Permit ELECTRICAL PERMIT -
CITY TIGARD RESTRICTED ENERGY
rll DEVELOPMENT SERVICES PERMIT #: ELR2003 -00366
13125 SW Hall Blvd., Tigard, OR 97223 (5031 639 -4171 DATE ISSUED: 12/1/03
SITE ADDRESS: 09095 SW BURNHAM ST PARCEL: 2S102AD 01300
SUBDIVISION: ZONING: CBD
BLOCK: LOT: JURISDICTION: TIG
Project Description: Tenant Improvement
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:
WYATT, DEWEY ACTION TECHNOLOGY SYSTEMS
c/o WYATT, EUGENE 835 SE 17TH AVE
9095 SW BURNHAM PORTLAND, OR 97214
TIGARD, OR 97223
Phone: Phone: 231 - 1992
Reg #: LIC 157630
ELE 26- 775CLE
FEES Required Inspections
Description Date Amount Ceiling Cover
[ELPRMT] ELR Permit 12/1/03 $75.00 Wall Cover
Elect'I Final
[TAX] 8% State Surchar€ 12/1/03 $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 throuc
Issued by ( ' i 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 639 -4175 by 7:00 P.M. for an inspection needed the next business day
DEC -01 -2003 10:56 ACTION TECHNOLOGY SYSTEMS 503 231 1402 P.01
i , ,Electrical Permit Application
'11 RECEIVED - ? "3 -�3
City of Tigard .. _ PtrnatNo_:
13125 SW Hai BJv L Plan Review Other
Tigard, Oregon 97223 DEC 01 200 Dozer Perna No.! -
phone; 503 - 639.4171 Fax: 51158.--1 lest Review Land Use
3atetuer www.ci.tigardor.us CITY'- TIGA', . ; � .I ' DaalB : Case f 1 CmoCr kais.: , _a Sao rzge 1 ror
24 -hour Inspection Request: 31 )WIi IV' ' = • - lutunactboa: s • , • leusesw Information.
. .i,•?.::;: .` t 3rtl c T7WORK';.: k' , , : - -- - -, `Y > - .,- _ „ rPIIit `itEln `'(IL`l dcaf _,r• _
II. New collstmt:tion I Demolition ❑ Se+niete over 22S a p t i ti'citicy
rl/r •lacetaent • Other: coaviie over sailing p Addition/alteratio
Q Service over 320 amps- rating or Q Sueldin� ove Lafl00 aqurrre Cvxt.
• VA ' '=p'':; `7.t. ' TR ACORCO e l e's 2 ` : , . .. l & 2 farmer d''dlittas fora worm nseidmat►I units in
P 1 & 2-Faau y dwelling p Comrmereialttndustsial System over 600 volts nominal one Moire Atx�es Building
R O ther iltnil t dace sex Feeders, 400 [[odic
r occupant load over 99 persons Manufactured swum= or RV piste
• Master Builder Other CI Earesslidtting plan Caber
.` :sf _. - a .. =t1 • i T iON .- Subunit sets of pleas wn1b nay et above.
The above age eat walkable to tutudreary em 'ems service. $ 11rT1i7�Iil Road Job site address: I I' W _.,_ ; :.r ► . : pt_ 1: 7W , 4.
Slits #: Eld A. #: Number o giusoeetSoas txr a'mie sllewect
' - ,' xt Name: . .W. Properties ' - Feat's) rent .
Ctnss street/Directions m job site: iv r err >�
deRt� ! sw a m armed garage.
Service i.ciodetb
1000 so. ft. er loo ` 145.15 4
Each maimed silo sq. rt. or portion tt ,ot ' 33.40 t
Sabdivisivn: j I.ot #: Lirnjeeel eeerm residential moo
Limited .. :. - oon residamlal 15.00 2
, Taxmapfparcei #: 655 -F4 rorhmsmehmaedtomea mead= dwelling I
. ' 4 s si•. _'e§. : : :' !, D :WORK -J� r :::.. . _ _ ` - }' .' =Zee's "Val. order 90.90 2
installation bur sm�oeadoa.tedaaotoa.�
system Idleratle.orr•ksaeiso:
200 sow er lei 8030 2
201 mbec to 4O0wee Alai \. 2
401 ow* to 600 arms 160.60 2
�. _ _ . 1 24060 2
1 sr volts 454.65 2,
, Net. R.00no.a a ll 66-x3 2
is Temporary sonic= or faoders- iragtaloiot000,
• Ci lState/Zip: � ed'a or relocation:
1 6645 1
Pb ile: Fax 331 =pa to 400 =is r 100.3 i 2
aos
401 es 400 pr 1 133.73 I 2.j
Igo' '. §D -° - 1• '' Broach dreoits - sew, aloerattv., or I
Name: e A_ Fee Ike tomb ®raves with pu+dmsc of
' Address: ter rioo or &Ma tie each booth circuit 6.65 _ 2
City/QtatclZap_ B. Fee for breads auks rddaurt rein of
+�] service or lodes' foe, first banob cbomt 4685 2
Phone: . Fax: Foch sailboat txeoottcircuit !,-es 2
E -mall. M10w(,entioo or feeder Ore i dT
. r . a` _ [.YfP ER/ECTQR. - , -r: .. ' �s^ ° Fit eCF►mtie¢r Qek - 53.40 a
:.� s ; FaCh a or waste t thtio C _ FAO 2
Job No: 3i>is<al cirwit(a) or a lira kW clergy iii, -
mina Business Nante Action Tecimolo_ S st - n - e a te - 1 t z 2
Address: 835 SE 17th Ave.
Ci !State /Zi : PORTLAND, OR 9 7214 , lddiA.oeI n one auewable :.E saF of the :
^ P er per Wk. 1 tans) 62.50
Phone: 1 - - ” Fax: 503-231-1 I eevno ioaS _ -
C .� 1.1C !1i' • r t)t r'• -. _r- . lir :_rr -�� = ; - ''e; :- -.
�
Supervising electrician • /d /r � :1 v Subtotal ` $ 15 .Eli
-; ..., 4 I .•. Ztir� j .°•� Plan Rcvicw (23 % of Permit Fee) s G .00
Print N - wiles: ;f _r • • lc .*, 83LtA _ statesurrharati of Plinth Fes=! $
, \ TOTAL FERZ T FOE S g 0
Authorized / Notice, This permit sesgeaa expires u:
tieires ire permit sot obtotoed ...chin
110
, X , 11 — Date; 12/01/03 120 smear ie nn m ez
boon as eaesplets
ff ` 'Fro m•tbodokgy set by Tri -CWe4' 8.11 ssLIndustryService $ogerd.
Rena Kirkland
(Pkace print nam )
i :1bsts1Permic Forms \E!ePerrratApp.doc 01 MG