Permit =,.
1h ' CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00228
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/28/2008
PARCEL: 1 S126DC -04400
SITE ADDRESS: 09430 SW CORAL ST 200 ZONING: C -P
SUBDIVISION: LEHMANN ACRE TRACT LOT: 007 JURISDICTION: TIG
PROJECT: DENNIS CLARK DDS
Project Description: Altering (1) protective signaling system.
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:
MARTIN BUILDING LLC ACTION TECHNOLOGY SYSTEMS
9430 SW CORAL ST STUITE 100 835 SE 17TH AVE
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: Contact #: PRI 503 -231 -1992
FAX 503 - 231 -1402
Reg #: ELE 26- 775CLE
FEES LIC 157630
Description Date Amount
[ELPRMT] ELR Permit 7/28/2008 $75.00
[TAX] 12% State Surch 7/28/2008 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
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: /,,,., �i _....._ i�-- Permittee Signature: s' 597/ �� r
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.
'Jul 28 2008 3:06PM HP LASERJET F® p.1
E1ectriea1 Permit A.pplicatio �� i•ul. UI 16'I.. I1ti 1,",ON,1,1' ,' `''. .
City of Tigard q �ti�� Rece .
III ' y N . .'"1i'; 8 /'../ra CS r - lit No g. i �i (! �. ,<.t
13125 SW Hall Blvd -, Tigard, OR 97223 ,�\ ;tee' . , aw ��
• ' _ -,' , Other Permit:
' Phone: 503.6394171 Pax; 543,598.1960 '`�G
r'i / ,A I. I . Internet; www.tigar , i Inspection Line: 503.639.4175 r �� 0% ®�0 a . Noli • eady/By; Jude Ed See Page 2 for
d- or, ov ned /Method: 7 0 ❑DDO DDODDDOADOfa
e, , ^: - �. , r , °may^ a: •, y ,.. .,,, y ,.,, a y „��., �,.,, .���,��.�.��,�'.l� ...... a -. = .. .r .,. ,
�y ' l ;,r n ri .,. try; 1 ",i illy,. - . p ,.-.:-- � . !}c. ' t . . `.q� ,� "t ti4 B lI ti eI-:� Y '�,,. it ai; { , : � n er i r ,
New construction ction �1' tr, Addition/alteration/replacement /
i �' 't � J v Ja, 1 t So e ek 111 that 400 em u i sc� ts of w/ •AT 1 p c e i J ` F ) );
4
❑ ply
( items checked below
❑ 0 p or more ❑ Building aver three stories,
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards
r, "..aPtt4 .; ; .:: , Sf¢hN "hu;(a' (y(�' / ^ r j y a'� [ �� ( �� `r;- - ': exceeds 10,000 amps at 150 volts 01 _' ❑ Floating buildings
' I1Mf .1W^'S' ^'Th•�'fIV7yM'J�ii(t 1 1At \�..il• ..
"- "' r ” . -r " " - - - -'• " - "' •" "�� � � " - - "" � �'° leba to ground, or exceeds 14,000 ❑ Cammmcial -use agricultural
❑ 1- and 2-family dwelling 2 Commercial /industrial ❑ Accessory building amps for all other lnstalletiooa. buildings.
171 Multi family El Master builder Other:
i�.., , . ❑ Fire pumv, CI Installation of 75 KVA or
" u: *:.` "SNP r� >, -a+ w "� u ❑ Smergerwy tystem, larger separately derived system.
,;.: t. . o: ..
.., rim�,':',o• e "•.. wrfti��.n «�! , ,6, � .., '.: � v, ' �x , - �ip.lr?.,. r ❑Addition of now motor load of ❑ „ . „ „
Job no,: 14045 i Job site address: 9430 SW Coral St.' 1001Q'ormore. occupancy,
❑ Six or more residential twits, ❑ Recreational vehicle parks.
City /State/ZIP: Tigard, OR 97223 ❑ Health -cart facilities, ❑ Supply voltage far more than
. - . _ [Hazardous locations, 600 volts nominal.
Suite/bldg. /apt. no.: 200 Project name, l ark DMD PC 0 Service or reader 600 amps or mote. p
O r /,, '' soli °'" .`. )."
Cross street/directions to job site '
/ /�/�/��/ � C� ✓iLG � 1?eicgadon i OW. I t+ee, I Tow �
New residential single- or multi - family dwelling unit.
. Includes attached garage.
Subdivision: I Lot no.: 1,000 K. ft. or loss 145,15 4
Ea. add'l 500 sq. ft, or portion 33.40 1
Tax map/parcel no.:
...... ......Y:- nYrta,: id r . -, ,.w- .:,�,a- ' - - ; -���x w'a' residential
.
4,d , ! s ttI iQ i C�[q,85t r > Limited th energy. sq. r ft.) 75.00 2 hale
.,, , .. . r-r . ,'_.,.:... ' ' - ... - ...." .J.�` ",.N:ab?�rl „"'iPhdll' !Ge'Yra,�, r.wt,,,t.f.,,u.,;l, with above s
Limited energy, multi-flintily
Intrusion alarm additions residential (with above sq. it.) 75 -00 2
Services or feeders Installation, altteratlon, and/or relocation
:.
200 p o cc 0
--..: -r 1 JR,,: a ' yt P 1,Pt i I n iijrc I ''�aa,;? /,4 X5,(1 ' lit ' I n . , 201 amps to 400 a mps 8S
' , :., ;. s 1 06. 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240,60 2
Address: Over 1,044 amps or volts 454.65 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 100.30 2.
intended for sale, lease, rem, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, Cr panel
Owner signature: Date:
- y, .r:",4 ?�7, h r cs A. Fee for branch circuits with
.' ; f ,'... , • :-,.. , „': s �,a: 4., : ,N,.^IwMiy 'r MI,T,r p,.S, r t I ' . •uhJ� , abort service or feeder fee,
t }! iZ �TtT11'. #
each branch circuit 6.65 2
Business name: B, Fee rbr branch circuits
without service or feeder fee,
Contact name: 46,85 2
first branch circuit
Address: Each addl branch olrcuit 6.65 2
—
Miscellaneous (service or feeder not Included)
City /State/ZIP; Each manufactured or modular
90.90 2
Phone: ( ) Fax : ( ) dwelling, service and /or feeder
Reconncctonly 66,85 2
E - mail: Pump or irrigation circle 53.40 2
- ; �,�a�r1, u:° ,..s,: =;;,,: .� „�, "t>�i�llit'r.'I�i�:' ,�„ ,,,{ � ` ;f ,,,, �. > .1 .. g nor outlineli lighting 53
a i. :1,,f"' _ ..n ,..r. �i.ri.� ....,.
4. , � -, : { ,,, ;; .,, y;r ;,,, ::x::;r- , ,,.���, , d,V ` ,;.,, "LFd,a�e ; S, id,i'�yiti ;:i(c,�i g g ,40 2
Business
83 17th d . � ms ...,._ LC energy panel, alteration, or -._ . -.-
Signal circuit(s) or limited -
Businessname; 1110 lORy Systems LL
Ave. cxtensiem. Describe: Page 2 7 5 ' �� 2
City /State/ZIP: Portland, OR 97214 Each additional inspection over allowable in an _of the above
Per inspection 62,50
Phone: ( 503`231-1992 Fax: ( 503) 231 -1402 Investigation per liour(1 br min) 62,50
CCB Lic,: 157630 Electrical Lic, 26- 775CLE Suprv, Lic.: 5 79LEA Industrial planter hour 73,75
...,: : e:.�::': i yy ��,,. r, e.lv.}'.:r::1 •-:. -,
Suprv. Electrician signature, required: ;; . ;::,,:r .:. ................ .. Grt.
���.�FJr:: }
_ total: /5 ,61 ..
Print name: Date: Platt review (25% of permit fee):
�r Q�� �� d i2t D
j .. 7 28 SOB Sta te surcharge (12% of permit fee): 9.00
Authorized signature: tt` 0a TOTAL PERMIT FEE: 84.00
This permit application expires if a permit is not obtained within 190
Print name: Rot rk:lista Date: 7/28/08 days after It hes been accepted en wmplete.
• Number of inspections allowed per permit.
l' 1sulldlnilPermbs \aLc- rermltApp.doe 05/23)06 420.4615T(11/05/COMWEB
•
CITY OF TIGARD
A ,
BUILDING DIVISION . PERMIT #: ELR2008-00228
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED
' 7/78/2008
Phone: (503) 639 "PI t
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 0/13/2008 TIME: 7:00Am PAGE: '17
SITE ADDRESS: 09430 SW CORAL ST 200 CLASS OF WORK:
SUBDIVISION: LFHMANN ACRE TRACT LOT #: 007 TYPE OF USE:
PROJECT NAME: DR DENNIS CLARK
DESCRIPTION: Altering (1) protective signaling system.
OWNER: MARTIN BUILDING LLC, PHONE #:
CONTRACTOR: ACTION TECHNOLOGY SYSTEMS PHONE #: 503-'231-1992
Inspection Request Scheduled For: Date: W13/2008 Pour Time:
Code # Inspection Description Corifi . Contact # Message
.. vo 074129-01 603-231-1992 N
bl
Co\rec to s/Instr tions:
.
N
NN N N
Q \
Al \
a PASS El PARTIAL APPROVAL LI CANCEL 0 NO ACCESS
lEI FAIL El CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: GTh 1.\6 a LE-I Date: 1. I IA Phone #: (503) 718- 2-111/4,