Permit 171! CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00226
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/26/2007
PARCEL: 2S 110AC -00400
SITE ADDRESS: 14723 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
[ELP1tMT] 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:-
� / Permittee Signature: S /i
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.
06/26/2001 TUE 13:04 FAX p �e.� J � �n It('�J ^��7 //�) // /9�/ . I�l008/038
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Electrical Permit A p11CatIOn t A FOR OFFICE USE ONLY
t •, t• 1 c Received � (^ I
C Tia J ` d J 2007 Date/By: /214 J V Permit No.: r ,. - -��
a 13125 ity SW of Hall g Blvd., rd Ti O 972 23 flan Review
C ' • Phone: 503.639.4171 F x:� 3 B Date/13y: Other Permit:
TIGARD inspection Line: 503 j G DIVISION Date Ready /fay: I�y�/ !� See Page 2 for
Internet: www.tigard____,___ Notified/Method: 1 1 I � Supplemental Information
;TYPE OF WORK '• , ' PLAN REVIEW - ' ' •• .
12) New construction Addition /alteration /replacement Please check all that apply (submit sets of plans whims 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 0 Commercial agricultural
❑ 1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
Multi- family ❑ Master builder ❑ Other: 0 Fire pump. 0 Installation of75 KVA or
JOB SITE INFORMATION AND `LOCATION m. em.
0 Em ergency system, larger separately derived system.
0 Addition of new motor load of
Job no.: Job site addre.4J ') 3 S k).3 0 t ` r r +`C"i .Qi 100HP or more. occupancy.
❑
�l "" l ❑ Six or more residential units. Recreational vehicle parks.
•'"
City /State /ZIP: 9 /'l 0 Health -care facilities. D Supply voltage for nose than
A ❑ Hazardous locations. 600 volts nominal.
Suite /bldg, /apt. no. '' Project name:11rnW ( /t.,fl - ❑ Serviceorfeeder600atupsormore. • f ��� 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
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK ' (with above sq. fl
/; ,' f, Limited energy, inutti- family 75.00 2
' �;: I, . , : \ / La,A I" -;✓ r residential (with above
or feeders installation,_ alteration, and /or relocation
200 amps or less 80.30 2
❑ .PROPERTY OWNER I ❑ 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: a 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
' I] -APPLICANT ❑ CONTACT PERSON above service or feeder fee,
\ each branch circuit 6.65 2
Business name: tkV
� -,r (.' -' . ' I :� r''
�,r \/ � { ... , a'i,I t ( /`• ; ' t B. Fee for branch circuits
t1 f G. f l 1 j �; p p {�� withord service or feeder fee,
Contact name: / g ai l , " 6 A ,( . : :: , ( . / f"lon� Nic v s first branch circuit 46.85 2
branch circuit 6.65 2
e �' {\r- . ' .1 't )t r "t ' ` 1 t Each add'I
1 k \ mil. -
Address: t 1 6 1 (; ,∎ (• A/ ', I. t t ! (�. t V 1 I t V (.,•, ); } l
r- cS
Cit / State/ZIP: t ! , ; '3 ` \ 7 Miscellaneous (service or feeder not included)
Eac manufac or modular
y �1� J (j �(i 't 90.90 2
Phone: y,,�, ' Fax: / , dwelling, service and /or feeder
( G '�� F :g s� `'C2� _ Reconnect only 66.85 2
E -mail: // l �\ iwS ,s nor-f -kiS '�o,'Yl KY7 • Ca?1'7 Pump or inigation circle 53.40 2
CONTRACTOR : Sign or outline lighting 53.40 2
Business name: p ,� /� n Signal circuit(s) or limited -
) L [ , Lx 2 t I ���� L 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.: \ l \ -1 1 Electrical Lie.: Suprv. Lie.: Industrial plant per hour 73.75
1 • ELECTRICAL - PERMIT FEES.,
Suprv. Electrician signature, required: Subtotal:
Plan review (25% of permit fee):
Print name: Date: State surcharge (8% of permit fee): (p n'
Authorized signaattiie `:r _7 .,..:„- --- _ TOTAL PERMIT FEE: �' -
I ,.. This permit application expires if a permit is not obtained within 180
Print name: �- I 1 a • A - ' ∎ v . -k 4 d,'I ( ` C (. Date: tP/D1 OT days after it has been accepted as complete.
Number of inspections allowed per permit.
I: \Building \Permits \EI.C- PsmitApp.doc 05/23/06 440.4615T(II /05 /COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007 -00226
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/26/2007
Phone: (503) 639 -4171 a, ��i 1w'
Inspection Requests (24 Hrs.): (503) 639 -4175 • ,..' ` I..
INSPECTION WORKSHEET FOR DATE: 7/11/2007 TIME: 7 :01AM PAGE: 58
SITE ADDRESS: 14723 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 - 2546920
Inspection Request Scheduled For: Date: 7/11/2007 Pour Time:
Code # Inspection Description Confirm # .Contact # Message
199 Electrical final 051772 -04 503 - 519.7466 N
Corrections /Comments /Instructions:
1 PASS n PARTIAL APPROVAL ❑ CANCEL NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: ..7" UV (A:. I,.-G Date: ' • it ` 0 1 Phone #: (503) 718- 1-4IA