Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° . COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00147
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/6/2008
PARCEL: 2S 110AA -02500
SITE ADDRESS: 11050 SW GAARDE ST 11 ZONING: R -12
SUBDIVISION: JOLENE APARTMENTS LOT: JURISDICTION: TIG
PROJECT: JOLENE APARTMENTS
Project Description: Units: 11 - 15. Installing fiber optics for Verizon.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPEIIRRIGAT:
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:
CORBETT HOUSE LLC NORTH SKY COMMUNICATIONS INC
621 SW MORRISON ST #800 11818 SE MILL PLAIN BLVD STE 4
PORTLAND, OR 97205 VANCOUVER, WA 98687
Phone: Contact #: PRI 360 - 254 -6920
FAX 1- 866 -530 -4325
FEES Reg #: ELE 17- 154CLE
LIC 14117
Description Date Amount
[ELPRMT] ELR Permit 6/6/2008 $75.00
[TAX] 12% State Surch 6/6/2008 $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: /' _ _ . r ermittee Signature: Qi� C �G y�
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.
JUN 05 2008 1 1 :56 PM FR TO 5035981960 P . 0 4
,
■ 1, REcovEt
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Electrical Permit Application . ... .,. ..•1:. . F0ii OVFIC.E .:...;..,,:. ,:'' . .,':.., • '. ,. ,:: .,, .
JUN 0 5 2008
--,.......: City of 'Tigard JUN s • - '
iffilliff fin nun 9h,.. ka-c y
.
• .. 7 13125 SW Hall Blvd.. Tigard, OR 97
59stTY OF TiGAR: , PotTer ., : lc'', - 1111111
•, g ..• Mune: 503,639.4171 Pax: 503.
TIGis. tospectioo 1„,inc: 503. 639.4 175 Dim rlikir rillnol Wm. RcMYIUY' See El Nigc 2 for
BU t a_!...m. vi.,7 I i! 1 '01 4 I Notaied/Meibod: WM &mph:motto' Information
Internet: wwwitgard-or
' .:.'‘ ' ':':'.::•:.:. ',..•':, •:.:. '.' :: .. '''' : ..'TYPE ;OF .WORK ..,. ' :. .. .. . '..• : : .,' -:.':'.'-' PLAN RFVThW
pl ono: all dint a pply (stitiotit 2 sett or plans wtitents elieckini below):
0 New constntction [il Add ition/alterationkcplacetnent
1:l service or fccd. ;Drips or C110/0 LI Bla Id ing over 1111110 Steles,
0 Der 0 Othcr: where the available Cant current ri Mnrinas amt tmaXyan19.
. . . , . . eXceeds t0.000 ainli s. at 150 stilt, m n I kitti builtlinp.
• • :'.,' - ..;•• ••.' .*-., ,• :: : CATEGORY OF ': CONSTRUCTION.. • • . - .. , • ..-:.,: ::.. ,..' • ' '
tc, to vound. or exceeds ROW CI Comm:aVI:11-wce agriCulocial
11 I - and 2-family dwelling 0 Cornmercial/inclustrial CI Accessory building afflps for all Whet inmallatiOns. boilcliog.i.
Multi-fatnily 0 Master builder 0 Other: o Fire pamp
' 0 Iimallation (1175 KVA at
, T . ,T 0 Eino■rocy system, larpr Sep0111tely ttetived Vstc al.
JOB 'SITE INFORMATION AND LOCATION : .• '' ..:.:. , ' : . • :" . :.. 0 Addition of new ttnaor load o( 0 - A" "S", "1
11,11)HP or mom. oectimmy.
Job no-: Job site addres 11050 SW GAARDE ST 0 Silt Or MOM PCSitilentiDI tini13. 0 Itecreatiennl vehicle vales.
City/State/ZIP: TIGARD, OR, 97224 0 1 r0eilitieS. 0 Supply voliago for in n
neo than
. 01417.araniu locations. 600 vin wiiitinid.
Suite/bldg./apt. no.: 11-15 Project na JOLENE APTS u Sevier, or feeder (300 amps. Or Alms.
- a' : :.•:-.''' . • . • ...• ' FEE SCHEDULE ,. •
Cross Street/directions to job site: Dexer10011 I J rec. Total •
------, •-,•••••••• New residential single-. or multi-Family dwelling unit.
Includes attached garage.
Subdivision; _hot no.: 1.000 sq, ) t. or less 145.15 4
- Ea. 00'1500 sq. R. or portion IMI 33.40 1
'Fax map/parcel no,: •
Limited energy, rcsiticmial ill 75,00
a
DESCRIPTION OF WORK • (with above ,: .10
75.00 IIII
II .
INSTALL FIBER OPTICS FOR VERIZON Limited energy, roulti-fann1y residential (..vith above. sa. 11,1
-- Services or feeders installation. alteration, and/or relocation
200 amps or less 80.30 2
' ..: '' .• ' ' 0 PROPERTY: •, ', '' ' : .1:... ... ' '.. ' 0 TENANT ' ' '. ‘, ' ' 201 amps to 400 limps 106,85 2
El
-j-\''f''.--4.--NrFir-t-ii-s-------' 40 I amps E0 600 amps
601 amps to 1,000 amps 160.60
240.60 Ill
Address: 6 i .s LA ,. _ rNuy 'S ,... V.---- ) ilerck) Over 1,000 amps or volts 454.65 al
Ten ry
City/State/ZIP! 1"7
services or feeders installation, alteration, and/ca-
-t.i, - c,
_ relocAtiOn
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
201 ■
Owner installation: This installation is being made on property that town which is not amps to 400 amps 00.30 2 -
intended for sale. lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 am s 133,75 2
Branch circuits - new, alteration or emulsion. yr panel
Owner signature:_______ ,.,_,Date: ------, A, Fce fot• blench circuits with
• .. ' '• : • ' 4 - D APPLICANT : ' .,•:, l: . . :. IR - CONTACT PERSON • above eervicc or feeder fee, 6,65 2
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. o. Fec for branch circuits
without service or f
Contact name: RYAN ROBERTS . feeder ee. first branch circuit 46.85
II
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each acid' I branch circuit. MI 6 =NM
Miscellaneous (service or feeder not included __
City/StaterlIP: VANCOUVER, WA 98684 Each manufactured or modular
90,90 ill
• dwel(iee. service andlor feeder
Phone: (503 ) 519-5264 Fax: : ( ) 1 Reconnect only .
66.85
, E-mail: mdggrenorthskvCom Pump or irrigation circle
..._ 53.40 Min
. . ' ..' • ' : . - '' " . . • CONTRACTOR . • • .... •• ' ' Sign Or (iodine lighting 11111 53.40 Ell
Sisititl eircuit(s) Or limited
Business name: NORTH SKY COMMUNICATIONSJNC. oncrgy mute!, alteration, or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: Page 2 $75.00
. . „... ...
City/State/ZIP; VANCOUVER, WA 98684 Each additional ins , ection over allowable in any of the above
Pci' inspection Mi 62,50 Ell
Phone: (360) 254-6920 Fax: ( ) 1-866-530-4325 Investigation per hour (1 hr min) 62.50 _ IM
CCB Lie.: 14117 Electrical Lie.i 7-154CL g soil', Lie.: Industrial plant
173LEB ndus
_ . -- - -- - ‘...., • per hour 11.1 73.75 ..- ..
ELECT ,.
RICAL PERMIT FEES - - Mill
Suprv. Electrician signature, required: 414 I A r Subtotal: ., e I
Plan review (25% of permit fee):
Print name: JACK CAGLE Date: 6_5_08
State surcharge (12% of permit foe): $9.00
Authorized signature: .....00 „ / , . / TOTAL PERMIT 012E: $84.00
./ • - This pcnolt upplkahuu evirv. a a permit is not obtain hin ed wit Ise - Print name: ETHON A. DOLPH Da 6-5-08 days nP(en li has hem atotpt0t1 nos tomplete.
', NnWiben or iospeeliOnS showed per perinil.
litlInSti1n811'eriniD.U.C.1 \ stint itipp.ilDn 04/23/06 ,i4o-51 yro inkl/COMAVIIII
** TOTAL PAGE.04 **
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR200B- 00147
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/6/2008
Phone: (503) 639 -4171" i. ' iI
Inspection Requests (24 Hrs.): (503) 639 -4175 x40'
INSPECTION WORKSHEET FOR DATE: 0//6/2006 TIME: 7 :00AM PAGE: 31
SITE ADDRESS: 11050 SW GAARDE ST 11 CLASS OF WORK:
SUBDIVISION: JOLENE APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: JOLENE APARTMENTS
DESCRIPTION: Units: 11 -15. Installing fiber optics for Verizon. .
OWNER: CORBE E1 HOUSE LLC, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-254-6920
Inspection Request Scheduled For: Date: 5/16/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 071409 -02 503 - 209-7014 N
Corrections /Comments /Instructions:
�� 1
,
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION 17 ADDITIONAL FEES ASSESSED
Inspector: 1/,://44 Date: 6 /1 / Phone #: (503) 718 -