Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00448
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 1 ZONING: C -P
SUBDIVISION: HILLCREST APARTMENTS LOT: JURISDICTION: TIG
PROJECT: HILLCREST APARTMENTS
Project Description: Install low voltage fiber optics for Verizon. Units 1 - 4.
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 503.246.6699 or 1.800.332.2344.
Issued By(" , /�/ /JjJ / ` / f/ Permittee Signature: cf2i,
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 12:14 FAX X003 /011
•
ril O li'li -
Electrical Permit Applicatio OFFICE USE ONLY
City f Tigard 1 O 200 I E q DEC f-.. / 47 S Pemit No.: � 13125 S W Hall Blvd., Tigard, OR 97223 r � Other Permit: ic Pr
F T I G A "• r w
Phone: 503.639.4171 Fax: 503.598.1960 l ate / gy
Inspection Line: 503.639.4175 �` O �i ; Rcad tB
TIGARD g g g�I LD NG D I VIS y Y _ Supplemental See Page 2 for
Internet: www.li and - or. r ov btified/Method: ` /,(,:,', Supplemental Information
TYPE OF'WORK':" .. PLAN "REVIEW
❑ New construction OAddition /alteration /replacennent Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or mote ❑ Building over three stories.
❑ Demolition ❑ Other:
where the available fault current El Marinas and boatyards.
CATEGO4:' ? OF. `CONST"R JCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Cmmnercial -use agricultural
1,1] 1 - and 2- family dwelling ❑ Commercial /industrial ❑ " Accessory building amps for all other installations. buildings.
Multi -family ❑ Fire pump. ❑ lnslallation of 75 KVA or
} . ❑ Master builder ❑ Other: ❑ Emergency system. larger separately derived system.
,., : '..., . : JOB:.SIT IN FORMATION ANA:•LCATi011
O .. ❑ Addition of new motor load of ❑ "A" "E" "1-2", "l -3
Job no.: Job si a ddre ss : r> 100112 or more. occupancy.
R
��( f El or more residential units. ❑ Recreational vehicle parks.
_ , ' n 9 2 - ❑ Health -care facilities. ❑ Supply voltage for more than
City/State/ZIP: �
1 t �1 t ❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no. f' 1 try l . ` A Project name: Y , A / / 1�TC S ❑ Service or feeder 600 amps or more.
Cross street /directions to job site: PAP SCHEDULE : ;
nesn4ptimt I Qty. I tree. ' 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 4
Tax map /parcel no.:
Ea. add') 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION`: OF:WORh; ' •.,:',': (with above sq. R.)
J '190r 1 Limited energy, multi - family
1'� Ji..IN�,/`.." .. \O1 . -- ri eiv 12.ic f residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and /or relocation
0 ..PROPE, RTY O\'1'NER_' : ..
amps or less SO 30 2
O; TENANT ` 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps I60.60 2
601 amps to 1,000 amps 240.60 2
Address: _ ver 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 I
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
Owner signature: Date: A. Fee for branch circuits with
-- arch circuits -new, alteration, or extension, per panel
— _ th
APPLICANT " ONT' 1`C F PERSON Ar above service or �feedet• fee, n
n o"
,+ // 'C 6.65 2
Business name: b it u '\ ( ' f) /1,,� « ;t,� ?'v t•r '1i�p,,,,,s,:; /". 1. f 0,A. Fee b
� � ' B. Fee for branch circuits
Contact name: [� /� 1 f / without service or feeder fee,
1 vOV „ e T- first branch circuit 46.85 2
Address: (6 } t./ 'elk' Ii ! t" t `- k V a Each add'I branch circuit 6.65 2
+' ?' �( Miscellaneous (service or feeder not included)
City/State/ZIP:
\ j .\ /(,, / ,! � > O (; Each manufactured or modular 90.90 2
• Phone:( ()) (.i_(�,, 1 Fax:: ) t4 ;Z• Reconnect only and /or feeder
�; 2:1 "" Reconnect only
E -mail: ,1rnvNunc: ( ovoAesV' I.` (t) V \\;(v) , cio f y� Pump or inigation circle 53.40 2
.- • -: 7 7' COATBACT It:.: -': f . - ' `" ' Sign or outline lighting 53.40 2
Business name: 7< 1 L x IOV - Signal circuit(s) or limited -
energy panel, alteration, or
Address: ` \SID a 6 , \ \ �` am Q V. t extension. Describe: I Page 2 16 2
City /State/ZIP: il\/Ve ( \l , \ l [p 1 ( VO 9N ( `1 Each additional inspection over allowable in any of the above
s vl l ( Per inspection 62.50 '
Phone: (A) ) '. �"f' ......-1A '10 �� i Fax: (9 ,O) 2J t.{ .,. . t
�1 Q� 1 Investigation per hour (1 hr nin) 62.50
CCB Lie.: \ (..1 1 1 I Electrical Lie.: Suprv. Lie.: Industrial plant per hour 73.75
ELECTRICAL "? PERMIT `.FkES;.:
Suprv. Electrician signature, required: Subtotal:
Print name: Date: Plan review (25% of pennit fee):
State surcharge (8% of pennit fee): 19J
Authorized '" - --
orizeci sigti�ttFe.. r'`"'"" "r �: -
4 .r 4 TOTAL PERMIT FEE: ` /
Print name: `n� I ".(,(: This permit application expires if a permit is not obtained within 180
'(�/ 1 , V' Y ' I �- , (, , �' 1 'T j D ate: 2 • ( 2_ ,. i days after it has been accepted as complete.
` " Number of inspections attained per permit.
l: \Building \Permits )ELC- PenxitApp.dnc 0503/06 440.4615T(1 I /05 /COM'WEB
, . . .
CITY OF TIGARD
,.
BUILDING DIVISION .
PERMIT #: ELR2007-00448
I ' 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: j 2/ I212007
Phone: (503) 639-4171 .14,414111111`
Inspection Requests (24 Hrs.): (503) 639-4175 ....„...., ---
INSPECTION WORKSHEET FOR DATE: 12128/2007 TIME: 7:00AM PAGE: 11
SITE ADDRESS: 07582 SW HUNZIKER RD 1 CLASS OF WORK:
SUBDIVISION: FutteREsT APART maws LOT #: TYPE OF USE:
PROJECT NAME: HILLCREST APARTMENTS
DESCRIPTION: Install low voltage fiber optics for Verizon. Units 1-4.
OWNER: PETRUSHKIN, SUSAN RO SE, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360
Inspection Request Scheduled For: Date: 12/213/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
'135 Low voltage 062293-.02 503-209-9546 Y
I t
Corrections/Comments/Instructions:
(fili-.-
,,..
_... •
,..,/,.
PASS r7 PARTIAL APPROVAL 0 CANCEL pi NO ACCESS
r7 FAIL I l CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: G • W Cleo (--.- Date: i7-' 2:6• 0 1 Phone #: (503) 718- ViLl'i