Permit •
`` .� CITY OF T I G A ®" ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 -00066
TIGARD DATE ISSUED: 3/19/2008
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S102DB 00301
SITE ADDRESS: 13070 SW ASH AVE 29 ZONING: R - 12
SUBDIVISION: ALDERBROOK APARTMENTS LOT: 008 JURISDICTION: TIG
PROJECT: ALDERBROOK APARTMENTS
• Project Description: installing 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:
GEORGE & GWENDOLYN CARNEY NORTH SKY COMMUNICATIONS INC
BY NORRIS + STEVENS REALTORS 11818 SE MILL PLAIN BLVD STE 4
520 SW 6TH #400 VANCOUVER, WA 98687
PORTLAND, OR 97204
Phone: Contact #: PRI 360 - 254 - 6920
FAX 1- 866 -530 -4325
FEES Reg #: ELE 17- 154CLE
LIC 141171
Description Date Amount
IELPRMTI ELR Permit 3/19/2008 $75.00
[TAX] 12% State Such 3/19/2008 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
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: �,p� �,�r/ . --ez 2c
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.
. 03 /19/2008 WED 8:59 FAX
I, C..- 44) I006/006
•. .
.. ..?-cic:, e.,
El ectrical Permit Applic. 1 ' ' ,,--,,,-. - . •: '-:,,,,..-..:., ...; volt OFFICE' USF' UNIFY' ''''"'"..":'
City of Tird 0 ejl tik 0 N.J.'
.. 13125 SW Hull Bl Tigard, OR 97223 r .;i. I - \ lik a u \C°;,„''e 1 , 13 e ,,,,,-
Er
g : Phone: 503.6394171 Fax: 503.598.1.260IS4 ‘") r. 11116 Date/B : / TAMMIIIIIMEMIMBN
a
Other Permit:
TIGARD
Inspection Line: 503.639A175 ,t% • 0.7 - Date Rcady/Dy; turn: See Page 2 for
Internet: www.tigard-or.gov ,9 0.91 Notifiedllvlettiod: Supplemental Information
':::::,''..:',':.*:": : ,'::::: ' '.:: '-: ;: ' :',.: 1 '': ':: : s'::'.: .:-...: :,:.•:. ...: ,...'.'-';:::: ':•;,....: ':.:': :' ..:: ': :, '. r','.
Please check all Mar imply (submit 2 sets of pluus wiitems checked below):
El New construction II Addition/alteration/replacement
0 Service or feeder 400 amps or more 0 Building over three stories,
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEUORY tIc/E CONSTRUCTION ' ': .'.', -:':: :. - .2:-. : ' '.:':..:•.... exceeds 10.000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 0 Commercial-use agricuhural
0 1 - and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder El Other: 0 Fire pump. 0 Installation 01'75 KVA or
- - '-'. • - ., .-..... - ' .. ..„ . , ..., ... 0 Emergency system, Niger separately derived system.
.
:...1: 11 ...., :,.:1:.'10)1;:SXTE INFORMATION AND :LOCATION '.‘ • '... . . ... • :,:.:•,:':: 0 Addition of new motor load of 0 "A","F","1-2...,"I -3",
Job no.: Job site address:1 3070 SW ASH AVE. IBOPIP or more. occupancy.
... - - 0 Six or more dental units. 0 Recreational veltirdc parks.
City/State/ZIP:PORTLAND, OR 97223 0 Hcalth.care facilities. 0 Supply voltage for more than
. 0 Hazardous locatiom. 600 volts itominal.
Suite/bldg./apt. no.#29-36 Project name: ALDERBROOK APTS. 0 Service or feeder 600 Imps or mare.
,11::1 .:::..: : :. : :, ., . ' •::: FEE SCHEDULE. ' :.:" .. . - : : :.,..:.'.
Cross street/dimctions'to job site: 1 -i Ai. I Qly. I Fee. I Trout I . -
New residential single- or inulti-family dwelling unit.
Includes attached garage.
_
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15J _ 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax ;nap/parcel no.:
Limited energy, residential
75.00 2
.... :'.': : ::' .: : ; .:. ': : . : .: • :, DESCRIPTION.OF.WORK: : - '..: ' ..'",'" ." - . . , .. : (with above sq. 0.)
ener,
INSTALL FIBER OPTICS FOR VERIZON Limited gull-family
residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
0 '..:PROPERTVOWNER' :'..:':,'.., :: : •.:. ...:: ,'.: :.:::••:,'....' 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. FCC for branch circuits with
. ; . ;i: : • ::-. ,:. I.:r. ; 0:APPLICANT.•:::'..•:.:; :,•..1 : ;. - . - .:." 151 ]: CONTACT above service or feeder fee,
6.65 2
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. B. Fee for branch circuits
without service or feeder fee,
Contact name: MONET VIVEROS first branch circuit 46.85 2
Address: 11818 SE MILL PLAIN BLVD. STE 410 Each add'i branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP:VANCOUVER, WA 98684 Each manufactured or nodular
90.90 2
dwelling, service and/or feeder
Phone: (360 ) 254-6920 Fax: : ( ) 1-866-530-4325 Reconnect only 66.85 2
E-mail: mviverosAnorthskycomm.com Pump or inigation circle 53.40 2
.. .
... : i: ' '::':,....,::..::::. i.' • :: : : . •:. .1.• . .7 1. ......':::.... ',:',,' Sign or outline lighting 53.40 2
Signal circuit(s) or
Business name: name:NORTH SKY COMMUNICATIONS, INC. energy panel, alteration, or
_
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Page 2 $75.00 2
City/State/ZIP: VANCOUVER, WA 98684 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (360) 254-6920 Fax: ( ) 1-866-530-4325 Investigation per hour (I lir min) 62.50
CCB Lie.: 14117 Electrical Lic.i 7-1 54CLE Suprv. Lic.: 173LEB Industrial plant per hour 73.75
'.. ..' 7. .. ELECTRICALTERMIT.'FEES ''..- :: j '
Suprv. Electrician signature, required: Subtotal: $75
Print name: JACK CAGLE Date: 3/19/08 Plan review (25% of permit fee):
State surcharge (12% of permit fee): $9.00
Authorized sit-i ,-...!..t 1° . l ', . - :-- ..._. TOTAL PERMIT FEE: $84.00
Print name: TERI A. MIKULIC Date: 3/19/08
This permit application expires if a permit is not obtained within ISO
days after it fins been accepted as complete.
Number of inspections allowed per permit.
isnailitingTerinitaTC-Pennit Arm.doc 05/2306 445.45151'(11/05/COMAM
CITY OF TIGARD
A • BUILDING DIVISION .4* PERMIT #: ER2008-00066
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/19/2008
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 Agr
INSPECTION WORKSHEET FOR DATE: 3/2612008 TIME: 7:00AM PAGE: 33
SITE ADDRESS: 13070 SW ASH AVE 29 CLASS OF WORK:
SUBDIVISION: ALDERBROOK APARTMENTS LOT #: 008 TYPE OF USE:
PROJECT NAME: ALDERBROOK APARTMENTS
DESCRIPTION: Installing fiber optics for Velizon.
OWNER: CARNEY, GEORGE & GWENDOLYN PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC (1 o Nit, PHONE #: 360
Inspection Request Scheduled For: Date: 3/26/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Eloctiical final 067352-02 971-563-9326 Y
Corrections/Comments/Instructions:
•
•
N g PASS I I PARTIAL APPROVAL 111 CANCEL n NO ACCESS
n FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: N66 L Date: 3.2.,‘ Phone #: (503) 718- 1'100