Permit C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 - 00161
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/22/2005
PARCEL: 2S 110DC -02200
SITE ADDRESS: 15532 SW PACIFIC HWY C -7 ZONING: C -
SUBDIVISION: WILLOW BROOK FARM LOT: 011 JURISDICTION: TIG
Project Description: Limited energy, CCTV.
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:
TIGARD CENTER ADT SECURITY SERVICES, INC
9777 WILSHIRE BLVD. 2815 SW 153RD DR
#609 BEAVERTON, OR 97006
BEVERLY HILLS, CA 90212
Phone: Phone: 503- 469 -7244
Reg #: LIC 59944
ELE 26- 209CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 6/22/2005 $75.00
[TAX] 8% State Surcha 6/22/2005 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: s f i Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
06/21/2005 15:46 FAX 5034697110 ADT SECURITY 0001
`Electrical Permiit _ 4. FOR OFFICE USE ONLY'
City of Tigard n `d ■ vi ► petit No. :6a /• is )6,1
13125 SW Ha11 Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 F " "'' ° " Other Pest=
Inspection Line: 503.639 4175 _• �- : i Date RcadyF y Ed See Page 2 for
Internet: www.ci.tigand_ar.US Noti$edlMetlwd: Supplemental information
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- ,:I New construction ❑ Addition/alteration/replacement Please check all that apply:
['Service over 225 amps, comm'l ❑Flazardous location
❑ la emolition ❑ Other: ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft,
f IT 1 PI..2T I . y 'r L' IT, 74YfT >I JI6 4'rl� � �9r1 Jf11 I III: ,
111 ' ` {� I I + n r u. �, 1 a ! of 1- and 2- family dwellings 4 or more new residential
u � I '��!� ;_ �I'I' F�?f '! -� i - .�'I� ;I�:,.I.:1F�i::.>L'Jy.�
❑ 1- and 2- family dwelling Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi- ftumily ❑ Master builder ❑ Other: _ Illr Oct
❑ upant load over 99 persons ❑ Manufactured structures or
t r-�- ) f -, F ; 1 i I'i TI'1Z -{i- ' BI J� C01'. 1 7. u lf 5 � rl � , :� . i,,; F RV park
4d��l�i <<':?i, f . ? 1 . ,' 1 ea i �sL �i 4. j,1f! �, ' !4,5_1M 1 .2,,JO ;,i. , uh I. Il I tl .t , 11 I�{II fa 1_. I i,e ❑Bgress /lighting plan
❑ Health -care facility DOrher:
Job no.: ` ;* L , 6iy Job s=ite address: •9 j 3 , •l � ' l I, - l Submit Z sets of plans with any of the above.
City/Stare/ZIT: .. I. : r lb r I ' r G- ti The above are not applicable to temporary construction service.
'
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Suite/bldg./apt. no.; "4ect name: '
• � DeprIplIon Qty. Bee. 7otsl
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 aq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tex map/parcel no Limited energy, non - residential 75.00 2
i 'N''I .,, ,' � ' l l, f1 i r - SY " " 4 , ', I11 Ilf - 1` J l I !
., I l�tIIII ' �i i l i > _ + 4 d1 4 ' � l 1 Ic I y t A r I
t.� _ .J �._ I - : ,.1.1 , iy r. , a-. I. l e an.. _Z..._..:._..- ,'+r ;.(: -7 r „ l
_il _ . 47. " . .:,, -- fl 'Il P h manufactured OT modular
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocatio
200 amps or less 80.30 2
. T 1),.r� , 7: L , 7: ', F, 7••-"-1 106.85 2
�.� ,' 1 � r 1,, rtic I �r r ; � -`rl , ' ' „ J P �� 1 s ' i o1� i�l' r 't '� y rl-I H �.r�i � i I� 201 amps to 400 amps
:^4.:',:: 1 J q y ' � c i . { !� !i ? I ! . +ir�'S .n . 1 1_fri yI r.��'_II� .r{ 1 =� 1 I i- �,' zs: -4' Yr,:- � !I E , 1 4 160.60 2
� _-- 1i,._- � � 01 amps w 600 amps
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 services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 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 10030 2
intended for sale, lease, runt, or exchange, according to ORS 447, 449, 670, and 701. 401 amps ro 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
ff '' 77 C I' 1 qq f A. Fee for branch circuits with
.I. 31 I I f. 7 Il I � [ 11 a ' . I ,' -1 { I T ' I I r 3 1n. 1 - :. , A . I 1 1c. ti i r uy�Y \I . ,4,:t . .4- Jdl!I1r ` _ -_ ?,) � I .,4
I I_:.,,r_,1, . ,� . _I _ .t _ _. . - �� -1 t _ L_ _° service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: wfthour service or feeder fee, 46.85 2
each branch circuit
Address: Each add'I branch circuit 6.65 2
City/ State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: • ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(a) or limited -
�_�� r 1 1 . ,y r IIIrI 1J. IV F +I I I( lSf II I I � 111 , � 1 t lh'l d r . I I l , .l : I , i f j !E II r { energy panel, alteration, or
LL :41P,t� it {I I. ;Ir 1 I 1 v iii l e _1'- J{., r.'_�, I__�.1:. -J ru:. . ! u ^._.,_fl..aL n. Describe: l Page 2 15 a), 2
- extension.
Business name: ADT SECURITY SERVICES, INC. - -
� ; , r, - • • Each additional Inspection over allowable in any of the above
Address: , . : • , • : 'r tat , Per inspection 62.50
City / Statc/ZIP: (503) 4637100 Investigation per hour (t 1tr ®n) 62.50
( ) Industrial plant per how 73.75 .
Phone Fax: ( ) I I I n rl ,s-rt� V �.
II II II Li��lnl,i.r��LFttl•: -LI ���.�tf �1.1 ��r�i � ;lifl llFLLi -
CCE Lic.: ai L4 eclat : c.: JfILt ugrv. Lic.: g- _ Subtotal
Suprv. Electrician signature, required: _ Plan review (25% of permit fee)
State surcharge (8% of permit fee) b. to
Print name: ' L r - . Date: • .� TOTAL. PERMIT FEE
gi.DD
Authorized signature: This permit application expires if a permit It not obtained within 180
days after it has been accepted as complete
Print none: Date: 1 %Mil • Fee a othodology set by Tri- County Building Indutey Service Bow
...Number of inspections per permit allowed
MauhdngwettetaLC mitApp.due 17N3 4a0- 461 STD QW2/COM/WEB
CITY. OF TIGARD
' I BUILDING DIVISION ' .. PERMIT #: ELR2005 00161
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 6/22/2005
Phone: (503) 639 -4171 � 1 i l h
Inspection Requests (24 Hrs.): (503) 639 -4175 __'
INSPECTION WORKSHEET FOR DATE: 7/20/2005 TIME: 7 :11AM PAGE: 41
SITE ADDRESS: 15532 SW PACIFIC HWY C - 7 CLASS OF WORK:
SUBDIVISION: WILLOW BROOK FARM LOT #: 011 TYPE OF USE:
PROJECT NAME: T - MOBILE USA
DESCRIPTION: Limited energy, CCTV.
OWNER: TIGARD CENTER, PHONE #:
CONTRACTOR: ADT SECURITY SERVICES, INC PHONE #: 503-469-7244
Inspection Request Scheduled For: Date: 7/20/2005 Pour Time:
Code # ,,,,,,:,=.e - - '. • Description • # Contact # Message
1 .; ••� . tage ! 011785 -01 503-469-7244 N
Et ta/Czargents/ l In ' sfrnctions: o 117- o]
NI PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: .40 r Date: t Phone #: (503) 718-