Permit ,£ CITY O F TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
°` COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00253
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/27/2007
PARCEL: 2 S 112 B D -00100
SITE ADDRESS: 14660 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. Apartmnet numbers 73 -96.
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 B �ti Permittee Signature: )9L // `ff (3)/0
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'V26/2007 TUE 13:14 FAX 0037/038
'. a 1 t , 1'GL� ' ( I2 1 ue_ '0 2': L - 57)
�I� S
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard i r
Eiew O l S Pennit No.: L�1 l ��3
Phone: 503.639.4171 Fa a 503:598`[960 Date /By: Other Permit:
TIGARD Inspection Line: 503.639.417`5, I n' 2 6 2007 Date Ready /By: Jul- / 6I See Page 2 for
Internet: www.tigard- or.govJ V IV Notified /Method: + Supplemental information
.. • RE OF(Woirik:W.1 .
T',
PL 1N REVIEW: :.: ; . " :,;:;:.
Fr ,-,:: lte . t ra ui onlrepl ti • e
❑ New construction A /a jil a 'cement d Please check all that apply (submit 2 sets of plans whims checked below):
❑ Service or feeder 400 amps or more ❑Building over tlucc stories.
❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards.
CATEGORY ; U
OF 'CONSTR : exceeds 10,000 amps 31 150 volts or 0 Floating buildings. • • less to ground. or exceeds 14,000 ❑ Commercial -use agricultural
❑ I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
Multi- family ❑ Master builder ❑ Other: e. t on of 75 KVA or
0 F ire pump. ❑ Installation
. ... •
..: ........... load of
Emergency system. larger separately derived system.
JOB SITE ' INFORMATION. :AND; LOCATION
❑ Addition of new motor oad o ❑ "A ", "E ", "1.2 ". "1 -3 ",
�'(� rr rn IOOHP or more. occupancy.
Job no.: Job site address:`4�k- I(y/ K' / � 0 [ ] Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: ' aY4 1 0 0 9 ❑ Health -care facilities. ❑ Supply voltage for more than
Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no. ci D l 7 3,.9 t' jest name: g Ohrf rk \J (- ❑ Service or feeder 600 amps or more.
` FEE SCHEDULE '
Cross street /direction to job site: Description 1 Qrv. I 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. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
75.00 2
. ,." . .. . . ':. ' N'
DESCRIPTION :OF' WORK (wit above sq. ft.)
�� Limited energy, multi - family
� 1 . . ; (Pr i› ') ( 1 1( ,:?iii � - j c \ 1..I4, .,`. ._ t .1...., �. • ;1 i .,,,,, 7i `1 lF'?'(( 1 f).07-) residential (with above sq. ti.) 75.00 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
: '❑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 voles 454.65 2
Cit / State/ZIP: Temporary services or feeders installation, alteration, and /or
Y 'relocation
Phone: ( ) Fax: ( ) 200 amps or Tess 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. Fee for branch circuits with • iii APPLICANT • • ,'CONTACT PERSON • above service or feeder fee, 6.65 2 • each branch circuit
Business name: NUfli4 / k 1) f l ,,f, l/`,. f t U \ ,L /'r \. ( ( -\ . V f B. Fee for branch circuits
/ without service or feeder fee,
i ( - / t ,.•t \ 46.85 2
Contact name: (
fi t; },,,J,S �� , •. � ��, 1.: ,,. ' t I. first branch circuit
1 I. Each add'1 branch circuit 6.65 2
Address: 1 ( L (2'.... r;'? 1 'f ; 1 i t t ;' \0 t t( \1 i,j 0 C' ,.:1 -- ■ Miscellaneous (service or feeder not included)
City /State/ZIP: \ Ir ?' i (' )ij, e ', ;
A/ \ , � I. j: 7 Each manufactured or modular 90.90 2
1'\ . `f � 1,4 dwelling, service and /or feeder
Phone: ( ,j.;;) 1,0 ' ''''K Y I F (,( ) 1 /..1,16 ' ?�C,)' 4, Reconnect only 66.85 2
E -mail: 1.- „(.. �)l " ,l/1 (0-: C c)i/A)1\ J � .\ \(/ • Cb �� Pump or inigation circle 53.40 2
S ign or outline lighting 53.40 2
() Signal circuit(s) or limited -
Business name: ( c 4 - e . (y, c.' n ),DV p energy panel, alteration, or
Address: extension. Describe: 1 Page2 'G 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.: 1(.4' -1 t Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
. :;:`ELECTRICAL'PERMiT• `` :;:;:'::..,:
Suprv. Electrician signature, required: Subtotal:
- Date: Plan review (25% of permit fee):
Print name: State surcharge (8% of perrnit fee): r).)
a
Authorized signature:. :',u; ^` "- -'w m>, ' ' - " =` 4-.- _ -- - TOTAL PERMIT FEE: �1
� 1 ) Y ' This permit application expires if a permit Is not obtained within 180
l,� Print name: 'y. 1 N . ( (,(,,, •1 (., , C ' Date: �i ?7 � n / 01- days after it has been accepted as complete.
y t ° Number of inspections allowed per permit.
I:\ Building \Permits \ELC- PamitApp.doc 05/23/06 440.461ST(II /05 /COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007 -00253
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/27/2007
Phone: (503) 639 -4171 a° '
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/16/2007 TIME: 7:04AM PAGE: 38
SITE ADDRESS: 14660 SW 76TH AVE CLASS OF WORK:
SUBDIVISION: BONITA VILLA APARTMENTS LOT #: 065 TYPE OF USE:
PROJECT NAME: BONITA VILLA APTS
DESCRIPTION: Install low voltage fiber optics for Verixon. Apartmnet numbers 73-96.
OWNER: WASHINGTON CO. HOUSING AUTHORITY, PHONE #: 503-846-4794
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360 -254 -6920
Inspection Request Scheduled For: Date: //16/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 0520213 303 503. 849.5198 N
Corrections /Comments /Instructions:
FASS 1 1 PARTIAL APPROVAL [ CANCEL n NO ACCESS
1 1 FAIL H CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-