Permit CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00453
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/12/2007
PARCEL: 25101 DB -00201
SITE ADDRESS: 07582 SW HUNZIKER RD 17 ZONING: C -P
SUBDIVISION: HILLCREST APARTMENTS LOT: JURISDICTION: TIG
PROJECT: HILLCREST APARTMENTS
Project Description: Install low voltage fiber optics for Verizon. Units 17 - 20.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: DATA : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
PETRUSHKIN, SUSAN RO SE NORTH SKY COMMUNICATIONS INC
7315 SW 27TH AVE PO BOX 87550
PORTLAND, OR 97219 VANCOUVER, WA 98687
Phone: Contact #: PR! 360 - 254 -6920
FAX 360 - 254 -5097
Reg #: ELE 17- 154CLE
FEES LIC 141171
Description Date Amount
[ELPRMT] ELR Permit 12/12/2007 $75.00
[TAX] 8% State Surcha 12/12/2007 $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 t� OUNC at 5' .246.669 or 1.800.332.2344.
Issued By: ���� ,,aye " Permittee Signature: q
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.
12/12/2007 WED 12:16 FAX 00 0 8/0 1 1
, iitok5x/-1 fx
,y • tlectrieal Permit Applicati M ECEIVEI , OFFICE USE ONLY
. i
Received 11 1„ /, c-
City of Tigard d
Dale/B , k/2.419 - 7 — ,..) Permit No.: ELpie 2009 __ 00#5
• 13125 SW Hall Blv Tigard OR 97223 EC 1 2 2007 Plan Review
Other Permit:
1 11 I : • Phone: 503.639.4171 Fax: ' 503.598.19M •• Date/By;
TIGARD
Inspection Line: CITY . 503.639.4175 Date Ready/By: lukitn E5 See Page 2 for
OF TIGAFiD
Internet: www.ttgard Notified/Method: Supplemental Information
• , ' ..........,.. „... . . ... , . .. ... , . „ ,, , ,,, ...,.... ,
.yiat• ii,f4110. ,.-•,,,,,-,:...--. : - ..-..- -•,,".', .,.- --:-.kLAN, ..,.-',..,-, ,• ,"-.-",,,,,:
0 New construction .Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below):
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.
'..,'•": ': .•.:''' CAT-EORY, OF:,.CONTRITTION •; ,-, , ::.:, --,,".: :.,' x . at ps a 0 Floating buildings.
less to ground, or exceeds 14,000 0 Commercial-use agricultural
0 '1- and 2-family dwelling 0 Commercial/industrial CI Accessory building amps for all other installations. buildings.
Multi-famil 0 Master builder El Other: PFire pump, 0 Installation of 75 KVA or
•,:;i:: - , : - - . 1':::: , , , , ,,.'. : :: , :::, .44b,ii.,Sfre,ii,ittomAiliji,i46 , .,, ,.;::::-:,,::::,..;,.,,, 0 Etnergency system. larger separately derived system. load of
...
Job no,: Job site address:
I 00HP or more, occupancy.
! au. k tit pf . , -
. — . . El Six or more residential units, 0 Recreational vehicle parks.
City/State/ZIP: --c. , i IIMIM VZ, 0 Health.care facilities. 0 Supply voltage for more than
• — 0 Hazardous locations. 600 volts nomina I.
111/0
Suite/bldg./apt. no.0, i ( 4t 0 Project name: t alrifZ El Service or feeder 600 amps urinate.
_ s
, i : •'-:','.'::• ': ', 'fE1(:;.SCH0/1,31Lt!
Cross street/directions to job site:
Description I Q0iii 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 1 4
Ea. add'l 500 sq. ft. or portion 33.40 I
Tax map/parcel no.:
Limited energy, residential
75.130 2
i?cliOlP1119N ..9f.: WORK: , :,..., ..... .,.. ',.,,,..':. :': .:• ..,,-.:.!-.:: (with above sq. ft.)
116611/B /0 W 0 1 1 ,A Ve/v
... • - A ) , Limited enei multi-family
residential (with above sq. ft.) 75,00 2
Services or feeders installation, alteration, and/or relocation
„ .„. ..., . . ;.. , . .... ,, ,. .....: ,... .. . ,.., . . , „. „ _, 200 amps or less 80.30 2
E: : : ' • , '"-''. 1:-- ' 17 :':':' ;, •: .0 :: ,.. rPlA'NT, -'':', ' :: ''''''' 201 amps to 400 amps 106.85 2
Name: 401 amps 10 600 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 fe eders 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
::' '' ; •.j:'', 1 ,1111 ki ,•; :': .: : • •:::' : ::V.. . . ', ,,:, above service or feeder fee,
6.65 2
each branch circuit
Business name: t\t,P
) ( i:V,, , ,f (AItityl./\ t , t);,/‘ / k , (' ar i,,,- i r i l —
13, Fee for branch circuits
•
I 1 without service or feeder fee,
Contact name: 01 . -'' i \ i ^)
first branch circuit 46.85 2
Address: ..
I { ( 6 ,( vv \'‘I i \ 0 0 4 a ' Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
"t4aIlLy(j_Vitk ,_.._. j,). I 1 Each tnanufactured or modular
90.90 2
dwelling, service and/or feeder
Phone: ( . (A2,0 k Fax: : v ) 5 25 . Reconnect only 66.85 2
E-mail: .tf\LIN4,2a.ce Y1C4011 WI , CO WI Pump or inigation circle 53.40 2
:::::i:: • ::'..',':2::::.':::':.,::':',',: .':: ..,..•:'. I ..::CiDf!iT,O.AQ-,t A • ••:: : • . ;: , :• . ;• : :•, : - :::.,.11: :,..,..: : • •:.: • ..:, , • .•::: ••• • ,::•-.::: Sign or outline lighting 53A0 2
Business name: ()
0 CVYVI -e., .-- 01O1OV Signal circuit(s) or limited-
energy panel, alteration, or
Address: t \ SI e, NAk\ ?\ 1 v2\z, extension. Describe: \ Page 2 16 2
City/State/ZIP: aY\CMN \k \ , \k) 9F-),(81 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (12t10 )2,,C21.1 --(A 1_,0 Fax: ( ?J 2,„6(..( - 600 i
Investigation per hour ti lir min) 62.50
Cal Lie.: ‘141 \ 1 I Electrical Lie.: Suprv. Lie.: Industrial plant per hour 73.75
::•'.: L. '::
Suprv. Electrician signature, required:
Subtotal:
Print name: Date:
Plan review (25% of permit fee):
— State surcharge (8% of permit fee):
Authorized TOTAL _.
TOTAL PERMIT FEE: \ ----
---zt--, -----------...
./P. . A 5/\ \/ 1 / 0 r r This permit pplication expires if n permit is a not obtained within 180
Print name: ( \ - 1 A,/ i /. , /
w 'i ,. v_ , L Date: 12.12 ,
days after it has been accepted as complete.
^' Number of inspections allowed per permit.
1ABuildingWermits \ELC-PcrmitApp.doc 05/23/06 440.4615TO I/05/COM/WEB
•.
CITY OF TIGARD
44
BUILDING DIVISION PERMIT #: ELR2007-00463
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1211212007
Phone: (503) 639-4171 iN4PI• 0
Inspection Requests (24 Hrs.): (503) 639-4175 ..d.IN■
INSPECTION WORKSHEET FOR DATE: 12/21/2007 TIME: 7:03AM PAGE: 60
SITE ADDRESS: 07682 SW NUNZIKER RD 17 CLASS OF WORK:
SUBDIVISION: FIllicREgr APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: flli CREST APARTMENTS
DESCRIPTION: Install low voltage fiber optics for Verizon. Units 17-20.
OWNER: PETRUSHKIN, SUSAN RO SE, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-254-6920 -
Inspection Request Scheduled For: Date: 12/21/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 062012-02 503969-5989
Corrections/Comments/Instructions:
N
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11 /
•
•
ASS n PARTIAL APPROVAL 0 CANCEL n NO ACCESS
FAIL n CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: Cr.' V Date: 11 t % 7 Phone #: (503) 718- IAA_