Permit a.: i 4.
I� CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00225
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/26/2007
PARCEL: 2S 110AC -00400
SITE ADDRESS: 14719 SW 109TH AVE 1 -4 ZONING: R -12
SUBDIVISION: TIMBERLINE APARTMENTS LOT: JURISDICTION: TIG
PROJECT: TIMBERLINE 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:
TIMBERLINE APARTMENTS LLC NORTH SKY COMMUNICATIONS INC
BY WPL ASSOCIATES PO BOX 87550
522 NW 23RD AVE VANCOUVER, WA 98687
PORTLAND, OR 97210
Phone: Contact #: PRI 360 - 254 - 6920
FAX 866 -530 -4325
•
FEES Reg #: ELE 17- 154CLE
LIC 141171
Description Date Amount
[ELPRMT] ELR Permit 6/26/2007 $75.00
[TAX] 8% State Surcha 6/26/2007 $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 •uestions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued /� � Permittee Signature: �(',' [9 (A f7 61
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.
06/26/2007 TUE 13:03 FAX i2007/038
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Electrical Permit Application I. q �; FOR OFFICE USE ONLY
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CI of Tigard �`' �� ° �` Received ` /,�] o o
S
Date/By: Pennit No,: E 4 . _ S
e: ( U7 c
V 13125 SW Hall Blvd., Tigard, OR 97223 Pisn Review
Phone: 503.639.4171 Fax: 503.S98I196 6"" 2001 Date /By: Other Permit:
Inspection Line: 503.639.4175 " ` �� Date Ready /By: 1 See Page 2 for
TIGARD p r -r Notified /Method: Supplemental Information
Internet: www.tigard-or.gov CITY OF TIGARD ��
..:, TYtEJdFj�N OL ' . IVIS ..
.
PLAN REYIEW .
❑ New construction ,Addition /alteration /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" 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"
f Multi- famil ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
/ m. y
Emergency syste larger separately derived system.
JOB SITE INFORMATION: AND LOCATION '' ❑ Addition of new motor load of ❑ "A", "E", "1 -2 "I -3 .
Job no.: Job site addreSS� (�-.� C' (At" Q,,N� 100HP or more. occupancy.
r 1 1. S I 1 t 7 l r t " � ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /$fate /ZIP: (� El Health-care facilities. ❑ Supply voltage for more than
�� 1 // ❑Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.' U I b 1� Project name: (�,,� \o�,�/t ❑ Service or feeder 600 amps or more. • •
� "` . . FEE SCHEDULE .
Cross street/directions to job site: Description i Qty. I Fee. I Total I •
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'I 500 sq. ft. 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
.,i � r� �) 75.00 2
4-" , - ,lf. i � f " it , ^� .l 1 ,, - r ) V 4 / 1 1 2 r/ "} residential (with above sq, ti.)
'" Services or feeders installation and /or relocation
200 amps or less 80.30 2
❑ ;PitOPERTY OWNER 0 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 i
Owner installation: This installation is being made on property that I 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 • ' • - . . Q .APPLICANT I • : O "CONTACT PERSON above service or feeder fee, 6.65 2
' . \ each branch circuit
\ I t - ` \ ( "._ / �,e <-, r.; " i f ( Al •6 B. Fee for branch circuits
Business name: 1 v ! ,, ti � �,.•�i' �l.l t l � ��''�'• ,• J -'t. i
without service or feeder fee,
F t' 1 e'r: S 46 "85 2
Contact name: - AA la A, , .1 i ; , x , 1 1 ���� IV�iry first branch circuit
Address: I ( 1 c f,; ST VA ' i OA i f `!'V.j� /3 .�,,.��..
Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: `/(.q�j�/'j''}f, T i� A t :. 1, ,. -3 •f ;i� '� Each manufactured or modular
y� `h V dwelling, service and /or feeder 90.90 2
Phone: (36 '2.54409U) • Fax:: ((g • S. 3 2 � Reconnect only 66.85 2
E - mail: 7n 5 e I /Ott {'1Sk- y CVrn m • col'? Pump or irrigation circle 53.40 2
g lighting n or outline li htin g 53.40 2
n jy ` Qt'Ci ` �- Signal circuit(s) or limited-
Business name:
G✓Y'Y\ -e.- V. � energy panel, alteration, or
Address: extension. Describe: ' 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 hr min) 62.50
CCB Lie.: \ /...AAVI /...AA- 1 Electrical Lic.: Suprv. Lic.: Industrial plant per hour h 73.75
. ELECTRICAL'' PERM IT. FEES:.. .
Suprv. Electrician signature, required: Subtotal:
Print name: Date: Plan review (25% of permit fee):
State surcharge (8% of permit fee): (p t7j
Authorized signture:..:;"',_ •='' =:.:w, TOTAL PERMIT FEE:
r I This permit application expires if a permit is not obtained within 180
Print name: ‹fN Jrr ( 1� " ��/ /� 1 �� _ (� j "i �. , ��` (� Date: I ��
l days after It has been accepted as complete,
1 t ` * Number of inspections allowed per permit.
1:\ Building \Permits \ELC- PcrmitApp.doc 05/23/06 440- 4615T( I I /05 /COMVWEB
r
CITY OF-TIGARD
BUILDING DIVISION PERMIT #: ELR2007 00225
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/26 /2007
Phone: (503) 639 -4171 A m141(
Inspection Requests (24 Hrs.): (503) 639 -4175 :_..
INSPECTION WORKSHEET FOR DATE: 7/1112007 TIME: 7:01AM PAGE: 54
SITE ADDRESS: 14719 SW 109TH AVE 1 - CLASS OF WORK:
SUBDIVISION: TIMBERLINE APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: TIMBERLINE APTS
DESCRIPTION: Install low voltage fiber optics for Verizon.
OWNER: TIMBERLINE APARTMENTS LLC, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360 -254 -6920
Inspection Request Scheduled For: Date: 7/11/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 051772 -08 503-519-7466 N
Corrections /Comments/ Instructions:
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: N(),43 Date: 1 • it • Phone #: (503) 718- 4L4