Permit Mil CITY OF TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00254
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/27/2007
PARCEL: 2S 112BD -00100
SITE ADDRESS: 14650 SW 76TH AVE OFFICE /COMM.CTR. ZONING: R -12
SUBDIVISION: BONITA VILLA APARTMENTS LOT: 065 JURISDICTION: TIG
PROJECT: BONITA VILLA APTS
Project Description: Install low voltage fiber optics 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: 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.
Issued By 1�� ' Permittee Signature: 3e, ° 41 f/ Cal On
•
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.
.4'6/264'2007 TUE 13:15 FAX 2038 /038
e i i ast,-i-Ly ? ( tAC " 'p -.2` - L -. -o .r
Electrical Permit Application > FOR OFFICE USE ONLY
Received •
City of TigardRF ' " pate /By: SL PennitNo.: X2200 ' �2
' 13125 SW Hall Blvd., TagardrOR 9722' O Pla» Review t?
/ �
Phone: 503.639.4171 Fax: 0011,'t59e Date /By, Other Permit: J' inspection Line: 503.639.41 _ Date Ready /By: ij gi See Page 2 for
TIGARD Internet: www.tigard- or.gov � �
�` _,. 1 E P"` �® Notified /Method: Supplemental Information
� t �° t ttttck®
T *E +1WOR`* t ' .. . PLAN REVIEW: • .
❑ New construction , Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 arnps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
• ''.CATEGORY.:'OF ,CONSTRUCTION • • exceeds 10,000 amps at 150 volts or ❑ 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 E Master builder ❑ Other:
Fire pump ❑ installation of 75 KVA or
.. y
. _ ❑ Emergency system larger separately derived system.
' `, : . : ' :JOB SITE •INFORMATION :AND LOCATION
❑ Addition of new motor load of ❑ "A° "E" "1-2". "1-3",
Job no.: Job site address: ( Y `/ O / t xf C //� / 100HP or more, occupancy.
❑ Recreational vehicle
❑ Six or more residential units. parks.
City /State /ZIP: �' �� tt q Z ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Sui telbl dg. /apt.no.: l�) ' Project Project name: b on( \ i1 1 4,/O. 0 Serviceorfeeder
V 1 FEE SCHEDULE ::.:'.
Cross street /directions to job site: Description 1 Qty. i Fee. J Total 1 .
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. fi. or less 145.15 4
Ea. add'l 500 sq. fi. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
. 75 2
DESCRIPTION OF WORK : (with above sq. fl
r f r Limited energy, multi- family
a �,I C' , 1 .,.G..10' ', 7 / ( �i ;I (. .•�f '' �1f.J 7
'U \ a ) residential (with above so. ft.) 75.00 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
0 .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: / State/ZIP: Temporary services or feeders installation, alteration, and/or
Y '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, Rer panel
Owner signature: Date: A. Fee for branch circuits with
: . ❑ .APPLICANT = CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: N (? j -= '` \ . ,...--/r,`, . , �, 4.
i 1' J ,%,:;: . k: T B. Fee for branch circuits
Ii� ,; . t ,�
/; r / i „ without service or feeder fee, 46.85 2
Contact name: f'f lF�..•�} �,{ ,: .- -f ;,
. first branch circuit
, l r r' Each add'1 blanch circuit 6.65 2
Address: 1 ( f ; \ C ( -'// .r; t l k k' iL `'f ! _ . \ f.' ) li �; )
t f t . Miscellaneous (service or feeder not included)
City /State/ZIP: \
ed o
fact
Each . ' jr, , ' k, (' ' 11. / t • f I / c' , - -.! manufactured modular
i ., ; t7✓ ' V (.N \ J ;\ J ; l 2 �. 90.90 2
dwelling, service and /or feeder
Phone: (?;i', I L L?._) ( ) ' '11;52: 1 Fax: : (�� � 1 I.V j - ?,.)C14 Reconnect only 66.85 2
E 1 .1 .e/t 1/\ ii r\ ov ) \ �/ � . f A �� t�1 \ Cb rn um r o' irrigation circle 53.40 2
ign c
CONTRACT S
., . r outlin e lighting 53.40 2
O / Li Signal circuit(s) or limited-
Business name:
c) ('l,/`(\/1 t, 1. :C O- ^ i j t -- energy panel, alteration, or
Address: extension. Describe: Page2 le 2
City /State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (I hr min) 62.50
CCB Lic.: \ \ \ -' i Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
•. ' , ELECTRICAL.PERMIT:'FEES :::':; >::'; :
Suprv. Electrician signature, required: Subtotal:
Date: Plan review (25% of pennit fee):
Print name: State surcharge (8% of pennit fee): Uj n)
- attirfez `,�,,,_:FF "'
Authorized sign "" ____ . - ti TOTAL PERMIT FEE: %1 -
This permit application expires if a permit is not obtained within 180
Print name: <.(71 1 1,; `n 1, C. i C / J Date: i C nl 09-- days after it has been accepted as complete.
" Number of inspections allowed per pennit.
I:\ Building \Pcrmit$ELC- Peimi 05/23/06 440- 4615T(11 /05 /COWWEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007-00254
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/27/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/18/2007 TIME: 7 :01AM PAGE: 7
SITE ADDRESS: 14650 SW 76TH AVE OFFICE/COMM.CTR. CLASS OF WORK:
SUBDIVISION: BONITA VILLA APARTMENTS LOT #: 065 TYPE OF USE:
PROJECT NAME: BONITA VILLA APTS
DESCRIPTION: Install low voltage: fiber optics for Verizon.
OWNER: WASHINGTON CO. HOUSING AUTHORITY, PHONE #: 503.046 -479.4
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360 -254-6920
Inspection Request Scheduled For: Date: 7/18/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 052271 -01 503-849-5198 N
Corrections /Comments /Instructions:
IZASS PARTIAL APPROVAL fl CANCEL 1 l NO ACCESS
n FAIL [ l CALL FOR INSPECTION 1 I ADDITIONAL FEES ASSESSED
Inspector: /1 Date: 7- 7 Phone #: (503) 718-