Permit •
ELECTRICAL PERMIT -
CITY TIGARD RESTRICTED ENERGY
I I I DEVELOPMENT SERVICES PERMIT #: ELR2003 -00384
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/18/03
SITE ADDRESS: 15860 SW UPPER BOONES FERRYRD B -15 PARCEL: 2S112DD -00500
SUBDIVISION: OREGON BUSINESS PARK 1 ZONING: I -L
BLOCK: LOT: JURISDICTION: TIG
Project Description: BA with integrated access control. -
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: ACCESS CON X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ADT SECURITY SERVICES, INC
15350 SW SEQUOIA PKWY #300 2815 SW 153RD DR
PORTLAND, OR 97223 BEAVERTON, OR 97006
Phone: 503- 624 -6300 Phone:' ' 503- 469 -7244
Reg #: LIC 59944
ELE 26- 209CLE
FEES - Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 12/18/03 $75.00 Elect'I Final
[TAX] 8% State 12/18/03 $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 41:612.1-1__ Permittee Signature (Ai
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:
- Ca11 - 639 -4175 by 7:00 P.M. for an inspection needed the next - business day
•
•
12/17/2003 12:07 FAX 5034697110 ADT SECURITY Z001
• 4, Electrical PermitAppiication
4 1 Datere:ceived: i/ n 0 ' 9 Permit no.. ',1003 - 6
• v 1= I 1 ` City of Li '
�
± C�gard ����'� V��'� >;o�app> no.: �piredate
City of Tigard Address: 13125 SW J-Iall Blvd; T igard, O1 97223
Phone: (503) 639-4171 L��b 1 / � j,�3 Date issued By:" Receiptgv.: -
Pax: (503) 598 -1960 Case file nog Payment type:
CITY OF TIGARD
Land use approval, BIM niAir r ,, l „ v'v'm
TYPE OF PERMIT
❑ 1 & 2 family dwelling or area ssory e giI Commercial/industrial 0 Multi - family O Tenant improvement
❑ Now construction ❑ Addition /alteration/replacement D Other. _ ❑ Partial .
•
' • JOB SITE INFORMATION
Job address: J C C) SSIN Y`ppM P YLiS rvl,vu Bldg. no.: n Suite no.: Tax map /tax lot/account no.:
Lot: � I Block: I Subdivision: _
Project name: O J A i p A j j a l ., Description and location of w o r k on premises: !•i w re r c ! ! /!
)?shred date c+f • letion/inspectioe: :rf _ - ,IfL i'".?'
i (1JN'lRACfOR APPLLC:1TION FEE SCHEDULE
Job no: ilk".K. - i 6. I - o1
ft
Business name: Arfr .St's r(I y >D • dna Qty. (ei. Total . no. do •
Address: 2 $ IS �1 S3 r *Baal •sitrE�Je ormulti -ramg per
City: S�t14t'�"f01A J State: 0RI ZIP: 9 70 0¢ si atktdtedgataga
Phone►{ 49.1100 Pai •' /. t a'7413-mall: 1000 s9- It or less • 4
CCB no.: su l Brij I Elec. bus. lie. no: Z6 O?C LE t?aat e ddidana150p sq. ft or portion thereof w
Cityfinet� liana: �energy, - 2
Limited =logy, sots- naidcndal . 2
•
S
- A- i�.�.er t � /03 mnfactorodhoneormodulardwelling
Sian f auperv,a electrician (required) Date Service and/or • 2
Sop. duct. name (print): 4;20 • • U$
lloeesepo: LEA 3 8f- Serrtcaorfeeden- (astallation,
PROt ERI'a OWNER alterxdonorre)rratiiam
200 amps orlus 2
Name (print): ('' bia.. SCA wei a, 201 amps to 400 amps . 2
Mailing address: 401 [impala 600 sups 2
• 601 WI. to 1000 amps 2.
City: I State: I ZIP: Over 1000 antpa or rolls 2
Fhone620 405 I Fax: I E -mail: Reconnectedly 1
Owner installation: The installation is being made on property I own 7hanporarr senicerar feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation:
ORS 447, 455, 479, 670, 701. Zoo amps or loss 2
201 amps to 400 amps J 2
Owner's si ture• Date: 401 ro 600 amps _ 2
Br ench clreults- new, alteration. •
Name: or =ch=ai=n per panel:
A Fee for branch circuits with purchase of
Address: aerviee or feeder tee, each branch circuit 2
City: J State: I ZIP: B. Fee for branch Circuits without purchase `
Phone: 17 E-mail: of service or feeder fee,ftrstbranchcircui 2 • .
Bach additional branch circuit -
!'LAN REVll;ll' (Please check all that :lplil)) Mist (Serriceor feeder not Included): '
O Service over225 amps-commercial 0 Health fsentry Bach pump or irrigation circle 2
0 Service over 320 amps -raring of 1 &2 ❑ Hazardous location _ Bach sign or outline lighting 2 -
family dwellings 0 Building over 10,000 square feet four or Signal cireuit(s) or limited energy panel, ��
O Syatom over 600 volts nominal more residential units in one structure alteration, or extension. 2
0 Building over three atoriea U Feeders, 400 amps or more •Dcacriptioa
O Occupant load over 99 persons 0 Manufactured structnrer or RV park &eh Each additional Inspection over the allowable In any of the above: •
0 Egress/lighdngplan . O Other: Per inspection
Submit _ sets of plates with any of the above. Investigation fee ( l I ]
The above are not applicable to temporary construction service. ocher
Not all lwtadtepona accept crcdil catch, please call Jurisdiction for mono information. Notice: This permit application Permit fee $ • 7 , : i
0 Viaa O MasterCard expires if a permit is not obtained Plan review (at — %) $
Credit said number / / within 180 days after it has been State surcharge (8%) $ 1, . --
isltylrw accepted as complete. T I TAIL $ •
Name of cardholder m shows on credit cant
Cardholder signature $ Amours /� ■ ■
440.4615 (6J)Q QM)
i .
•