Permit CITY OF TIGARD ELECTRICAL PERMIT
N, ',"" PERMIT #: ELC2007 -00067
COMMUNITY DEVELOPMENT i
DATE ISSUED: 1/29/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 • PARCEL: 1S136CC
SITE ADDRESS: 11744 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: Service for new collocaction on existing tower. Job No. 12353
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
GRUNBAUM FAMILY TRUST OREGON ELECTRIC GROUP
21390 SW EDY RD 1010 SE 11TH AVE
SHERWOOD, OR 97140 PORTLAND, OR 97214
Phone: Contact #: FAX 503 - 535 - 2763
PRI 503 - 234 -9900
FEES
Description Date Amount Reg #: ELE 26 -95C
[ELPRMT] ELC Permit 1/29/2007 $80.30 L1C 203
[TAX] 8% State Surcharge 1/29/2007 $6.42 SUP 4460S
Total $86.72 REQUIRED ITEMS AND REPORTS
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 • - an 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center.
Those ru - s are set fort in 0 952- 001 -0010 through OAR 952 -001 -0100. You may obtain copies • hese rules or direct questions to OUNC at
503.246 •699 or 1 .800.3 ( .2
Issued = • ULJVV Permittee Sign •':i
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:
ONTRACTOR 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.
11111111W216 06:43PM FROM -OR ELECTRIC SVC - 5035352T63 T -891 P.005 /010 F -468
nlectmlca1 remit application i C
RE City of Tigard / d D 13125 SW Hall Blvd., Tigard, OR 97223 ' per mew r dy
Phone: 503.639.4I71 Fax: 503. 598.1960 4 " , I n, t . ... ! I " Date/By Other Permit:
Inspection Line: 503.639.4175 • j F1 1v TOG' h Al '_ a. " I P i Date. Ready/By: ®Pate 2 far Internet www.cLtigard.or.us N ol i5 edlMerhu>ek I St�,te mformatton
TYPE OF� Or 1 i�1 PLAN REVIEW _
® ' tsictd New construction ❑ Addi6on/alteia /t Please check all that apply:
❑ Demolition 0 Other. l4�� ❑ice over 225 amps, cotttm'1 ❑Hmeardous location
['Service over 320 amps - rating ❑ Buildng over 10.000 sq. R,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ® CommerciallinduStrial ❑ Accessory building 0 System over 600 volts nominal units in one ,ttnlctune
❑ Multi - family ❑Master builder ❑ Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑ Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LLOCAATION , . ❑EE�ig�"g Flan RV park
Job no. : 12353 I Job site address: ' / / 7 e m a.) Ad fi C r )? ❑Htslth facility ❑Other
Submit 2 sets of plans with any of the above.
City /State/ZIP: TIGARD, OR 97223 The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: I Project name: CLEARWIRE CELL TOWER Fes' SC J Qtr I .E
Description I Qty. Fee. I Toad I '•
Cross Street/directions to job site: MIGHT BE SLIGHTLY ISOLATED New residential single- or multi family dwelling unit.
Includes attached garage.
NEAR THE JUNCTION OF 99W AND SW 72 AVE 1.000 sq. IL or less 145.15 4
` Subdivision: I L n o.: Ea. add'1 500 sq. ft. or portion 3140 1
- Limited energy, residential 75.00 2
Tax map /parcel no.: Limitedenergy, non - residential 75.00 2
DESCRIPTION OF WORK . Each manufactured or modular
POWER TO NEW CELL TOWER dwelling, service and/or feeder 90.90 2
Services or feeders instillation. alteration, and/or relocation
200 amps or less / 80.30 2
❑ PROPERTY OWNER' I 0 TENANT 201 amps to 400 amps 106.85 2
L 401 atrtps to 600 amps 160.60 2
• Name: /� ,t >d 6,14H rAN /Lys - r r , 601 amps to 1,000 amps 240.60 2
Address: d1/ 390 67y pn Over 1,000 amps or voles 454.65 2
q,, ! Reconnect only 66.85 2
City/State/ZIP: fit.)00� a / _ No Temporary services or feeders Installation, alteration, and/or
Phone: ( ) 1 Fax: ( ) relocation
200 amps or less 66,85 1
Owner installation: This installation is being made on property that 1 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 600 amps 133.75 2
Owner signature: Date: Branch circuits - now, alteration, or extension, per panel
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
— -
each add'l branch circuit 6.65 2
City/Statc/Z1P; Miscellaneous (service or feeder not included) _
Phone: ( ) I F ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal citcuit(s) or limited -
CONTRACTOR maw panel, alteration. or —
ectetsion. Describe: Page 2 2
Business name: Oregon Electric Group
Address: 1010 SE 1Ith Ave - Each additional inspection over allowable In any of the above
Per inspection 62.50
City/State/ZIP: Portland, OR 97214 . . . investigation per hour (1 hr min) 62.50
Phone: (503) 234.9900 [Fax: (503) 535.2763 • • - Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES'
CCB Lie.: 203 J Electrical tic.: 2 6- C . l up , C.: 4460S . Subtotal so , 30
Suprv. Electrician signature, requited: ,/.
. /. Plan review (25 % of pantit fee)
Print name: I/ 1� �� V 1 , a , .: 1/ �. - State surcharge (8% ofprnnitfee) /p. 4t:
Y �r�^ ^ t 7 L1t F ,, , TOTAL PERMIT FEE 8 (p. 7
Authorized signature: , _ +� This permit application expires If a permit Is not obtained within 150
days after It has hero accepted as complete
Print name: hA / A 4 , , d J 4 -' - / I ■ . 01 • 07 41, • Fee methodoloby set by Tri-County Building Industry Service Board
•• N or impC Casperpemttit allowed.
■;%Bache oPe,mitsl6LC- PmnhtAtp4ee 1203 44046 I5Tt1NO2/COMIw®
C2 - A-0 ccs1.(' - la,e,._ r ICL44 , q, vL6 /0)
CITY OF TIGARD 10 •
BUILDING DIVISION PERMIT #: ELC2007 -0U067
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/20/2007
Phone: (503) 639 -4171 A = ; ,� 1 i
Inspection Requests (24 Hrs.): (503) 639 -4175 �!'+�
INSPECTION WORKSHEET FOR DATE: 3/8/2007 TIME: 7:01AM PAGE: 14
SITE ADDRESS: 11744 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: CLEARWIRE
DESCRIPTION: Servire.for new colloraction on existing tower. Job No. 12353
OWNER: GRUNBAUM FAMILY TRUST, PHONE #:
CONTRACTOR: OREGON ELECTRIC GROUP PHONE #: 503 -234 -9900
Inspection Request Scheduled For: Date: 3/812007 Pour Time:
Code # Inspection Description Contact # Message
115 a • ' al service 044523 -01 503- 849 -3291 Y
or - • - • nstructions:
G lt-t 5- 515 V
*PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: v 1 V 8 u( Dater 210 Phone #: (503) 718- 2144_