Permit 1 '
CITY OF TIGARD ELECTRICAL
RESTRICTED CTED ENERGY
r DEVELOPMENT SERVICES PERMIT #: ELR2000 -00060
All 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 03/17/2000
SITE ADDRESS: 11975 SW PACIFIC HWY PARCEL: 1S135DD -05000
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Install 1 protective signaling system in existing commercial building.
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:
DORN, FRANK D + RHODAJANE TRS ADT SECURITY SERVICES, INC
c/o TRENARY, BRYAN W /JUDITH A 2815 SW 153RD DR
WEST, ROBERT C BEAVERTON, OR 97006
BEAVERTON, OR 97007
Phone: Phone: 503469 -7100
Reg #: EL E 2620990 LE ORIGINAL
EL 2620C
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT KJP 03/17/200C $60.00 0000747 Elect'I Final
5PCT KJP 03/17/200C $4.80 0000747
Total $64.80 •
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 th o •gh • R 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987. p
Issued by �
Permittee Signature 'L
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 1t) lam' DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY( OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rec'd by:
1312� BLVD
TIGA p OR 97223 PRINT OR 1. TYPE ` �� G ® Date Rec'd:
V - 503 -639 -4171 X304 �-/ :a��� `�' tiV(� �. 2 f
Permit #: &L D-00760
F - 503 - 598 - 1960 INCOMPLETE OR ILLEGIBLE APPL TION 4 � Cust.Call'd:
t /it) - 0 X WILL NOT BE ACCEPTED , ti , \ O ,,44%
Name of Development Project TYPE OF . c . • K I VOLVED - RESIDENTIAL ONLY
�
n V Restricted E n
i f / � - 1I0R�I fi P t1r � 4 L_ (FOR ALL SY , ; � S) 560.00
JOB Street Address Ste #
ADDRESS ' Ic75 to U1 . _Ge Check Type of Work Involved:
Cit /S ate Zi one # El Audio and Stereo Systems
I c-? P �i7 3 r Ph, oz_t n
Name
E l Alarm
t � p..
OWNER Mailing Address ❑ Garage Door Opener'
City/State ' Zip Phone # ❑ Heating, Ventilation and Air Conditioning System*
Name ❑ Vacuum Systems*
ADT SECURITY SERVICES, INC. ❑ Other
:ONTRACTOR Mailing Address 2815 S.W. 153rd DR.
BEAVERTON, OR 97006 TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Prior to issuance a City/State (50 » b9 -7100 Phone # Fee for each system $60.00
:opy of all licenses (SEE OAR 918 - 260460) -
are required if Oregon Contr. Brd Lic # Exp. Da e
expired in C.O.T. 4-4'961- '/7 �/ Check Type of Work Involved:
data base). Electrical Con r. c. # p ate , rte
9 /0 67100 J ❑ Audio and Stereo Systems
C.O.T. or Metro Lic. # Exp. Date
❑ Boiler Controls .
Owner's Name
❑ Clock Systems
OWNER - Mailing Address
APPLICANT ❑ Data Telecommunication Installation
City/State Zip I Phone # ❑
•
Fire Alarm Installation
his permit is issued under OAE 918 - 320 -370. This applicant agrees to . .
take only restricted energy installations (100 volt amps or less) under this ❑ HVAC
?.rmit and to do the following:
❑ Instrumentation
Only use electrical licensed persons to do installations where required.
Certain residential and other transactions are exempt from licensing. ❑ - Intercom and Paging Systems •
These have asterisks(*). All others need licensing;
•
•
Call for inspections when installation under this ❑ Landscape Irrigation Control*
permit ready for
inspection at 503 - 639175; ❑
•
Medical
Purchase separate permits for all installations that are not ready for an ❑
inspection when the inspector is out to inspect under this permit; Nurse Call
Assume responsibility for assuring that all corrections required by the ❑ Outdoor Landscape Lighting*
inspector are done, and;
•
Protective Signaling
Assume responsibility for calling for a final inspection when all of the
corrections are completed. ❑ Other
•rmits are non - transferable and non - refundable and expire if work is not
.rted within 180 days of issuance or if work is suspended for 180 days. Number of Systems
e person signing for this permit must be the applicant or a person • No licenses are required. Licenses are required for all other installations
:horized to bind the applicant.
3g FEES: •
ti. ENTER FEES $ 6 Q , t0
b06 (.05 X TOTAL ABOVE) $ . 8
'thority if other than Applicant TOTAL $ 6 q, g a
.tsVorms resele.doc 3/98
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested q f/g . AM PM BLD
,n
Location (Ci — 7 S Y Q.0 Suite MEC
Contact Person It Ilk/ _ v Ph V ia q' i 0 PLM
Contractor A 1 Ph SWR
BUILDING Tenant/Owner S Y 111�C - '�l/yl 6 /39f i ELC ,`
Retaining Wall ELR 7--ten OCOIDC)
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation -
Drywall Nailing i
Firewall '7
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL _
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
S
Rough In
UG /Slab
Low Voltage
Fire Alarm
eco ART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for rei spection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date 6710 Inspector Ext
Final
PASS PART FAIL D NOT REMOVE this inspection record from the job site.