Permit � CITY OF T GARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00123
Tlii 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/11/2007
• PARCEL: 1S135DA-02402
SITE ADDRESS: 11155 SW HALL BLVD 1 - 8 ZONING: R - 12
SUBDIVISION: ST. JAMES APARTMENTS LOT: 010 JURISDICTION: TIG
PROJECT: ST. JAMES APTS
Project Description: Installation of fiber optic for Verizon.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
JOHNSON, LYNNE AND R BLAKE NORTH SKY COMMUNICATIONS INC
TRUSTEES PO BOX 87550
2445 -A MAKIKI HEIGHTS DR VANCOUVER, WA 98687
HONOLULU, HI 96822
Phone: Contact #: PRl 503- 209 -7521
FAX 866 - 743 -3974
FEES Reg #: ELE 17- 154CLE
LIC 141171
Description Date Amount
[ELPRMT] ELR Permit 5/11/2007 $75.00
[TAX] 8% State Surcha 5/11/2007 $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: )14 4 fIFI 1'u j��;t/ 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.
MAYS - 11$7 a 10:19AM FROM -North Sky Communication 3602545097 T -371 P.002/017 F -380
Electrical Permit Ap P cati . 1 b v ,, , T ., ,, . . .
� 5 _
'' ' -' ' , City of Tigard � Peril No.: L — we — pp 1,2 -
li t' 13125 SW Hall Blvd., Tigard, OR 972_23 ; , . Plan Review Other Permit
a Phone: 503.639.4171 Fax: 50 3.598.1960,-; i 2O Dateltiy: _
y ins eetion Line: 503.639.4175 Date Ready/By: tom: BI Sec Page 2 for
TItrARD' P ` N otified/M etbe4 - 11� SupplcmentaLInformation
,.� a +gal Internet www.tigard-or.gov CITY Y V r 1(� r� r ,
+ , „� ,. y- " ' c. ) ;, , ,p f ,i` ,■- -r,� s ` r + ,, , S Y ..' , y' t �' s l i., + / � �r�e� ♦ j r +, c r
s�;l.`"'i -2, 1 4 >'• " 1 , ai : -.1 i i T e y •t� k l 1 1,- � - Il, r�lt d 'f, 1 0 y r � r ,411 . : . , r f , 'ti"' ! .,,. r�' ^..,..„ . 1, .�! C`J,'al',L `!�-'` P,aC+3 °s3„+�,'+,r.,, .vf'..IS,. ^ �SCi'�SC� A,t � 2Lvtli:+:'� '1k�'T .
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wll i1 mac` , Please cheek all that apply (subm 2 sets of plans w /items checked below):
❑ New construction • ddition /alteration/replacement
❑ service or feeder 400 amps or more ['Building over dime stories,
❑ DemohtiOrt 0 Other: where the available hull current ❑ Marinas and boatyards.
t'1 �r ; i P t 11 1, 4 ' lit 1 i 4 ' 1. '• e t i g+ , 111 A6 ' i i a r� ^ 1 , ° ■ Y' R j
, exceeds x0.000 amps at 150 veils or ID Floating buildings-
?1!,1 1 ` , k , ! . ; . - b. ?� ' :,..0.....4•:...- `' l 'tl , . WrI t t : :l • .
f,� , .. � , , �L.i:�:,rS• -v - N ,sa4z�' � " � leas to mood, or exceeds 14,000 CI Commercial-use agricultural
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other instillation 'i. buildings.
►I Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
y « . tl , t l r 1,, -0 �� ���-��-; z "' a, ��y r r , „ r ` t s , } ' f 1 ,+ ❑ Emergency system. larger separately derived system.
?4 i 1 i s i" ` 1r 1 14 r ryx i .rr5•i , , a i iiir °a n , !•. u c a ' r . "'. • . r P. $ `. ❑ Addition of new motor load of ❑ .. „Le "1-2", "1-3", •
�.
10011P or more. occupancy.
Job no.: Job site address:
❑ Six or more residential units. ❑ Recreations! vehicle parks.
City/State/ZIP: 4i gi1 ❑ Health -Gars facilities: ❑ Supply voltage for more than
IY , V /'k ❑ fluardous locations. 600 volt; nominal.
Suite/bldg./apt. n 0.: Project name: 0 - ❑ Service or feeder 600 amps or more.
1 J� ilZ.1114 Y .?!. +'+ ,04 l �•1 A �' :SF.S9a�4 a 6yc r� i' ' jr •L.` 6 ,ip 3ir : j,i4 t ,
-- :^ .;' 5I�Y ' F.�y
Cross street/directions to job sit c; 'mailman 0 i Fee. 1 Tend 1 •
Now residential single or mulli family dwelling unit.
6 1 - CK (r O rV _ Includes attached garage.
Subdivision: t-= - Lot no,: 1,000 sq. fl. or less 145,15 4
Ea. add'I 500 sq. fl_ or portion 33.40 l
Tax map /parcel no.: Limited energy, midcntial 75 2
%� t a d-1n, ! t r— +� 1 ,,{ O •�T -- , �'(�� ','" . h ° � : (wh a. R) 00
iifE llHe. ;1t'� ;tiki 'Ller l l ei x`14 +t1"ai ' 1 : 1 1. 2! CPA.* •••AA 7
Lr /101) residential (with above sq. ft,) Limited
it tmbuvc aq ergy , multi family
75,00 2
1 n
Ai 1I , 411
11� ' i Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
{ F ill`. F ' r �' ; '6 11 � a ,• r S' 0 ■ '. igr 4 {` a' ', ° ' . ,�, a! L � rl 'jFn 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: Ovei 1,000 amps or volts 454.65 2 -
Ci /State/ZIP: Temporary services or feeders installation, alteration, tend /or
_ ' relocation _
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1 _
Owner installation: This installation is btatig made on property that 1 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 599 amps 133,75 2
Branch circuits - new, alteration or extension, per panel
Owner signature: Date: ' A. P for branch circuits with
tn's,r i $ ,f, i f ! ' e i+ 1' }�_� L � 4� " +',, gRa 01 y. p V s, a! a service or feeder fee,
t.L 2I W+ ° A • 1, r ' ?i9 � i 11!1. t . il- ibj . ti d,4 jf `� 1 , 6.65 2
each branch circuit
Business name: I\titk li t ,__ 61 ,0 B. Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: i.a ^., A • • eh. SrStbranch circuit
•
- Address: 1 14. 1 1 r �� • Each add'1 branch circuit 6.65 1 2
• L7 C� r' ` • t/ 1 ` ' 1 Miscellaneous (service or feeder not included)
City/State/ZI � 1 !
v Each innnufactured or modular 90.90 2
'1 ' I dwelling, service and/or feeder
Phone: (6 ) 20 ' -12-2,‘ Fax: : (' ,. 1 L b M � I "� - � Reconnect only 66.85 2
E-mail: V , AA Web OA l Cb V Pump or irrigation circle 53 ^40 2
'?Fish Ill 'Magi ' _., m ><?5" r4Vg 1 a .. l o a i?"'r.. ,1 c �r -t '` t :r , ra ti •;'‘t ■ Sign or outline lighting 53.40 2 Signal
Business name: M t . 1 * Ci �ypatie limited or
extension Describe: I Page 2 iG 2
Address:
City/State/ZlP: _ Each additional Inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) 51 \ O I Fax: ( ) Investigation per hour (1 he min) 62.50
CCE Lic.: 1c \ 1'1 1 [Electrical Lic.: 11 15 2} Tprv Lic.: a Industrial plant per hour 73.75
C'l ri 3 ; > ,;! i + - � {.d.• '':e•',i ,1.,'YJ�V•':�i�'MSr '++fi5+1�•r11"«i__ +� rs "i ''' t 4,.
Suprv. Electrician signature, required: I Subtend:
1 Datc: Plan review (25% of permit fee):
Print name: I_ State surcharge (8% of permit fee): (p 6)
Authorized TOTAL PERMIT FEE: . $1
/��� ( Y 1 ' `� t L t C Date: h�j 1 V This permit application e xpires if a permit i s not complete.
within 180
Print name: t e 1 t days after it hu been accepted as eomplotc.
` N umber of impactions allowed per permit
r :\Dut7Smaermapat -PemitApp.doc 05 /73/06 440- 46I5Ttt 1 AO3 /COM/WEI3
' CITY OF TIGARD -
BUILDING DIVISION PERMIT #: ELR2007 -00123
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/1 1/200 - 7
Phone: (503) 639 -4171 ' ", �'' �. i '+t
Inspection Requests (24 Hrs.): (503) 639 -4175 '.� °''
INSPECTION WORKSHEET FOR DATE: 5/21 /2007 TIME: 7:02AM PAGE: 41
SITE ADDRESS: 11155 SW HALL BLVD 1 - CLASS OF WORK:
SUBDIVISION: ST. JAMES APARTMENTS LOT #: 010 TYPE OF USE:
PROJECT NAME: ST. JAMES APTS
DESCRIPTION: Installation of fiber optic for Verizon.
OWNER: JOHNSON, LYNNE AND R BLAKE, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 503 - 205.7521
Inspection Request Scheduled For: Date: 5/21/2007 Pour Time:
Code # Inspection Description - no firm# Contact # Message.
199 Electrical final 048691 -01 \ \\ 503-849-5198 N
Corrections /Comments / Instructions:
PASS f PARTIAL APPROVAL ❑ CANCEL I NO ACCESS
n FAIL 1 I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: v 9) L 1 ' ," v Date: v Phone #: (503) 718 - 2-1111‘