Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
� 1�'� DEVELOPMENT SERVICES PERMIT #: ELR2001 -00044
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/20/01
SITE ADDRESS: 12750 SW PACIFIC HY PARCEL: 2S102BD -01503
W
SUBDIVISION: FREWINGS ORCHARD TRACTS ZONING: C -G
BLOCK: LOT: 001 JURISDICTION: TIG
Project Description: Alarm
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATAITELE 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:
GOSPODINOVIC, RO SE BRINKS HOME SECURITY
12770 SW PACIFIC HWY 8080 SW CIRRUS DR
TIGARD, OR 97223 BEAVERTON, OR 97008
Phone: Phone: 641 -0574
Reg #: SUP 2650JLE
LIC 44421
ELE 34166CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 2/20/01 $75.00 2720010000 Elect'I Final
5PCT CTR 2/20/01 $6.00 2720010000
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 Permittee Signature' 01,�,��., 4, ,A j4
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
10/18/00 WED 11:22 FAX 503 598 1960 CITY uh TIGARD 0002
r
Electrical Permit Application
Date rereived62 ad p / Permit no.: Ea Zoo[ -DOO '
t�• l' 1Y City of Tigard _., � g ProjecVappl.no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
. ; . tYPL or millet . '. •' .
O 1 & 2 family dwelling or accessory ! CommerciaVindusttial O Multi- family 0 Tenant improvement
O New construction O Addition/alteration/replacement O Other: ❑ Partial
loll ,SITE INFORIIATION• • , -
Job address: /.2-75 O Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: Block: Subdivision:
Project name: Description and location of work on premises: Alm" - ,l A
Estimated date of corn 'letiof/ins. 'on:
. CONTR ACTOR APPLi(:Al'lON 'FEE SCIIEUULE • Job no: / ( 2 0 / 6 3 F ee M ax
Business name: J. ,,f �,,y, - Des ion IN (ea) Total no. irtsp
New residential -single ormultl- family per
Address: r r s- ,,, t 221 On_ dwe llingtmit[nciudesatfacbedgarage
City: j ' , Statc:b2 Ey, 7 t5 A i Serviceincluded:
Phone:s if Y/_ • (6 Fax:G y! -0 9, A E -mail: 1000 sq. ft. or less
CCB no.: B , 'lee. bus. lie. nog /6, c Fact additional 50Osq. it. or portion thereof _
City/metro tic. no . Li •t . � , . . i.
Cit
y 11 1 • 0 / Limited energy, non- residential ___ 2
• 1 7_1 �. Each manufactured home or modular dwelling ■■■
Signature of supervising electrician (r uired) Date , a, , Service and/or feeder 2
Sup. elect name (print):�7frlfF Services or feeders— installation,
Ill
fft« alteration or relocation:
PR0YLItT1' 011 ' N I:R 200m or
a.sless 2
Name (print): _ „. _ ^ ^ fC_ . 201 amps to 400am.s 2
M ailing address 401 amps to 600 amps 2
601 amps to 1000 amps
State: ZIP: / St ZIP 2,13 over l000atrtpsorvolts P P _ 2 ___ 2 •
Phone:. • -, ; 67— 1211 E -mail: Reconnect only __ I
Owner installation: The installation is being made on property I own Temporary aersicesar[eeders- 1111MM . 2
which is not intended for sale, lease, rent, or exchange according to imhstaltalian ,allcratlan,orrelocaHott:
ORS 447, 455, 479, 670, 701. 200 au s or less
201 amps to 400 amps
_ 2
Owners signature: _ Date: 401 to 600 am. �_ 2
ENGINEER Branch circuits new alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit
City: State: ZIP: B. Fee for branch circuits without purchase III
of service or feeder fee, first branch circuit:
Phone: Fax Each additional branch circuit: __
. • PLAN RI?%II•:11'(Pie:tse'tlteclt all that ,apply) ' Misc. (Service or feeder dot included):
O Service over 225 amps- commercial 0 Health-care facility Each pump or irrigation circle . 2
O Service over 320 amps -rating of 18t2 0 Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10 ,000 square feet four or Signal circuit(s) era limited energy panel.
O System over 600 volts nominal more residential units in one structure alteration, or extension* a 15 2
O Building over three stories Cl Feeders, 400 am more � or •Deacri .lion:
O Occupant load over 99 persons O Manufactured structures or RV park Each additional Inspection over the allowable In any of the above.
O Egre.sstightlngpian U Other: Per inspection __—
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $ 15. (X)
Not alt Jaaisdrations accept credit cards, please call Jurisdiction for more infotmatloa Not ice: This permit application
O visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card cumber: / / within 180 days after it has been State surcharge (8 %) .... $ . (o. OD
6rpites accepted as complete. TOTAL $ Q • DU
Name of cardholder as shown on credit card
$ —
Cardholder signature Amount
440 -4615 16/00iCOM)
CITY, OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 0.7 - 7 - - / AM PM BLD
Location / Z. 7S fc t (-/ Suite e-/ ( MEC
Contact Person Ph Ze) 674 Z PLM
Contractor fi r, �� lL Ph A -8 SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR 2„ u / – GU 00-(
Footing Access:
Foundation FPS
Ftg Drain — r✓L SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Fire wall
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
RT FAIL
EL CTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
F'•:
PART 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 reinspection RE: Unable to inspect - no access
ADA
Other oach /Sidewalk Date /A Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.