Permit r CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00260
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/3/2007
PARCEL: 2S 110AC -01200
SITE ADDRESS: 11336 SW BULL MOUNTAIN RD 1 -A * ** ZONING: R -25
SUBDIVISION: BULL MOUNTAIN HGTS. APARTMENTS LOT: JURISDICTION: TIG
PROJECT: BULL MOUNTAIN HEIGHTS
Project Description: Install low voltage fiber optics for Verizon. Units 101 -104 & 201 -204.
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:
ANDREWS MANAGEMENT LIMITED NORTH SKY COMMUNICATIONS INC
11336 SW BULL MOUNTAIN RD #103 PO BOX 87550
TIGARD, OR 97224 VANCOUVER, WA 98687
Phone: Contact #: PRI 360 - 254 -6920
FAX 866 -530 -4325
FEES Reg #: ELE 17- 154CLE
LIC 141171
Description Date Amount
[ELPRMT] ELR Permit 7/3/2007 $75.00
[TAX] 8% State Surcha 7/3/2007 $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: �� a Permittee Signature: a m' 1
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.
07/02/2007 MON 18: FAX x 0002/011
? 1 i l iii5L 'I-( -" 1 i ) MMtG�' ? D 2`5L` . JUG
Electrical Permit Application FOR OFFICE USE ONLY .
� ' ve
City of Tig ii' E Lr' l�a Recei•._ 5 Permit No.: E-L Z I. `— 1 a 13125 SW hall Blvd., Ti atd, OR d L� �� Date/t3y: d g [Ian Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 � 200 -7 Date/By:
TIGARD Inspection Line: 503.639.4175 JUL 0 !.+ / Date Ready /By: wcie: 121 See Page 2 for
Internet: www.tigar'd or•.gov Notified /Method: Supplemental Information
TYPE.OF:� olvisiO1 PLAN REVIEW `: : :
❑ New construction Addition /alteratrmt( 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.
'.. C . - : - ., •.:1.:,- - ::•. . CATEGORY' OF CONSTRUCTION r
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: 0 Fire pump. ❑ Installation of75KVAor
JOB SITE INFORMATION AND.. LOCATION • ' ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A "E" "I 2" "1 -3"
more.
ZJ f�, t`\' R 1 l , 1 I00fIPormore. occupancy.
Job no.: Job site address:
!�� \' mil% / f `�.1V\ 1 "����� {17.11! �'1 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: i i� �(11�7 (�'� U �7�� ❑ Healthcare facilities. ❑Supply voltage for more titan
1 t ❑Hazardous locations. 600 volts nominal.
/ant. no.: Project name: t �' (`' < ❑Service or feeder 600 amps or g- 1 Q " �(�� ?L11� 1� '�1,1 �� t t \ �
SU Ite /bid TEE SCHEDULE .. -. " .
Cross street /directions to job e: ) i 2 ., Description I Qtr. I Fee. i Tout 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'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF. \�OR1C `. (with above sq It) 75.00 2
/ t (' / r! L energy, multi- family
j ( -I .r `:. ...1," :'c2flh/ b, J! ,.:. " - t `'/ `�t il i F� /t ) residential (wf h I. ) 75.00 2
t above sc ft.
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
, - ... ❑ PROPERTY- -OWNER :. . .. .. ❑ TENANT 201 amps to 900 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 I 454.65 I 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 ex_ tension, per panel
Owner signature: * Date: A. Fee for branch circuits with
... . : ::❑ :MT Ll cANT . . .1 :. : :.`�jCONTACT PERSON •'• : ' above service or feeder fee, 6.65 2
(S \ each branch circuit
Business name: NOV-itL�fl ''; j..1 V�t �' r. , i { f \ I /" 1 Oi 1 - B. Fee for branch circuits
�/1 i1 �' ' ' `` . t � e without service or feeder fee, 46.85 2
Contact name: ` \ t i t < first bunch circuit
�
// �` 7 . , . , 7 ! a � t > / • ,.., '". Each add'I branch circuit 6.65 2
Address: I U e:: S "•/ t s i i i t l• 1 ! 1 ( " ;.,.` ). -
t� t' �' ' r , Miscellaneous (service or feeder not included)
y 7 th- V` _ �.. t
Cit /State /Z1P: \ Ir, , ' . :�':( ' " • f \ J 41 ( ... ../ Each m or modular
1•. , t� .fi 90.90 2
t dwelling, set and /or feeder
Phone: ( _ %) � � � � Fax:: ' (7O e5? , ! 7Z 1— Reconnect only 66.85 2
E -mail: t " Pump or irrigation circle 53.40 2
C .. _ Sign or outline lighting
53.40 2
1' Signal circuits) or limited -
- Business name: i �!�t � I�(•.. e�11'1'�t�4�1iea�1.l.M energy panel,altetation,or
Address: extension. Describe: i 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 hr min) 62.50
— CCB Lie.: ,(,..\.1 \-1 i Electrical Lic.: Suprv. Lic.: Industrial plant per hour 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): {fj t9,)
Authorized signature :. , ..'`" _7- ...,,= - -
TOTAL PERMIT FEE
Print name: �
R. This permit application expires if a permit is not obtained within 180
Q A i N V\/ 1 ( _(, c . t (: .. - Datc: 1--.'Z : 0 •�
days after it has been accepted as complete.
t / " Number of inspections allowed per permit.
l: \nuildingWer :nits \ELC•PennitApp.doc 05/23/06 440 461ST(II /05 /COM'waa
7/27/2007
Case Activity Listing
'EL
11:13:51AM
G, Case #: ELR2007 -00260
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ELR1010 Application received 7/3/2007 None RECD FAX 7/3/2007
SLN
ELR1020 Permit created 7/3/2007 None DONE SLN 7/3/2007
SLN
ELR1030 Check for parcel tags 7/3/2007 None DONE SLN 7/3/2007
SLN
ELR1280 Issue permit 7/3/2007 None DONE SLN 7/3/2007
SLN
ELR2135 Low voltage 7/25/2007 7/26/2007 7/26/2007 None PASS GN 7/26/2007 052812 - 02 — 503 VM -
GN Y
ELR1740 Case finaled 7/26/2007 None DONE GN 7/26/2007
GN
Page 1 of 1 CaseActivity..rpt
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007 -00260
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/3/2007
Phone: (503) 639 -4171
A �
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/26/2007 TIME: 7:03AM PAGE: 26
SITE ADDRESS: 11336 SW BULL MOUNTAIN RD 1 -A m CLASS OF WORK:
SUBDIVISION: BULL MOUNTAIN HGTS. APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: BULL MOUNTAIN HEIGHTS
DESCRIPTION: Install low voltage fiber optics for Verizon. Units 101 - 104 & 201 - 204.
OWNER: ANDREWS MANAGEMENT LIMITED, PHONE #:
• CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-254-6920
Inspection Request Scheduled For: Date: 7/26/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 052812 -02 503- 849 -5198 Y
Corrections /Comments/ Instructions:
k
PASS I PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL I CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: 1 N ®`.) l Date: 1 (I
2 - b 61 Phone #: (503) 718- 21 146
•
1