Permit ix.
rte`
A,r,
CITY OF TIGARD ELECTRICAL ENERGY
RESTRICTED ENERGY
J�,L A _�l�i DEVELOPMENT SERVICES PERMIT #: ELR2003 -00394
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/30/03
SITE ADDRESS: 09898 SW TIGARD ST PARCEL: 2S102BA -00302
SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. ZONING: I -P
BLOCK: LOT: 022 JURISDICTION: TIG
Project Description: Job No 083 -17436
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:
TIGARD INDUSTRIAL LLC ADT SECURITY SERVICES, INC
11336 SW BULL MOUNTAIN RD #103 2815 SW 153RD DR
TIGARD, OR 97224 BEAVERTON, OR 97006
Phone: Phone: 503 469 - 7244
Reg #: LIC 59944
ELE 26- 209CLE
FEES Required Inspections
Description Date Amount Ceiling Cover
[TAX] 8% State Surcharl 12/30/03 $6.00 Wall Cover
Elect'l Final
[ELPRMT] ELR Permit 12/30/03 $75.00
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 1 110 throuc
Issued by / Permittee Signature K
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
12/30/2003 14:00 FAX 5034697110 ADT SECURITY 001
• - A ,, ; i * ,4-1-T To P it-K U, /- .
' )E lectrica1PermitA►pA�ication
S r,1- '`�►� City of Tigard .. • • Ptlimltno.: _ ib 103'
Prgleci/appL no.: Expire date:
City of Address: 13125 Sy,' HMI Blvd, Tigard, OR 97223 •
Phone: (503) 639 -4171
Date issued: By: Receipt no.:
•
Pax: (503) 59 &1960 Case tile no.: Payment type:
Land use approval: _
1 TY1'E OF PERMIT
O I & 2 family dwelling or accessory IN Commercial/industrial Q Multi- family 0 Tenant
O New construction O Addition/attendion/replacement 0 Other O Partial improvement
t
JOB SuLE Itt \rl )r I,1 IoN
lob address: 11E ' ; 4 ► • • B ldg, no.: Suie no.: Tax
Lot: map/tax lot/account na.; •
...) .
S ubdivision:
Project name: 1=: I,: ► _ a • ;,y p . , ; , ■ . . , .f old< on preml
Estimated date of co.' .1
C' )NTlt,\CTOR APPLICATION FEE SCIIET)(JLE
Job no: o •
� �
Business name: Qty
�� Description
Address: $ ids I Newtr�dtntial- ,ormuld- famuyper
r' drrelIlggmitIncladeratlathed e.
I City: ; _ .. _ State: Olt ZIP:' • 6 su,ieelr ded:
Phony ; k • 6 • d o Fax; Q . g. J o mail: 1000 N. R orders
_ Each additional S Ot] •
CB no.: il L
Elea bus. lie. no: _ sq. A. or ponlon thereof w i
City /m .. lit . no
— - Limited residential ratnited energy, nonre�denaSol. err MUNI
2
• �._. _ _ KEtD3 ob manufactured home or modular dwelling
Si • nett of' au . ,, t , g electrician rt qui . • Date Service and/or feeder 2
I Sup. elect. name @in*: I SN , u5 Services or feeders — ptelallatlon,.
KSN
)'I(O Pl:ltT]' OWNER alteration or rebellion: u ■ III
200 amps or less
1 Name (print): _ a. ) • lAy s c . ' I ..s to 400 P,,. (p0 = _ � 2
Mailing address: / / ` a • /, • : 401 am 600amps
1 City: �� State:6 ' ZIP: 9' , 601 amps amps or _�_ 2
O - 000 ncit ompe or dolts 111.11 _ 2
' one:
/ , {j 1 Fax E-mail: ' - •notaonly MN MIN MI 1 _
in 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 Oadon,a�Itieratloo,
ORS 447, 455, 479, 670, 701. • 200 amps or Ices
Owner'S signature: 2or amps to 400 amps
- bate: 401 to 600 , . RI
EN G IN ECH Brmlclichwalb_ nerr, alteration.
Name: or extension per panel:
Address: A. Pea for branch circuits with purchase of
Ci : State: service or feeder fee,. each branch circuit
te: ZIP: B. Fee for branch circuits withoutpurchase
•Phone: l3^masll, of service or feeder fee, first branch circuit;
I'1 „1i \T Itl;l' {I 11' (Please clacclt all that ;tpial)') 1tionalbreachcireulj
(Service
irrigation feeder n circle
included): ��-
0 Service over 325 omps- cammerolal O t{ealth•cmefeolltq Bach pump or imigaliontircle . .
O Service over 320 amps-rating of lea 0 Hazardous location Each sign Z
family dwellings 2
O Building over 10,000 equate feet four or Signal clreult00 or limited energy panel,
O System over 600 volts nominal more reaidendal units In one structure alteration, or extension• I 75
O
Building overthtvemodes O Feeders, 400 amps ormons a 2
CI Occupant load over 99 persona O Manufactured atruimrtes or RV park Each a dition
O Egtessilighlingplan O Other Each ���� pection over the allogable In cagy of the Rhone
Submit
sets ofplamna with any of the above. • per � j at
The above arenot applicable to temporary O tau fee
4' construction service, Other .
all Judrdk s dent accept credit c , please eon Jurisdiction for more Inmnaq Notice: This permit application Permit fee $ 7vas O MastetCatd expires if a permit Is not obtained Plan rview (at %) $
f t.4oi
/ within I80 days after it has been Stets surcharge (696) $
Name or cardholder am mown on credit cold
TOTAL $
I
Cardholder algnalure ' S
Ammo accepted as complete.
• 4444613 (&00/CON)
•
•
CITY OF TIGARD 24-
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
n/ / BUP
Received �� Date Requested 2/ 5/C4 AM PM BUP
Location fl ?P' Suite MEC
Contact Person /Lita/Z- Ph ( 3/ 2- & Co // PLM
Contractor Ph (5 ) 4" 9 — 7 at( SWR
BUILDING Tenant/Owner aLcit c y ELC
Footing
Foundation ELC
Access:
Ftg Drain EL - -0 3
Crawl Drain
Slab Inspection Notes: n Q � i A • u,Lr d SIT
Post & Beam ' !/l Q X / e '.(i L4
Shear Anchors n
Ext Sheath/Shear
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
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
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date v — Q (( Inspector ae Ext
Oth- :
F' DO NOT REMOVE this Inspection record from the Job site.
PART FAIL