Permit CItY O F T I G A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
aw r DEVELOPMENT SERVICES PERMIT #: ELR2002 -00122
'� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/10/02
SITE ADDRESS: 11765 SW PACIFIC HY PARCEL: IS136CC -00100
W
SUBDIVISION: ZONING: C -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Alarm Panel conversion.
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:
BARASCH, STEPHEN ADT SECURITY SERVICES, INC
BY WORLDWIDE REAL ESTATE 2815 SW 153RD DR
GENERAL MOTORS CORP BEAVERTON, OR 97006
DETROIT, MI 48202
Phone: Phone: 503 - 469 -7244
Reg #: LIC 59944
ELE 26- 209CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 7/10/02 $75.00 2720020000 Elect'I Final
5PCT CTR 7/10/02 $6.00 2720020000
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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
Issued by . �� � 1C& Permittee Signature ' 7ti a42#4'0.01
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: P6 C L�
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
07/02/2002 15:28 FAX 5034697110 ADT SECURITY a001
- - . El
Date received: - /O- O Z Permit no.:
�
; of Tigard — -� °`
-L ., 1 0 Projed/apptno.: Expire date:
City ogard Address: 13125 SW Hall Blvd, Tigard, +ORk 2 2
Phone: (503) 639 -4171 ` Date honed: By: 1312:11 Rcceiprno `
Fax: (503) 598 -1960 � v' 1 * Case filo no.: Payment type:
Land use approval: �. � J3 ��‘ X 6 7
O 1 & 2 family dwelling or accessory IC CogarciaUindustdai 0 Multi - family 0 Tenant improvement
O New construction CI Addition/alteration/repIacement 0 Other 0 Partial -
JOB SITE INFORMATION
Yob address: // 765 5( Aw n - fir //ivy Bldg. no.: Suite no.: Tax map/tax lot/accountno.:
Lot: Block: Subdivision: /
Project name: &ALE .E. idariodent I Description and location of work on premises: [r _ o , VUF y Az.,4 P1t1 i>tifL
Estimated date of completion/inspection: .
CONTRACTOR APPLICATION FEE SCHEDULE '
Job no: OZ• 126 73 L_O 2 Fee Max
Business name: Arn- ,see ra! fI Dest�ptlo ,te a) Total no T int
Address: 22 IS 314 'Sd r - NewresIde d -single oronm- ramnyper
dwel l: gmat.Ltdudesatadvedgarage.
Cit Sesimertalk state: Opt' ZIP:* 97006 Senlalndaded:
Phoneteetpii 41'7 /001 Fait Sal E-mail: - 1000 sq. ft. Dries • 4
CCB no.: erg 4 I Elec. bus. lie. no: Z6.2 9t LE L e dditi°rta15 a sq ft. or portion thereof
Li en rr8deatisl l 2
City / m • • i e. no.: limited :, , non•resldeatial 2
B ade m anuratiod home or modular dwelling
.. ?• oz. OZ g
Si F. : , ' of supery , g - eetricion (required) Date • Service and/or feeder 2
Sup. ect.name X8 9 Services or feeders - fustallatlon,
P (ant} KRAVt License alteration orreloation:
PROPERTY OWNER 200 amps orless 2
Name (print): l ' 201 amps to 400 amps 2 - —
Mailing address: • 401 amps to 600 amps • 2
• 601 amps to 1000 amps . 2
Cie: I State: 1 l 21P: Over 1000 amps omits 2
Phone: I Fax: [E-mail: ' Reconncctonly 1
Owner installation: The installation is being made on property I own Temporary services or feeders - •
which is not intended for sale, lease, rent, or exchange according to ' hO°,a1 on, orrelocation
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: ^ 401 to 600 amps 2
ENGINEER lirench circuits - new, alteration, •
Name: or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: ZI: S. Fee for branch circuits without purchase
Phone: Fax: p 1. of service or feeder fee, first branch circuit: 2 .
• Each additional branch circuit
PLAN REVIEW (Please cheek :ill that apply) Masts Oar,iceor feeder not Included): •
O Service over 225 amps D Health - care facility Each pump or irrigation circle 2
O Services over 320 amps - rating of Ida 0 Hazardous location Each signor outline lighting 2 -
family dwellings 0 Building over 10,000 equate fear four or Signal dreuil(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration. or extension* I 7575 2
O1ganding over three stories O Feeders, 400 amps or more *Description;
a Occupant loud over 99 persons 0 Manufactured structures or RV park Each additional Inspection over the allowable In soy of the ahove:
O Egress/lightingplan O Other Per inspection I 1 • 1 .. I
Submit _ sets of plans with any of the above. investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $ 7S a
all Judt
Not a dlcdoos matte ern* cards, please call jurisdiction foe more information. Notice: This permit application
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit � number a O
I / within 180 days after it has been State surcharge (8%) $ 6 -_
•
Name of cardh cord older as shown on credit d
Expires accepted as complete. TOTAL $
a
Cardholder sienature Amount 0404615 (6/(1WCOM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION- Business Line: (503) 639 -4171 MST -
BUP
Received D^at�e / Requested / s' AM PM BUP
•
Location l ! 2 5 �" ��- / .0 f f p �J� Suite MEC
y
Contact Person A 1 -°11/A Ph ( 544) �-' �? ✓ PLM
Contractor Fl. D : 1' Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR r Z c 2 L c t �Z
Crawl Drain
Slab Inspection Notes: _ SIT
Post & Beam ' ? �/�' �Z l
Ext Shear Sheath/Shear th / Srs Shear C � r/ , / S 'g TN)
Ext eah/ V
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING —
Post & Beam
Under Slab
Rough -In IPf
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PART FAIL _
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
111 PART FAIL
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date T Inspect) Mr Ext
Other:
Final DO NOT REMOVE this inspection record rom the ' b site.
PASS PART FAIL