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Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00244 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/26/2007 PARCEL: 2S 110AC -00500 SITE ADDRESS: 14781 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 Reg #: ELE 17- 154CLE FEES 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 questions to OUNC at 503.246.6699 or 1.800.332.2344. Issued By Jr' Permittee Signature: 0 J/ 6 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 13:11 FAX 0026/038 1 ) ► G1 S (1-1'G( S ) r lfG! ' 0 '' 2 � j '— JU Electrical Permit Application FOR OFFICE USE ONLY � 9 �' Received A � City of Tigard �� ({ rn , 7� 6* S LI V Pe No. : ��JL' IN � a, Date/By: VJ ` © � " 13125 SW Hall Blvd., Tig ard,- y OR�98 � 223t, Plan Review Phone: 503.639.4171 Fax: 5031598.1960 zoos Date/By; Other Pennil: TIGARD Inspection Line: 503.639.4175 1 1 ,N 2, Date Ready /By: hu s l & la See Page 2 for Internet: www.tigard or.gov J Notified /Method: Supplemental Information . TYPE 071WORK :Mr Oe PLAN REVIEW. ❑ New construction Addition /alte P1'9 "tv rah u '" -epiacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more O Building over three stories. ❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards. • CATEGORY..OF CONSTRUCTION, exceeds 10,000 amps at 150 volts or O Floating buildings. less to ground, or exceeds 14,000 0 Commercial -use agricultural ❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. % Multi- family ❑ Master builder El Other: ❑ Fire pump. ❑ Installation of75 KVA or // ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND: LOCATION ❑ Addition of new motor load of ❑ "A ", "E "I -2 ". "1 -3 ", Job no.: Job site ad I r I -lam 100HP or more. occupancy. 1 . l t \ V 0 Six or more residential units. 0 Recreational vehicle parks. City /State /ZIP: 'li a 9 t [i , © Health -care facilities. O Supply voltage for more than I) J 0 Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: o- 1 Project namel rn V � w ^ ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: nescription 1 Qtr. I Pee. 1 Total 1 . New residential single- or multi - family dwelling unit. • Includes attached garage. Subdivision: Lot no.: 1,000 sq. 0. 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 • DESCRIPTION OF WORK (with above sq. ft-) Limited energy, multi - family �C ,'_.l I � � l1 .y✓ i 1� ( % (" / V(.34/ 1 F/ / 7 residential (with above sq, fl.) 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 € ,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 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 ' ❑ 'APPLICANT • • : I ONTACT PERSON above set or feeder fec, r 1 CO ach branch circuit Business name: i��UtL �, \ �J .; .. :.�� ` \ r .,.':, i 1. {: ;- r.- �, ,, r . 1 t,,:. � l.� B. Fee for branch circuits �! �` f f ' f < <' ;'g''' p A ,,r A `' '�\ S without set or feeder fee, Contact name: .r, i i ..( •'1' 1 / 4 one,I I �veY V fitstbtanch circuit 46.85 2 11 C' C' � J - j, r ' i r r'% . % •' Each add'I branch circuit 6.65 2 Address: 1 1 � \ �' � „` `•i r�i /% ; i ( � ;' E �/�., +'f fl bit t \I f;'• �'��/ ° •ii..% ).- Miscellaneous (service or feeder not included) City/State/ZIP: i ` fj�' �,. �j E��' E f� , , Each manufactured or modular �” ''� �� ( � dwelling, service and /or feeder 90'90 2 Phone: (V 1 ' 2. •�� Fax: :1(g • S , .q G _ * � r� Reconnect only 66.85 2 E -mail: 'i ��os fO► 1SI - y ears rn • cv-y✓1 Pump or irrigation circle 53.40 2 • • . ` CONTRACTOR • - Sign or outline lighting 53.40 2 C p rrt-- (( j �� Signal circuit(s) or limited - Business name: O ('/✓ 1f -e iJ -- O .. 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 ruin) 62.50 CCB Lie.: \ j,...\' \ `- I Electrical Lic.: Suprv. Lie.: Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: Print name: Date: Plan review (25% of pennit fee): State surcharge (8% of pennit fee): I, 17) atue :rw Authorized sign ,:.,.,. 1- : - TOTAL PERMIT FEE: Print name: 1 ' This permit application expires if a permit is not obtained within 180 ��, € � � \ (1�. 1 / �� ( (�� -'T S W ( Date: ��� ��/\ - " days after it has been accepted as complete. (� Number of inspections allowed per permit. 1: \ Building \ Pcmilis\ ELC-PennitApp.doc 0523/06 440- 4615T(11/05/COM /WEB CITY OF TIGARD BUILDING DIVISION PERMIT #: ELR2007 -00244 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/76/2007 Phone: (503) 639 -4171 t Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 7/10/2007 TIME: 7:00AM PAGE: 36 SITE ADDRESS: 14781 SW 109TH AVE 1 -4 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 #: 360-2M-6920 Inspection Request Scheduled For: Date: 7/10 /2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 051717-01 503 -519 -7466 N Corrections /Comments/ Instructions: \\%\\\. k ASS n PARTIAL APPROVAL I 1 CANCEL n NO ACCESS I FAIL I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: 11 6 Le Date: i 0 l7 Phone #: (503) 718- I"Ih1 '