Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 - 00424
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/23/2005
PARCEL: 2S 103DD -00800
SITE ADDRESS: 13815 SW PACIFIC HWY 110 ZONING: C -G
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Low voltage for burglar alarm.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOC 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:
D.W. SIVERS COMPANY ADT SECURITY SERVICES, INC
4730 SW MACADAM AVE 2815 SW 153RD DR
#101 BEAVERTON, OR 97006
PORTLAND„ OR 97201
Phone: Phone: 503- 469 -7244
Reg #: LIC 59944
ELE 26- 209CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 11/23/200f. $75.00
[TAX] 8% State Surcha 11/23/200E $6.00
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 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: ` 1'L� % /�! Permittee Signature: S? � sQ Nf
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.
11/23/2005 09:47 FAX 5034697110 ADT SECURITY 21001
• Electrical Permit A I I lic , l' o n V FOR OFFICE USE ONLY
City of Tigard G Received - D j /�� Permit G i0
13125 SW Hall Blvd., Tigard, 1 191 3 O� Date/9 : �Q /
Plan Review
Phone: 503.639.4171 Fax 51 .598,1960 4+� ^O L O k+ %li;•. 1'''' Date/13 : permit:
Inspection Line: 503.639.4175
k\0 P " � � C?P - '`- Date pea ely/By: El See Pa
Internet: www.ci.tigard.or.us `` �\ * `..__ ge2for
0% a v C -' NodC�ed/Method: Supplemental ltforinauen
i Y'� � rf L�jP� -� 'r, r*7 n� SU. � r ' 1'Li ..R � •t�1 R nx � i
t` I 3 � � r i ; { i t q F U + ,y 3 L I ( I t ' ' I i l'rl• 'ill . I y t . , .
�i_,'J t�l ,I; ' iP I ' . r s N L v i, w I 1 I �I� , °�. L r F I � 11n ; p . t
I Now construction _ .� _ , 1�2�I:c�b b „ ' : . '� . . ".wi o��i ill �. '
ction [] ,, .i ion/alteration/replacement Please check all that apply:
❑ m
Service over 225 amps, com'l ❑Ha2ardous location
C] Derllolihon ID Other
iIT`Cni li, T• n r t �,C;�T'�j ervice over 320
�'' 3 amps - rating sQ
�},� � ,Tu � l Bulldn over 10,
;, -�+ 1, 1., - „21 .am,: 1 ..B`a'li_ ;'vrt „8,4 'car- r it;; !w ` I tt w�,,"� . EiNi `11i`�li ❑S ►nP g g a id , l
- '� ��Rt�(�:dl'�.air •�r'•'C' 11:v.��'.���_l�ii(1ea of 1 -and 2-family dwellings 4 or more new res idential
❑ 1- and 2- family dwelling I Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
[] Multi - family ❑ Master builder ❑Other:
OBuilding over three stories ❑Fccders, 400 amps or more
R' : t , S r � 11 ,., ., ;, Y b ( Tr; ^ r s - t5 r.r �w . n ;;.ryt ° cr,7t1 5 : ru• .n ❑Occupwtt load over 99 petaOna ❑ Manufactured structures Or
Le' : •I••'} G ' � n,i 4 ' f a l •• , '. rt T '' - , . re 17 l r';r,4t rrrr-'-i ' a 4 +�� II ,; I�� O P'' ❑ Egre s si b ght m gPlan
RV park
L Gtic : k, u�, ,
Job no.:O " 0 ; . Mite address; • 1 l , ❑Health•care facility ❑Other:
_
S ubmit 2 sets of plans with any of the above.
City /State/ZIP; ♦ T he above arc not applicable to temporary 1 + b I .. PP construction service.
ld Ja t no.: - ; t r . : - ,� `I � l --tri�+,, i ctirY ii : c?1� ` ,' r ' :ii _ , , . •
1 , /� 1�T'i� ,
s p 11 • Project name: ( l.l.l J IM� U t. "f r J�L-ii' i _ •r: .'„• 1 �l 091• .,ire t ' • . •• -
'1 peon Qtr. Fee. Total
Cross street/directions to job 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.(1. or portion 33.40 1
Tax nzap /porcel no.: Limited energy, residential 75.00 2
c ter, 1 vv. rr�;r , Limited energy,
' 1 r t:,��,: ,P, ) } �. ° 7i 4 'n•S F" '�'" } "f1' � :, uilll "Tl,r•Zr,�L' . ES7'. 75.00 2
�•� � �U: .....+5 �.�.i. � v r.,. 4_..� 1L,. - i. , u.IL •.I �I 1zrti.;,.t.� .�•]iil�.���y'L�n '��. � r�.r��I�L hmanufactured or modular
dwelling, service and/or feeder 90.90 2
i ' L . _ . 1.
Services or feeders i nstallat i on, alteration, and/or relocation
200 amps or less 80.30 2
1}gr ;�- rOir .77 14 y7 4 � '. ° + lei ,7 ' .
�� w t ' y �: , i � r o sg '3 201 amps to 400 amps 106.85 2
.
.. iti. U .11j. o_1 ,, i rF _rs ,1 ..a.t - �1 ' y _, 4....;-,v,.. S'• k.
� .4'��r_ "" � �- .krtp" l , :'i ''r 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 454.65 2
- Reconnect only 66.85 2
City /State/ZIP: Temporary sea-vices or feeders installation, alteration, and/or
Phone: ( ) Fax: ( ) relocation
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, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date:
F , �, . _�.. ,� _ Branch circuits - new, alteration, or extension, per panel
N y �� },_ �I Lr ,J IJ� 1,4r I; �Trt ; �.�, t �� f htrr I I(m'r, I } k�' 1i�4 f ` :` y -O F ' . ''. A. Fee for branch circuits with
C i
V a T - a 51. ! '1 rJq(i., i 1_ 4 ;4,1 0 1A . lxll:?�:F4 Ut 4 SeCviCC Or f eeder fee, e.7011
Business name: branch circuit 6.65 2
,' Q ex B . Pee without service ser circuits
�� u
Contact name: 1 w;thw or feeder fee,
Address: each branch circuit 46.85 2
Each add'l branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: (b C l cg ()l l Pax: ( ) Pump err irrigation circle 53.40 2
J Sign or outline lighting 53.40 2
TE "�I,i 1=r III 1 r _ Signal circuits) or limited.
L au r(. I I,I �,(�;�I, 172. !`I1 `t.r �. s \, LE ;.,�. � T L!l.'�ltTll '1 j:�f T; i , enQgY Pond, alter3tiOn,Or
"� extension. Describe: I Page 2 15 -Dt) 2
Business name: ADT SECURITY SERVICES, INC.
Address: 2815 S.W. 153rd DR, Each additional inspection over allowable in any of the above
am : • , :r eI . Per inspection 62.50
City /State /ZIP: (503) 459-7100 Investigation per hour (1 hr mini 62.50
Phone: ( ) Fax: ( ) industrial plant_ per hour 73.75
1
CCB Lia .4.1 itg ! 1 = iii " �3.;411�!I +.k(:. �.17"'lyYl'`-,��`�'14,2i :Z:;•,aa:"j;••:1
Electrical Lie.: ,. • • G1.� . , 0
�"„ r '"
• �qL � uprv. Lic.: •
• , : Subtotal
Supra. Electrician signature, required: - Plan review (25% of permit fcc)
Print name: Date: + 3 D _ Stare surcharge (8% of permit fee) b-�
TOTAL PERIVEIT )r EE1 81. DP
Authorized signature: This permit application expires if a permit Ii not obtained Within Ind
days after It bar been aete fed as complete
Print name: Date: • Fee mcthodolory set by Tri -Cow odd' dustry Serv Board
"Number of inspections eft all
I' i 17103 a4o.461Sr(IWOS/COM/WEIi of
CITY OF TIGARD
BUILDING DIVISION PERMIT #:ER,2.1306430
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -417 ICI
Inspection Requests (24 .): (503) 639 -4175 F:_..
INSPECTION WORKSHEET FO' DATE: TIME: PAGE:
SITE ADDRESS: )? L S Pt c{ -j L I-414)A - CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: -
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: AD ` PHONE #:
Inspection Request Scheduled For: Date: t'L-I Pour Time:
Code # Inspection Description ••nfirm # Contact # Message
‘C\C‘ r" cs-+w s S
Corrections /Comments /Instructions:
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: < 4 - 5-1 N(36 Date: t qtr Phone #: (503) 718- 21`44,
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005 -00424
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/23/2005
Phone: (503) 639 -4171 /at 1 f
Inspection Requests (24 Hrs.): (503) 639 -4175 I L.
INSPECTION WORKSHEET FOR DATE: 121212005 TIME: 7 :19AM PAGE: 32
SITE ADDRESS: 13815 SW PACIFIC HWY 110 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: GARLIC JIMS PIZZA
DESCRIPTION: Low voltage for burglar alarm.
OWNER: SIVERS COMPANY, D.W. PHONE #:
CONTRACTOR: ADT SECURITY SERVICES, INC PHONE #: 503 - 469 - 7244
Inspection Request Scheduled For: Date: 12/2/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 022824 -01 503-968-7700 N
Corrections/Comments/Instructions:
Ha i J t€6 .6 I Gam► G 00
Ct-st.V■tY1:: titt,tl.
1 t5 pS 01 _
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Cr . 14 E B L.' Date: 12 - 1 .: 5 Phone #: (503) 718- 244k