Permit .
CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
off' I DEVELOPMENT SERVICES PERMIT #: ELR2005 -00305
� I � 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/26/2005
PARCEL: 1S126DC-04400
SITE ADDRESS: 09430 SW CORAL ST 200 ZONING: C -P
SUBDIVISION: LEHMANN ACRE TRACT LOT: 007 JURISDICTION: TIG
Project Description: Audio and Stereo.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X 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:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
MARTIN, ROBERT CLARE T & L COMMUNICATIONS INC
THELMA M PO BOX 87387
BY JO RENE M MOODHE VANCOUVER, WA 98687 -7387
SHERWOOD, OR 97140
Phone: Phone: 360 - 737 - 9725
Reg #: LIC 67787
ELE 37- 428CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[TAX] 8% State Surchar€ 9/26/2005 $6.00
[ELPRMT] ELR Permit 9/26/2005 $75.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are - for in OAR 952 - 001 -0010
through OAR 952- 01 -0100. You may obtain copies of these rules or direct ques, a� -' o NC at 51 - 46 -6699.
Issued By: Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
E,lectricalPermit A•: ?o t t` ________ __. �.__ EbRO .f_1]c- r...tsLQNl_�__._ ,____
C of Tigard Received �, L /�� ti Permit t No.:4 / g f , --B/ .$��
13125 SW Hall Blvd., Tigard, OR 9722 Plan Revi w /
Phone: 503.639.4171 Fax: 503.598.1' :t P 2 6 2005 ��'' "N '''i r ' 's � I''� DateB Other Permit: 3 C) 5'
Inspection Line: 503.639.4175 s' Date ReadyBy: ® See Page 2 for
Internet: www.ci.tigard.or.us lc\ Supplemental Information
l ' • BUrikara � PLAN REVIEW
❑ New construction t2 4tidition/alteratton / re l �A rtient Please check all that apply:
❑ Demolition ❑Other: ['Service over 225 amps, comm'! 0 Hazardous location
0 Service over 320 amps- rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION . " , • of 1- and 2- family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling ommercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family El Master builder ❑Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ['Egress/lighting plan RV park
'�
Job no.: Job site address: '1 :20 5C56J ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP:( r/ Qe---c.g C 7e G_.0_ - The above are not applicable to temporary construction service.
Suite/bldg. /apt no.: 0d Project name: D — C/ ./- �_ • ' FEE* SCHEDULE
CI a. Description I Qty. I Fec. I Total I **
Cross street/directions to job site: New residential single or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel n .: Limited energy, residential 75.00 2
� vA '' Limited energy, non - residential 75.00 2
�. 5 DESCRIPTION OF WORK Each manufactured or modular •
�� / S Q �� a d (y i S a dwelling, service and/or feeder 90.90 2
I /�- al�� Services or feeders installation, alteration, and /or relocation
U c' l (tiCLA- ' _ �Z3'c \- (, 200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 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 volts 454:65 2
Reconnect only 66.85 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, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
' ❑ APPLICANT ❑ CONTACT PERSON ' A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: pub U �
f C L W 4r - branch circuit
nn rr � B. Fee for branch circuits
Contact name: �S .5 - V� , .j (.-' (. T without service or feeder fee, 46.85 2
g each branch circuit
Address:
O g c l ?2? ?'7 Each add'I branch circuit 6.65 2
City /State/ZIP: 6_41/2„,ic___ �/,,4 O '7 Miscellaneous (service or feeder not included)
Phone: (j6c)) `7 3 7 9 7 Z� Fax::. .c")r72 ? / .6 c(�l Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
_ _ . CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: 6 j G/� , ffecUGc! c_c_A_ ------ Address O �� S - Each additional inspection over allowable in any of the above
Per inspection 62.50
City/ State/ZIP: (1�0..) 0- ‘r ---1 Investigation per hour (I hr min) 62.50
Phone: (3Q) 7 77 77 Fax: (36Q ) 73 7 6 76 913 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 677 Electrical Lic.:.7 X2 Suprv. Lic.: ‘,,g-y Subtotal
Suprv. Electrician signature, required: ,/ C�uJ - Plan review (25% of permit fee)
Print name: (---A fit/ �5 Date: - 6 —65- -65— State surcharge (8% of permit fee)
l TOTAL PERMIT FEE
Authorized signature:
IGUAL
This permit application expires if a permit is not obtained within 180
/
L days after it has been accepted as complete
Print name: S 5. kw, C-.3 Date: ' 9 2 �d 5 — * Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
i:\ Building \Pernits\ELC- PennitApp.doe 12/03 440- 4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard.
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
. RESIDENTIAL WORICONLY -: ,—
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
El Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
1 COIVIIVIERCIAL WORK ONLY: _-
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
'Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
El Instrumentation
El Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
•
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
i:\ BuildingWennits \ELC- PennitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR200000
i 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/26/2005 I
Phone: (503) 639- 4171 �I�ll(i
Inspection• Requests (24 Hrs.): (503) 639 -4175 �_' `__.,
1 INSPECTION WORKSHEET FOR DATE: 9/27/2005 TIME: 7 PAGE: 77
' SITE ADDRESS: CLASS OF WORK:
09430 SW CORAL ST 200
SUBDIVISION: LEHMANN ACRE TRACT LOT #: 007 TYPE OF USE:
PROJECT NAME: DR. CLARK
DESCRIPTION: Audio and Stereo.
OWNER: PHONE #:
CONTRACTOR: MARTIN, ROBERT CLARE PHONE #: .,
T & L COMMUNICATIONS INC 360- 737 -9725
Inspection Request Scheduled For: Date: 9/27/2005 Pour Time:
Code # Inspection Description • Confirm # Contact # Message
199 016683 -01 360 -737 -9725 N
Corrections /Comments /I - - .ons:
PIr1aan ) Ql., k c� oVt 5 a S . 61J !
PASS 7 PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
n FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: NN 1 -- Date: ( 2 1 Or Phone #: (503) 718- my-, •
.