Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00021
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/24/2008
PARCEL: 2 S 102 B D -010 01
SITE ADDRESS: 09969 SW WALNUT ST 11 ZONING: R -12
SUBDIVISION: WALNUT COURT APARTMENTS LOT: 007 JURISDICTION: TIG
PROJECT: WALNUT CREEK APTS
Project Description: Units 11 - 14. Fiber optics for Verizon.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
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:
BLINE, RONALD G + NORTH SKY COMMUNICATIONS INC
SAGUN, JUDITH L 11818 SE MILL PLAIN BLVD
2190 SKYLINE DR VANCOUVER, WA 98687
SEASIDE, OR 97138
Phone: Contact #: PRI 360 - 254 -6920
FAX 1- 866 -530 -4325
FEES Reg #: ELE 17- 154CLE
LIC 141171
Description Date Amount
IELPRMT] ELR Permit 1/24/2008 $75.00
(TAXI 12% State Surch 1/24/2008 $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 questio s to OUNC at 503.246.6699 or 1 800.332.2344.
Issued By: Permittee Signature: (�"�'2!
`/
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.
01/23/2008 WED 11:11 FAX 2)004/005
, , •
Electrical Permit Application � � « Folt OEFICI, USE ONLY
c ived
City of Tigard ' CEtea :� o, 4..i Penmt .�i_. ....454,2, 6 1 3125 SW HaII Blvd., Tigard, OR 97 Plan Rev' w
tl Phone: 503.639.4171 Fax: 503.598.1960 AN 6 ), .i4 Datdgy, Other Permit:
I' 1 Ci n k U
Inspection Line: 503.639.4175 s to Ready /By: luris: E5 See Page 2 for
Internet: www.tlgard-or.gov Gpq ut I lbwp otifted/Method: Supplemental Information
. . : , . . . , ; • : • ,'TYPE.OF.�W q $ a � � . . . , . •_ ., • - . . , . .• ' • •; , PLAN -.REVIEW •:.., ;. • •: 2. -
❑ New construction ❑✓ Addition /alteration /replacement Please check all that apply (subimt 2 sets of plans w/ttcros checked below):
❑ Service en feeder 400 amps or more ❑ Building over trace stories.
❑ Demolition ❑ Other: where rho availahle fault current ❑ Marinas and boatyards.
CATEGORY.OF• CONSTRUCTION . - .. ' ' '• , , , exceeds 10,000 amps at 150 volts ar ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial-use agncultural
❑ 1 and 2- family dwelling ❑ Commercialhndustrial ❑ Accessory building amps for all other installations. buildings.
S: Multi - family ❑ Master builder ❑ Other: ❑ litre pump. ❑ Installation of 75 KVA or
. ❑ emergency system. larger separately derived system.
'••.. , •- •. ..- JOB:SITE INFORMATION AND -LOCATION s 0 AdditIon of new motor bait of 0 "A ","E ", "I.2 ", "1.3 ",
Job no.: Job site address. W WALNUT ST. 100HP or mare. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP:TIGARD, OR 97223 3969 ❑ Hcatth•care facilities. ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal.
Suite/bldg. /apt. no.BLDG 3 \ Project name: WALNUT COURT APTS. 0 Service or feeder tS00 amps ormore.
FEE SCHEDULE
Cross street /directions to job site411 - 14 Ueicnpltoi I Qty 1 Fee. I Total f •
New residential single- or multi- family dwelling unit.
Includes attached garage,
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel Ito.:
Limited energy, residential 7500 2
DESCRIPTION • OF WORK '• . . (with above sq. ft.)
Limited energy, multi - family 7500 2
INSTALL FIBER OPTICS FOR VERIZON residential (with above sq.IL)
Services or feeders installation,alteration, and/or relocation
200 amps or less 80.30 2 •
• • - 0, PROPERTY OWNER • , ' • • '• ❑ • . •• : 201 snaps to 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: ( ) 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
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
' ' ❑ APPLICANT .. '. I • • El CONTACT PERSON.. • • . • above service or feeder fee, 6.65 2
each branch circuit
Business name:NORTH SKY COMMUNICATIONS, INC. B. Fee for branch circuits
without service or feeder fee,
Contact name: MONET VIVEROS first brunch circuit 46.85 2
Address: 11818 SE MILL PLAIN BLVD. STE 410 Each add'I brnnch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP:VAN000VER, WA 98684 Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: (360 254 -6920 Fax: : ( ) 1- 866 - 530 -4325 Reconnect only 66.85 2
E -mail: mviveros@northskycomm.com Pump orinigationcircle 53.40 2
, '. :c- • ' . „• CONTRACTOR . • .. • , - • '. • - Sign or outline lighting 53.40 2
Business name: NORTH SKY COMMUNICATIONS, INC. energy circuit(s) limited -
r energy panel, , alteration, or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Paget $75.00 2
City /Statc/ZIP: VANCOUVER, WA 98684 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (360) 254 -6920 Fax: ( ) 1- 866 - 530 -4325 Investigation per hour (llirmin) 62.50
CCB Lic.:141 17 Electrical Lic.17- 154CLE Suprv. Lie.:173LEB Industrial plant per hour 73.75
Al " ' • ELECTRICAL' PERMIT. FEES
Suprv. Electrician signature, required: J ACK CAGLE !!! �V` c Subtotal: $75.00
Plan review (25% of permit fee):
Print name: Date: 1/23/08 State surcharge (12% of permit fee): $9.00 _
Authorized si -
TOTAL PERMIT FEE: $84.00
This p ermit application expires if a permit is not obtained within 180
Print name: TE R I A. MI KU L I C Date: 1 /23/08 days after it has been accepted ns complete.
'• Number of inspections allowed per penmen.
t 1nudAingWermns\ELC•Pennoappdoe 03/211006 440.461ST(11/0S/COMAVE0
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2008.0003i
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/24/2008
Phone: (503) 639- 4171gr
Inspection Requests (24 Hrs.): (503) 639 -4175 _' 1.
INSPECTION WORKSHEET FOR DATE: 2/1/2008 TIME: 7 :02AM PAGE: G7
SITE ADDRESS: 09969 SW WALNUT ST 11 CLASS OF WORK:
SUBDIVISION: WALNUT COURT APARTMENTS LOT #: 007 TYPE OF USE:
PROJECT NAME: WALNUT CREEK APTS
DESCRIPTION: Units 11 -14. Fiber optics for Verizon.
OWNER: BLINE, RONALD G +, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360.254 -G92Q
Inspection Request Scheduled For: Date: 2/1/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 ElecUical final 044332 -03 971 - 563 -9326 N
Corrections /Comments /Instructions:
\\
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: N \69) L Date: Z1 " Phone #: (503) 718- Z.-