / within 180 days after it has been State surcharge (8%) , $ •
' Expires TOTAL as complete. TOTAL $ R .
Name of cardholder as shown on credit eaed
s
Cardholder /"
*Amore Amount �• � / • 440-4615 (6J00JCOI.)
10/0/2003 08:26 FAX CITY OF TIGARD (]001
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Building Division
Applicant Request to Cancel Permit
City of Tigard
TO: CITY OF TIGARD, BUILDING OFFICIAL
. 13125 SW Hall Blvd., Tigard, OR 97223 . RECEIVED OCT 2 3 2003
Phone: 503.639.4171 Fax: 503.598.1960
FROM: Applicant Name: OCT
Mailing Address: ztl J \5?1Yd Th 1
City /State/Zip: - 1 )- QQ\IQ -1 6n cRCNIs
Phone No.:T,M
• Fax No.:
PLEASE CANCEL PERMIT APPLICATION AND REFUND PERMIT FEES, IF ANY,
FOR THE FOLLOWING:
•
Permit No.: e - oo a 85
Type of Permit:
Site Address: \ Win �- %,c A(,
Subdivision:
Lot No.:
EXPLANATION: i O.XI GH Q V 1 Rt,i
Ujaa r rrr \o\
•
Signature: Q)\1).X \ \ 1�
Print Name: i(' \
•
FOR OFFICE USE ONLY
Route to Admin.: Date: By
Permit Canceled: Date: By
Refund Processed: Date: By:
a0o3 - yea 3 y/2 2/03
` )OD9 77 BOG 3 4Y/o iN3uiid ngTonns\RegCancelPernnic.doc 04/03 ��y�o