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Permit 0 � CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELO PMENT PERMIT #: ELR2007 - 00252 TIGARD 13125 SW HaII Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/27/2007 PARCEL: 2 S 112 B D - 00100 SITE ADDRESS: 14620 SW 76TH AVE ZONING: R -12 SUBDIVISION: BONITA VILLA APARTMENTS LOT: 065 JURISDICTION: TIG PROJECT: BONITA VILLA APTS Project Description: Install low voltage fiber optics for Verizon. Apartment numbers 49 -72. 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: 1 Owner: Contractor: WASHINGTON CO. HOUSING AUTHORITY NORTH SKY COMMUNICATIONS INC 111 NE LINCOLN ST PO BOX 87550 #200 -L, MS63 VANCOUVER, WA 98687 HILLSBORO, OR 97124 -3082 Phone: 503- 846 -4794 Contact #: PRI 360 - 254 -6920 FAX 866 -530 -4325 FEES Reg #: ELE 17- 154CLE LIC 141171 Description Date Amount [ELPRMT] ELR Permit 6/27/2007 $75.00 [TAX] 8% State Surcha 6/27/2007 $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. r Issued Bar � Permittee Signature: .9_ I( « fi ,9t2 (»'1 a 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. .06 2007 TUE 13: 14 FAX ` �� y� 036/038 r� - ,F`• ( ,��, e 1 -asL' i- ' 1v1 1- 1r/' -" � ° 2 L 5 pplica(io : . ,� Electrical Permit A FOR OFFICE USE ONLY , City W Tigard l t g NI 9 % 111 f Received Z e+ Permit No.: Gt! Ie � .-06 7 �" " 13125 SW Haft Blvd., Tigard, Oft 97223 Plan Review GJ� M ill Phone: 503.639.4171r `x 13 196o Date /By: Other Permit: TIGARD Inspection Line: 503 63 4175 Q F Date Ready /By: Ju t See Page 2 for Internet: www.tigard rorig � • E W Ye�I ® t V Notified /Method: J� Supplemental Information ❑ New construction Sg.Additionlalteratton /replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. : > CATEGORY i'OF 'CONSTRUCTION r excee 10,000 amps at 150 vo o ❑ Floating buildings. less to ground. or exceeds 14,000 ❑ Commercial - use agricultural ❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. %Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or ❑ Emergency system. larger separately derived system. .. ';JOB. SITE INFO > LOCATION ❑ Addition of new motor load of ❑ "A", "E ", "1 -2 ". "1 -3 ", Job no.: Job site addressi4'n -I � � �J� 100 or more. occupancy, ❑ or Six or more residential units. ❑ Recreational vehicle parks, City /State /ZIP: Ir 11 � ( ❑ Health - care facilities. ❑ Supply voltage for more than 1 1 ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no. c q n � WW ✓ ect name: \' J`'� t " J [ \ c ❑ Service or f 600 amps or more. � '1` ' FEE SCHEDULE Cross street /directions to job site: Description 1 Qty. 1 Fee. 1 Total 1 * - New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Ea. add'l 500 sq. fl. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 : : DESCRIPTION OF WORK' • (with above sq. ft.) _ Limited energy, multi - family '1 / l:; } ( 75.00 2 C% � ( ('�' C, \r" / Oil � (; ; (�✓ Veit,- 1 l� �} residential (with above sq, fl.) Services or feeders installation, alteration, and /or relocation 200 amps or less 80.30 2 `D :PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 Name: 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 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 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. Fce for branch circuits with .❑ : APPLICANT CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: (0 / Llrk ( '1)V'' , �'(• -)ta.i E'` o,/ °^ (. a.A. I 06 B. Fee for branch circuits i ,' ( � r i 1 .�:_,... Contact name: ' + without service or feeder fee, 46.85 2 t� /(f t �� : � ,( , ( t : ; ,< <I 1_ first branch circuit �! 1 ' i ' i +, r� f . �j �" Each add'1 branch circuit 6.65 2 r Address: (, ('; � 6 1 t ( t 1. \ 4 ' ‘.1 t.. (,, A 7") 'i.. :1 2. , '! 7 Miscellaneous (service or feeder not included) City/State/ZIP: ` i t ii (! ' ; ( j c, - 1 Each manufactured or modular Y . i ' {7V. .J , ` L � ', (. t 90.90 2 dwelling, service and /or feeder Phone: ( i ) c 1 ) 1,0 - "At , • l.: 1 Fax: : (�(. p ( tp) 1 e, C,2,-.)C,1 4- Reconnect only 66.85 2 E 1 4 �� ,'�' /�) 1P -' f Coin) c.) •l •�` °An \10 Cb t r 1 Pump or inigation circle 53.40 2 CONTRA R .:'1: : ... Sign or outline lighting 53.40 2 • (\ //r C /� ) Signal circuit(s) or iimited- Business name: L1 WV\ -P, V-- c O 0i.3v/ energy panel, alteration, or Address: extension. Describe: 1 Page 2 16 2 City /State /ZIP: Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: ( ) Fax: ( ) Investigation per hour (1 Iv min) 62.50 CCB Lic.: H'1 \-1 L Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75 `.: ELECTRICAL ": PERiMIT,. FEES':: :'. :•;:':`: :, :: :: •;:C: Suprv. Electrician signature, required: Subtotal: Print name: Date: Plan review (25% of pennit fee): State surcharge (8% of permit fee): . t) Authorized signs ure : " ' }-" ...Z; '` - _, TOTAL PERMIT FEE: 1 r 1 + (00(,0/0- This permit application expires if a permit is not obtained within 180 Print name: ' /V 1 + �� . '�1n 1 � � ,(f � i ' (. Date: , days after it has been accepted as complete. r * Number of inspections allowed per permit. lt\ Building \ Permits \ELC- PetmitApp.doc 0583/06 440.4615T(1 1 /05 /COM/ \VED CITY OF TIGARD BUILDING DIVISION PERMIT #: FL R 7' © Z S 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 ! oppo" Inspection Requests (24 Hrs.): (503) 639 -4175 p�I. INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: �6Zo W' 7 4'1' CLASS OF WORK: SUBDIVISION: i �� it,' LOT #: TYPE OF USE: PROJECT NAME: © /7 DESCRIPTION: OWNER: PHONE #: CONTRACTOR: 5J<y (0 crw►-i PHONE #: Inspection Request Scheduled For: Date: 7 — /s 0 7 Pour Time: Code # Inspection Description Confirm # Contact # Message / 3 S L--1/ 5 03 45'9 —si 9 Corrections /Comments /Instructions: • PASS l PARTIAL APPROVAL ❑ CANCEL n NO ACCESS 1 FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED • Inspector: Date: - 7 / vf Phone #: (503) 718- ;