Permit M! CITY OF T I G A R D ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00125
T 1513
[GARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 007
- - PARCEL: 1 S 135DA -02402
SITE ADDRESS: 11155 SW HALL BLVD 17 - 24 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 #: PRI 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 = • // r., / /, , i Permittee Signature: Set, 4-. J I . CA410 1
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.
MAY -11 -07 10:19AM FROM —North Sky Communication 3602545097 T -371 P.004/017 F -380
E1eC ricaii Permit Applicatio 1 ` 97223 F r P I :,,-,....,,,,,...,.„&..,,,,-,, : "` , F FIC USC 1 'a r t ! i "
1 0 ,. City of Tigard L DaDate/By. 5I1,tIo rJ1,14 PermitNo.: . —
:��)I2
i . , t Plan Review
. ; Other PPermit: Permit: r
I ;° 13125 SW Hall Blvd., Tigard, O Phone: 503 - 639.4171 Fax: 503.598.1960 ~f -I.'( 1 :! 2007 Date/[3r. �l – w 1 Z�
• * ": v 1 Inspection Line: 503.639.4175 Date Ready /By: Juris: /.. ® ec Page 2 for
� T1aRn C ITY O F TIG Ncaicmd/Method , �l.✓, Supplemental Information
;,•�.�.� Internet: www.tigud -0r.gov 'a t� D — C I
s ---! irk ^.Ci4.>•r Ni 'z�•�- -err ._r r ii gl l i!�t . ii ��C'?i'` r ra : ,r � , ,�• : c' ' t, ._ ,� Ili ,.: , - 72 9 i t„''
7 V '; F '�t I'Y f r T ''hVs r AA' q x < r ,L `ci j x 4af I �1 d,},� �? „ , ,,,,,, r. f,, 7 x i{ Jt itnu:.r : aca,,litI'�.
d , j�I',� 3 n ; da I � . � y.d...a .'"...:a 0}sy '�� ••14 „- � lihl1 GUl } .: . �fiSS i4„„ ��z._�J, ti r L^U } .,, R'
=, i N ew constru ction 4 Cti on Ad
" " diti .V....5 Please check all that apply (submit a sets of plane w /items checked below):
❑ New c /replacement ❑ Service or feeder 400 amps or more ❑ Building over three stories,
❑ Demolition , Other where the available fault current ❑ Marinas and boatyards.
,,. t; 'tfi r �, : '^ a it x -,.. S g^ , . ' ' euee� 1 0,000 amps at 150 volts or ❑ Floating buildings.
% `' +c`1'{ d - .�' 7 � \ 1',• W -4 (� C t! 1 0 G,. / I,,t, �.yiMryC,.t"'n,�I r U ∎ .
'�,IIfCUr11 °i,1lt'1 1 [ c� i,l S. 4: .•. �'. :1. ,.�i !. .uk
la;f•� .�. t ,6 �:iv ' •� c � , I•> ' - h � 'i'' less to ground, or exceeds 14,000 ❑ Commercial -we agricultural
0 1 - and 2-family dwelling ❑ Comrnet cial/industrial 0 Acc building amps for all other installations. buildings.
/^ Multi-family C] Master builder C] Other:
❑ Fire pump. 0 Installation of 75 KVA or
L ,� r� 1G 4 T w Fa „ I 2'r i c rl ai"t 1 Q Fmorgcncy system. larger separtualy derived system.
:tii a ."i. � nil ii � ✓1'1 D ' . 0 `' Iluk'. -� •. i ' + n':l,x ❑ Addition of new motor load of ❑ " A ° ••E••, "1 2 "1.3"
[Y �, �� 100J•1P or wore. occupation.
Job no.: Job site address: ❑ Six or more residential units. El Recreational vehicle parks.
n ❑ Healtlrrare facilities Supply voltage for more than
City/State/ZIP! 1 ' �� �/' F-' .. ❑ t 600 volts nominal,
e ct name: �1.� ` ❑ Service or feeder 600 amps or more.
Sltitdbldglapt no.: Project . — t �� ., r 4, r KCil
. Ati
Cross street/directions to job site: DeseriP6en Qry• F roan -
)�., Ncw residential single- or multi - family dwelling unit.
i n !"L6 11 - D Includes attached garage.
Subdivision: — T - Lot no.: 1,000 sq. ft. or less 145.15 4
, Ea_ add'1500 sq. ft. of portion 33.40 1
Tax map /parcel no.: limited energy, residential 2
' ; i , .f "t ', 't,, . ;;; ,i7,l l, tt ),str . 1 ` � ^19. I .mm. c 1;'474J! tt ,'41;n '"r1ti •p'� \r i' :: with above sy. 0_) • , lit/�/� Limited mercy, multi - family 75 - 00 2
4 A "94, ° / • MA • t�Y � ' J tsidcntia� with above sq. R)
Services or feeders installatiomodletation. and/or rclocrttion _
200 amps or 1es3 80.30 2
:C 1- - "PSiI . �r : ' 1 .4K, F l t '� 1.et s '. �t�"'! t ' 1 y to r h ' ,. .;r 201 amps m 400 amps 1 OG.8s 2
401 amps ro 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
Temporary services or feeders installation, alteration, and /or
City /State/ZIP: —
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 t 0400 amps 10030 2
intended for sale, leas; 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 Fee for branch circuits with
rive ri T l �,, 1 � 'T� / , t iZ'' ti , ai J .r r� mnl Hf it r 0 .. - f ' i
5261e L5.1, .. ° gr . - r , s� (, , i 9, ,' t �� ,, r]' ,.. ?,` !i. ; ra. .. , -- QAxr: i .e t '' • above service or feeder fee,
u , y ,. �_ yf�. �. LL�,�x.,Ksd ii 1*L }' . it each branch circuit b -GS 2
Business name: ND It , . .0W„Y4A ( "Olt B. Fee for branch circuits
2 - al without service or feeder fee, 46.85 2
Contact name: . >I� L 4 4 l first branch circuit
Address! - ,
1 Each add'l branch circuit 6.65 2
�' ' �r 1 6 `� V � � t v - Miscellaneous (service or feeder not induded)
City/State/ZIP: ��W �� L % I Each manufactured or modular 90.90 2
n rte., �L dwelling, service and/or feeder
Phone: (6 j) q �' 1) v ` Pax :: ( p� •1 1.T �1b .+ �j� i4' Reconnect only 6b -- 2
' f I
E -mail: I/ ' ll C 0 A I . Gb 1111 Pump or irrigation chute 53.40 2
�iiti "' 'I' , / T"o" 4 1:G a +fie.. i';' i > t g ?.1;4. Sign or outline iighring 53.40 2
Business name: 5 �m (( v ,� Signal panel, er or limited
• energy p alteration, or
Address: extension. Describe: ' Page 2 /\ 6 2
City /State/ZIP: T Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lie.: ‘ 4,1 �' Electrical Lie.: ( - �r S uprv. Lic.: Industrial ialplantpur 73.75
1 w
. u„r�,' a wo b
' .- °' ~X'7 1.4.1 i, .4,01. r ./, , l•
Suprv. Electrician signature, required: Subtotal:
Date: Plan review (25% of permit fee):
Print name: — State surcharge (8% of permit fee): 1p a
Authorized sL TOTAL PERMIT FEE: l
/i: ( A !1'�, . \i‘ t ' This permit epplcaGOn espirrs if a permit 1s not obtained witlrin 180
r
Print name: � 1 C Date: i • 1 ` V s after It bas been aces p led as complete.
Number of inspections allowed per permit
r es ,dtdins,l'ermirszc- rcmitAprwee OS/23/06 140.4615T(11/05 /COM/WEB
CITY OF TIGARD .
BUILDING DIVISION #: ELR2007 -00125
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5111/2.007
Phone: (503) 639 -4171 ,' ',,. p II
Inspection Requests (24 Hrs.): (503) 639 -4175 -�__.._
. INSPECTION WORKSHEET FOR DATE: 5/21/2007 TIME: 7:02AM PAGE: 39
SITE ADDRESS: 11155 SW HALL BLVD 17 - CLASS OF WORK:
SUBDIVISION: ST. JAMES APARTMENTS LOT #: 010 TYPE OF USE:
PROJECT NAME: ST. JAMES APTS
DESCRIPTION: Installation of fiber optic for Verixon..
OWNER: JOHNSON, LYNNE AND R BLAKE, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 503.209 -7521
Inspection Request Scheduled For: Date: 5/21 /2007 Pour Time:
Code # Inspection Description Confirm-# Contact # Message
199 Electrical final 048691 -03 503 - 849`5198 N
Corrections /Comments /Instructions: \`
\___)
•
PASS n PARTIAL APPROVAL El CANCEL ❑ NO ACCESS
n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G 1" %UT
Date:
t
Phone #: (503) 718 - __12-__4______