Permit CITY TI GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00455
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 25 ZONING: C -
SUBDIVISION: HILLCREST APARTMENTS LOT: JURISDICTION: TIG
PROJECT: HILLCREST APARTMENTS
Project Description: Install low voltage fiber optics for Verizon. Units 25 -32.
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 #: PRI 360 - 254 -6920
FAX 360 -254 -5097
FEES Reg #: ELE 17- 154CLE
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 to OUNC at 503. •6.6699 or 1.800.332.2344.
1 Q J f Issued B S ��L� Permittee Signature: `/,
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.
1 2 / 1 2 / 2007 WED 12: 17 FAX 00 1 0 / 0 1 1
. 'le. e i U-Ltbl 1- C L 7" ; ffi) ItC7 MCI! /—%- 540 - i)'2'" -
,
Electrical Permit Applica '
j r USE ONLY
t ECEIVED
li
r•
'
• City of Tigard i k Received T
, ji Permit No.. Lite 0 , ,_ 0 # 3
_ .i. 13125 SW Hall Blvd., Tigard, OR 97223 . , ...
ip
0 Phone: 503.639.4171 Fax: 503.598.1EL 1
.1. 4.•
' 2007 D
Date/By: i
Plan
I
Other Permit:
TIGARD
Inspection Line: 503.639.4175 Date Ready/By: in' is _ El See Page 2 for • •
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: 77 c Supplemental Information
.:. ‘: ' ':' , ', ' . : : :' ' ' i; ' , ' !: ?: ' :0:''-`. ‹ : :,'• ' ' ' . :': ': ' . ' :: ' :'. ;:..... :•';,... :' ,..:' . )0*.614.;} . e. ' "" GOI.VISPO.. ;:: ::•.•:::::: .....: ‘;.',......' '" '::;','-': ''... :. ::':,11 , '04 - 1 - .4SitOiv..:;.. , , , ,
0 New construction OAddition/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.
...:: :::.,...: ..,....A3-0 ,:, -:1:,.. ,1;.,,:. 2 ,. . I, ;:.:, e xce or (a ,,,::,,,,,,, b
,,,,,,
a gricultural
0 1- and 2-family dwelling 0 Commercial/industrial El Accessory building amps for all other installations. buildings.
Multi-family 0 Master builder 0 Other: 0 Fire pump. D Installation of 25 KVA or
. , -:-.: 0 Emergency system. .
. ,::.:::: -. :.':.f....' : . •: : SITE INFORMATION ..06.',01;ITZ larger separately derived system
,.:::. '.. .'",:': ' 0 Addition of new inOtOr load of 0
_.: •. ... ••• . ,..,. . ..,,, . .
occupancy.
Job no.: Job site addres7 S , i'\I ..\\nyvi 0 I Six or ore residential units. ID Recreational vehicle parks.
City/State/ZIP: _--, 0 Health-care facilities. Elsupply voltage for more than
0 Hazardous locations. 600 volts nominal.
s
Suite/bldg./apt. no. S tiz... Project name: \„\ \ (Te A 0 Service or feeder 600 amp or more d
-c , ,„ ..,.., „,... ; , „.,,,,..:, : ,,,., ., • ,,:- , .- .,,, ,..,-,.....,.. - , ..', ..,,, ..,,,r
) :: . - ••.. .......' -:,. ,: ' :-
Cross street/directions to job site: 14: 56-5
Description I Qty. I gee. 1 Total I *
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: , 1 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
75.00 2
i*tiOifil*.*:$*: .::: ':' - ': : ' . .N‘; : ' ,... ;.:. (wills above ael. ft.)
(WV) Limited energy, multi-family
residential (with above sq. fl.) 75.00 2
Services or feeders installation, alteration, and/or relocation
. . . 200 amps or less 80.30 2
: : :.-...:.:• :'cl: :',.' .:::..:: ::: '. 201 amps 10 400 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: ( ) I 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 pr panel
Owner signature: Date:
••- A. Fee for branch circuits with
... ::' . .;',:. .f.:r • 0 ..APPLJCANt .,.:: . !:' CONTACT PERSON . Y ..,. above service or feeder fee,
6.65 2
..
each bch circuit ._.
Business name: (411/),V\ Af A f t %/Lill\ ,.1./vivii (("),•171 ran B. Fee for branch circuits
• without service Or feeder fee,
Contact name: M 0 1,A64-- \ii
first branch circuit 46.85 2
Address: lit 1
1 ( <6 1Y., ,F VA 't '0 octl(l '-.) , Each addl branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: VOWAr W fk C 1,, 1 Each manufactured or modular
90.90 2
• ' dwelling, service and/or feeder
Phone: ( (0) (A 2 , 0 k Fax: : (cg(p1 ) S30:-. 9 2.5 .
Reconnect only 66.85 2
E-mail: , “\\Pf1111S.,e(OlitUl i \Y - 1tO\ Cita ?V(\ Pump or inigation circle 53.40 2
7 ::: :''';:: , '1'-: : , ,,.':::',.,:' CONWO1 .RS.:: ,::';::- c, • .. : ...: :..., ..:.. . ,.. Sign or outline lighting 53 AO 2
0
c.) CA/M-e, (k•-% 0 L Signal circuit(s) or limited-
Business name:
energy panel, alteration, or
Address: ( 3 „ yv c ),,,,,,,,, Q. ve extension. Describe: Page 2 1 2
City/State/ZIP: knCovae 1 VO 11\ 98 8-I Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (77t1f) ) -- lef 2,0 Fax: ( Q) 2)- - ;3611 Investigatio» per hour (1 hr min) 62.50
CCB Lie.: \ 141 \ 1 1 Electrical Lic.: Suprv. Lie.: Industrial plant per hour 73.75
,,,. - :•F.J._:ttIlliICA.f;;PERAII:CFEtS . ..','.:.:i.',;: , ; , ::) . :: : ;-T,:::.:
Suprv. Electrician signature, required:
Subtotal:
Print name: Date: Plan review (25% of pennit fee):
_ i State surcharge (8% of pennit fee): L.4 6)
Authorized signYtt-ik:,Z-,-7,,e(-m‘44`,4ff,t,...------. TOTAL PERMIT FEE: $ \ ----
_, --,„
This permit application expires if a permit is not obtained
Print name: -'1,rivt . Nv -- ur; • . Date: a . i 2,,,.o. days after it has been accepted within 180 as complete.
_
* Number of inspections allowed per permit.
1: \ BuitclingTermits \ELC-PermitApp.doc 05/23/05 440-46157(1 I /05/COM/WEB
' • ' - " ' '
C ITY OF ��mu m v�`m nn����um��
BUILDING DUNG DUVUSUON PERMIT #: ELR2OD7'O015G
13125 SW Hall Blvd., Tigard, OR 97223 ^ DATE ISSUED: •2y12/20O7
Phone: (503) 639-4171 /A*
Inspection Requests (24 Hrs.): (503) 639~4175
INSPECTION WORKSHEET FOR DATE: 12/20V2007 TIME: 7:01AW PAGE: 41
•
SITE ADDRESS: ()77 SW HUNZIKER RD )f CLASS OF WORK:
SUBDIVISION: HILLCREST APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: H|LLCRESTAPART&MENTS
DESCRIPTION: install low voltaqe fiber optics for Verizon. Units 25-32.
OWNER: PETRUSHKIN, SUSAN RO SE, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-2546920
Inspection Request Scheduled For: Date: 12/20y2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
4�\4 -�
135 Lwn�v�tagw 001920'01 503-369-6989 Y ,/' ` ^
Corrections/Comments/Instructions:
an ,
•
�� �� �/ �
�� PASS �� PARTIAL �� CANCEL / NO ACCESS
[ FAIL 0 CALL FOR INSPECTIO n ADDITIONAL FEES ASSESSED
Inspector: & NO6 11W � Date: t 0/V Phone #: (603) 718-
. .
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