Permit CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00240
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/26/2007
PARCEL: 2 S 110AC -00500
SITE ADDRESS: 14767 SW 109TH AVE 1 -12 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 questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: , / '// Permittee Signature: 3j 1) pp tI-i(Jr)
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 13:09 FAX 0022/038
- T,, v , 1 ) 1- aSL. - t - $ - ' !'1I 1C) " 2'/0':2-' - 5D'
Electrical Permit Applica.tien tt' FOR OFFICE USE ONLY
City of Tigard n l a . M
Received
y (� 3 Pe rmit No.: r7 --
'r 13125 SW Hall Blvd., Tigard, OR 97223, / Platt Review
P C t t l ��l Other Permit:
Phone: 503.639.4171 Fax: 503.591960 Date /By:
TIGARD inspection Line: 503.639.4175
CITY L 'L�lC P D Date Ready/By; ]urir 0 See Page 2 for
Internet: www.tigard - or.gov C% 6 it Notified /Method: Supplemental Information
-?1111 I atrt,PG.t .. !'A4k(1 fm
TS'PE OF WORK': PLAN REVIEW " ....
❑ New construction ,Addition /alteration /replacement
Please check all that apply (submit a 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.
'Multi- family ❑ Master builder ❑ Other: ❑ Fire pump, ❑ installation of 75 KVA or
❑ Emergency system. larger separately derived system.
. • . • JOB SITE INFORMATION ` AND LOCATION . _ ❑ Addition of new tooter load of ❑ "A ", "E ", "t -2". "I -3
Job no.: Job site add• n pi-J/1 0 p .,Q_, 100HP or more. occupancy.
'' ,, VV!! l ❑Six or more residential mots. ❑ Recreational vehicle packs.
City /State /ZIP: 'fl i v A ie. 9 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no..0 r..._. L.-_ Project name i rn /{ L W � ❑ Service or feeder 600 amps or more.
Cross street /directions to job site: ,/ "r 1 P� FEE SCHEDULE : `
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. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
- DESCRIPTION OF- WORK ' ; ' ' • - . . (with above sq. ti.) 75.00 2
( ( r � / /( t \ • Limited energy, multi - family
1• A ( 1,-' -,--. '
1 , % , ,t;' ".. ., . 1 • . ff `.�: • .1 y i Ver 1 /� )�/ ) fesidential ( with above s t1.) 75.00 2
Services or feeders installation 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 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 cittuits with
' . ❑ .. APPLICANT CONTACT PERSON • above service or feeder fee, 6.65 2
f":.•:\ t ' each branch circuit
�ljt7 ')nir\ s <�.;.; / /. ° i. /' L . t,/ �i
Business name: 1 �u t;; 1 "• \' (� l t 1 B. Fee for branch circuits
t I i ' R � r y � without service or feeder fee,
r
Contact name: Sf lO.,..6 l/ _4% / f 1�1on& V tve12) s first branch circuit 46.85 2
Address: ; ti„ t i • I) r. t • ) t ),,,,,ii--,,,_)).- Each add'1 branch circuit 6,65 2
F_ c' - Each manufactured or modu
Miscellaneous (service or feeder not included)
City /State /Z1P: \ J ' t
i f .> : f � (:)\ ` ' 7
V,,, 9-1-# J ( � O r 90.90 2
(j � �/ dwelling, service and /or feeder
Phone: ( 'Zt•9 Fax::1(Qo& • /�j — t f l � z / Reconnect only 66.85 2
�`Jl )S r' 19oth yGOmm • Cj» Pump or irri g ation circle 53.40 2
E-mail: � - •
Sign or outline lighting 53.40 2
Business name: n Signal circuit(s) or limited -
(> �jjy'\ �, - , <- }��7 \ / 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 (I Iv min) 62.50
CCB Lie.: \j,..\, 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): t,
Authorized sign&i?e:::.,,,,'�.'��. 's _ —,-. ;_ —__ TOTAL PERMIT FEE: ' -
f...\ T This permit application expires if a permit is not obtained within 180
Print name: <-( ( V\f1 1 V - ( (: ( ",C 7 Date: fl /'7e(/ days after it has been accepted as complete.
1(/ * Number of inspections allowed per permit.
I:\ Building Wennits\ELC- PcrmilApp.doc 05/23/06 445.4615TO 1/05/C01,4/WEB
___--_- __ ___� _—__� _ _ ' _ ___ — ---- _ _—_ _ _ - _ _ - _ - _ _ -- _ _ _-� _-__
/ CITY OF TIGARD ��nm n ��n mn�m��n��� _ _ �
BUILDING DIVISION ~ PERMIT #: ELR2007-00240
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/26/2007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 A- r.L.
INSPECTION WORKSHEET FOR DATE: 7/12/2007 TIME: 7:04AM PAGE: 1
SITE ADDRESS: 14767 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 \/wrbcnn.
''' OWNER: - TIMBERL|NE.APARTkHENT|B LLG- • , • PHONE #: - '-- `, , - ' -
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 38&254-6920
Inspection Request Scheduled For: Date: 7g12/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 05189403 505'519^7466 N
Corrections/Comments/Instructions:
S — PARTIAL � CANCEL � NO ACCESS ^ _-� ^ __ . '
I FAIL I I CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
/.1(6 C3 ~� ~� _ � � �� .1'44
Inspector: �.7 ^ »/
�~°~" ~–nc� ' Oa��� » v �� �� � Phone #: (503) 718-
-- . '