Permit . 4 4 g'
a CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2006 - 00297
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/1/2006
PARCEL: 25101 DC - 03800
SITE ADDRESS: 07190 SW SANDBURG ST ZONING: I -P
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Connection to PIV's.
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:
MCCORMACK, WILLIAM L + DARLENE T ADT SECURITY SERVICES, INC
7415 FAIRWAY LOOP 2815 SW 153RD DR
WILSONVILLE, OR 97070 BEAVERTON, OR 97006
Phone: Contact #: PRI 503- 469 -7100
FAX 503- 469 -7110
FEES Reg #: ELE 26- 209CLE
LIC 59944
Description Date Amount
[ELPRMT] ELR Permit 12/1/2006 $75.00
[TAX] 8% State Surcha 12/1/2006 $6.00 REQUIRED ITEMS AND REPORTS
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 or 1.800.332.2344.
Issued By: � Permittee Signature: 'LP t\Q-sc,
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.
Dec 01 06 12:19p Stephanie Pate 503-069 p.1
'/
F Permit Ap ?lica-tion FOR OFF)CE USE ONLY
•
RECE 1 VED Received 1
City of Tigard Dntci13y: ; At� i e ,11,x,- rerncitN -c -60/..1
13125 SW Hall Blvd.. Ti }yud, OR 97223 Plan Revtew ,.'^
Phone: 503.639.4171 RIX: 503.598.I960D E C 0 1 2006 °FY, l " 1 � Datailiv' Other rom a: —`
inspection Line: 503.639.4175 r , ! � Date Ready:By: rune Fri Sae Pagel tar
Internet: www.ei.tignrd.oi'.tn CITY OF TIGARD Notified•'Met hod: \uppkmt oral tnfurn.nlion
-®H \ V( llk15IOR; ... . . PLAN RtWIEW
❑ New construction L 7 ldilwn /aheraticnvreplaeentent Please cheek all t1i t apply:
❑
❑ 1)ClnoliCjon ❑ �tIiCT; Skvvice over 225 amps, conun'i ❑za
Hardous location
❑ Servi. over 320 amp - rating ❑ Bulldog over 10,000 xi. It.,
. CATEGUo(`Y'.Ot:" CONSTRU TION. . • . . of 1 - and 2d'amily dwellings 4 or more new residential
El 1- and 2- family dwelling e Commercial /industrial ~ ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ tluilding ova- (lace. stories 0 Foc4en , 400 amps Or more
❑ Multi - family ❑ Muster builder ❑ Other.
.._ ['Occupant load ova 99 pcmons ❑ Nlanul'actured structures Or
JOB SITE INNU7tMA1'ION AND [OCA'1CUY ❑fitec,v Ilihting RV park
'lob na.: � Job site address: f (� xC sr
❑ Health - care facility ['Other: _
o7 O7�i -/ � � O `�� ' D ea 1 Submit 2 sets of plans with any of the above.
City/Statc/Z1P: 7 i : a / QA' 97 3 'the above are riot applicable to tcmpor,'uy construction o vh c.
- -- Pe tz4o / e0AV/77AC/� 'MIC . f+C111)cuu1:1�
Suitt / bltiv,/ ;apt. no,; Project atone:
_ ___„ 1),.t•riplMa I (ly. I Mee. 7'Wel
Cron:+ Strcttddirection, to job site' New residential single- or multi- fancily dwelling unit.
includes attached garage.
f / ....d..../ ,00) sag it. of tees -.. 145.15 l 4
• / held'! 500 sq. ii. or portion _ 33. 1
Subdivision: [scat no.: _
---• - Limited energy, residential 75.00 2
- 1 - ax mapipa'ccl no.: I - ""�
Limittd cncrgy. mesa - residential 75.1X1
bl'SC1i[Jr.l'10\ OF' WORK:.: :,.. ,r.,.... .....J inanutncturcd or modular
,c}y� ,, + S r dwelling. setvicc an d:or (ceder 40.9(1 _ 2
(� � l Services or feeders installation, niteration, autL'or relot`.liion� ~
200 amps or less _ . _ _ I 80.30 I 2
• ❑ PR(1'PERTY OWNi.K • ❑ TENANT I 201 amps to 400 amps i 106 i 2
- -.___, 401 amps to 600 amps ! 160.60 ' 2
��
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or Lolls 351.65 . 2
- .._. -- '
Reconnect only 66.155 j : 2
City/State/ZIP: ' Temporary services or feeders installation, alteration, and,'or
relocation
Phone: ( ) fax: I ) 200 amps or less — 64.85 I �_.. i 1
Owner installation: This installation is being made on property that I own which is not ?01 amps to 401) amps 100.30 ' 2
intended for ;ale, leas, rant, or exchange, according to ORS 447, 440, 670, and 701. ; 401 ;amp lu 600 crimps 133,75 � 2
Owner signature: D ate: -- j Branch circuits - new, alteration, or extension, per panel
0 ,1'PPuc, l i'r • • ` ... • . I • X CONTACT PERSON •:' ! A. Fcc for branch Curuits with l -' ^
service or feeder fix;. each .
Busines.s name: - branch circuit 6.65 i 2
,,,. 13. F.,' for branch ctrcuits
Contact name J < 7 q XL� without Bt,Tvtee or femur rec. '
_ 'hit branch cimult i 40.85 1 2
Address: _ J , M T Bach add'l branch circu 6.65 L
..,...,.rte
City/SiltcJZJP: Miscellaneous (service or feeder not included) _
I "" Pump or irrigation einde 53.40 2
Phone: (13 )4*,? 49 (} l Fax: = ( ) Sign or outline lighting — 53.40 2
E- mail: Signal circuit(s) or limited-
. C_ONTRACTOR • ' .. • . energy panel, alteration, or
_ 1 Q
-' cstois on, f)ccCrihc: / Pa('c 2 1 2 •
Business name: ADT Security Service 1 —
•
Address: 2815 SW 153" Dr. Each additional inspection over allowable in any of the above
. - - - --- Per inspection 62.50
City/State/ZIP. Beaverton OR 97006 Investigation per hour (I hr min) _ 62.50
Phone (503) 469 -7100 Fax: (503)469-7114 In plant per hour Ing 73.75
'...CL'EC.TkIC4L PERMIT F'EE'S" •
CCH Lie._ 59944 El ectrical Lie,: 26- 209C1E Suprv. Lie.: LEA384 Subtotal Is °°
Suprv. Il.Icctriei:in signature, rc*.iuire.d: ��- /`2 eCla� f Plan review (25%, of permit fee)
Print name: // Ulte:f // d& I Slat �
�'� 1 Tt. TAL retini FEE g/, O
Authorized signature: , t . / , 'rhix wrmir upplicatiao cz it a permit la not obtained within MO
• h ��
w days alter it had bees. accepted at complete
Print name: /60,/ /614 v I s Date: - Fee Ir.c7mdoloipr set by TA-County iluiklinE• Inau..try• Service. Boned
-- Number of ins/nation: per pecan aneWed.
it,.,I,S, I sihill ?r- C- PerntijA .d .,c I :A.l 440.461 Fr( I ovioYwwt!ti
Jan 08 07 12:17p Stephanie Pate 503469 p.1
Building Division
Request for Permit Action or Refund o i : Y
City of Tigard
JAN — 8 2007
TO: CITY OF TIGARD CITY
Y
Permit System Administrator BUILDING DltriSION
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960
FROM: ❑ Owner ❑ Applicant ® Contractor ❑ City Staff
(chuck one)
Name: ADT Security Services
(Business or Individual)
0 1 D Mailing Address: 2815 SW 153 Dr.
//7/0 - ----- City /State/Lip: Beaverton OR 97006
Phone No.: 503 -469 -7100
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
® CANCEL PERMIT APPLICATION.
® REFUND PERMIT FEES. — 7 — C2 7,P(/S T /` C L°DU.tiT t /r?i S
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: L X 2CC& -GO,? 9 7
Site Address or Parcel #: 0 7/9 f e/ ,g1d7
Project Name: )27c 277
Subdivision Namc: Lot #:
EXPLANATION: �Ge- Gtz., -; . vai
G.�/;726. t�?-L � / ,e & /O o 3 % / 41 /000 '-i � �,4de--
7 tfitee_eir.;if zGv. a ec r '
Signature: /? -? c. � �`'` Date: 0/0 7
Shane Pate
Print Name:
R Policy
1 . 7'hc Building Official may authorize the refund i'f
a) re.'' (ix: which was erronwusly pad or collected.
b) not mon: than sO percent of 1ho permit fee for issued pumtits prior to any inspcCtiOn n.quccrs.
c) not more than HO percent of plan review foe whcst rm application is r:anceled before any plan review effort has been expended.
2. Refunds will be returned to the original Puyo in the some method in which payment was receivial.
FOR OFFICE USE ONLY
Out 1 . P - I B ' / Rte to Bld Admin: Date /A71', B ,d
ss
Refund Processed: Date /7 , 7 B , . Invoice Processed: Date y_ _� .T
Permit Canceled: Date / 7 0 7 • B N1rcel Ta Added: Date By
Reccjpt tt /G -5 79 Datc , Are 4 Method 4/24,4ST Amount $ P/. c--0
l : \BuildmgV'orms KogPiamitAction- ti lelg.doC Rev I0/17i05 ,e ^N' 60