Permit (29) CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
� DEVELOPMENT SERVICES PERMIT #: ELR2003 -00364
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/26/03
SITE ADDRESS: 16200 SW PACIFIC HWY A PARCEL: 2S115AB -01900
SUBDIVISION: TIGARD TOWNE SQUARE ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Limited energy for buglar alarm. Job No. 083 - 17314 -01
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: BURG ALARM X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
BIT HOLDINGS LTD PARTNERSHIP ADT SECURITY SERVICES, INC
BY FORUM PROPERTIES INC 2815 SW 153RD DR •
FIVE CENTERPOINTE DR STE 290 BEAVERTON, OR 97006
LAKE OSWEGO, OR 97035
•
Phone: Phone: 503 469 - 7244
Reg #: LIC 59944
ELE 26- 209CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 11/26/03 $75.00 Elect'I Final
[TAX] 8% State Surchar€ 11/26/03 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not .
started with' • :::: s of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to f► ow rules ado• ed by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 throuc
�,
Iss, ed by , 4 )�ijtA , i /�� % /i Permittee Signature L / 14
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
11/26/2003 15:16 FAX 5034697110 ADT SECURITY Ij001
•
• Electrical Permit Application
Ak � Datct tccived: / m0 , Permitno.: e r .
R C �IVE� , - _..3�
.- u .. Ci y of 1 �ga rd Project/appl.no.: 1x,_. dam
City of Tigard Address: 13125 SW Hall Blvd,3jggni My
Da
Phone: (503) 639 -4171 N ��JJVV �� 1v? t' issued: CMT' Receipt o.:
l (503) 598 -1960 CITY OF TIGARD Case file no.- Payment type:
Land use approval: WE DING DIVISION
TYPE 01 Pl ilIIIlT
❑ I & 2 family dwelling or accessory IN Commercial/industrial O Multi- family O Tenant improvement
CI New construction O Addition/alteration/replacement Cl Other. 0 Partial
.1013 SITE; INFOlUU, T10N
Job address: /[ . yr/ f o ' arl � , Bldg. no.: Suite no.:.-„;,. Tax map /tax lot/account no.: .
Lot: Block: Subdivision: -
Project name: Ira A 4, ' ' IAA 4 ,i ' . cdpdon and location of work on premises: i.. L /, / k 0 „ ,u ' 4 01 •
Estimated date o core dletion/in:. - don: -
CCINT llACFOR APPLICATION FEE SCHEDULE. •
Job no: �i, — 1 - ap '
Max
Business name: :i U ra Ivem►,�Itlt�m.1- >ar ' . - T no, ,
Address: 28 1$ .S t 53rd dwel!nrger Includes e b ed gac a g e . •
•
City: ilawerte State: Olt ZIP 7d0. Ser,lat deg •
Phone . 69 ' WO Faxes 1 ; f,d - mail: 1000 sq. ft. orleas • .4
CB no.: Slcc. bus_ lie. no: - - • W
Each addiooml SOO sq. ft. or pastier thereof • i
City /nr . 1k. no.: i u°+lmd energy, n�dential 2
Limited , 4 , noa- reside°tiai . 2
11 (Z1-4p2, Each rnanufecaaedhameor modular dwelling .
Si. ., :, _ of su , ra. electrician (required) Date • Service and/orfeeder • 2
Sup. elect- name (prliu) FA! K ' AK License to, LEA 3 get Servlas orkedrxa— Inslalldtlon, ,
PROPERTY OWNER
alteration Drrd0�10m
200 smAs erica 2
Name (print): a - .0 i a i o ta. 201 amps to 400 s 2
Mailing address: 401 ampere 600 amps . 2
601 amps to 1000 amps
City :: , Over 10
00 ZIP: 0 2.
oo amps or voles • 2
Phone: NIML1121 Fax: E-mail: • - ..nnectont
Owner installation: The installation is being made on property I own •Ibmpnrary services or feeders - •
which is not intended for sale, lease. rent, or exchange according to installatlon,allergia %or relocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 cusps to 400 amps 2
Owner's signature
Date: 401 to 600 am . 2
p ENGINEER Drench clawits -new, alteration,
Name: or extenders per puck
Address: A. Fee for branch circuits with purchase or
earviCe or feeder fen, each branch circuit 2
City: I State: I ZIP; B. Fee for branch circuits without purchase
Phone: F : E-mail: of service or (cedar fee, first branch circuit: 2 . •
• Bath additional branch circuit
PLAN 1tI V1E%V (Please check all that appl)) Mist. (Service orrteder bud included): • - ,
O Service over 225amps.00rmneretnl O Health- carefudlity Rash pump or irrigation circle 2
O Service over 320 arnps- rating of 1 &2 . D Hazardous location Each sign or outline lighting 2 •
farnilydwallings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel. x
0 System over 600 volts nominal • more residential units in one structure alteration, orextension' ' /5 75 2
❑ Building over three stoles 0 Feeders. 4 00 amps or room •Dra«9ption:
O Occupant load over 99 persona 0 Manufactured awctrrrn or RV park Each additional inspection over the allowable Iu say of the abova •
O 13gresza/Iightingplan 0 Other Perinrpeetion
Submit.__, set of plans with any olihe above. . Investigation ationfee I I • I `.. I
The above are not applicable to temporary construction eenice. Other .
Not ell ludtdladooa accept coedit cards, please can Jurisdiction for moos lnfwmarloe. Notice: This permit application Permit fee $ `' _
D lfisa 0 MasterCard expires if a permit is not obtained Plan review (at %) $
Ga card wombat I / within 180 days Sta surcharge (8%) $ . --
Expires aYa after it has been a !;
Name of cardholder as shown an credit card a P complcta TOTAL $
$ /�
Cardholder signature Amount / /L1 _ /� / J /� 440.4615 05/00/ Orr)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received / 2 Date Requ // ted ' " 7 - 'AM PM BUP
Location - 21 uite MEC
Contact Person , AI/4 ,■■ Ph ( (7) Of/- al 6 / PLM
Contractor 1 Ph ( ) SWR
BUILDING Tenant/Owner
Footing
Foundation ELC
Access:
Ftg Drain
Crawl Drain \—/'
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
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
4 04 arm
'T� PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE fl Please call for reinspe tion RE: 1SW
Unable to inspect — no access
ADASupply Line Approach/Sidewalk Date Inspector Ext
Other:
Final DO OT REMOVE this Inspection record rom the Jo ' site.
PASS PART FAIL