Permit Er CITY OF TI GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00239
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/26/2007
PARCEL: 2S 110AC -00500
SITE ADDRESS: 14765 SW 109TH AVE 1 -4 ZONING: R -12
SUBDIVISION: TIMBERLINE APARTMENTS LOT: JURISDICTION: TIG
PROJECT: TIMBERLINE APTS
Project Description: Install low voltage 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:
TIMBERLINE APARTMENTS LLC NORTH SKY COMMUNICATIONS INC
BY WPL ASSOCIATES PO BOX 87550
522 NW 23RD AVE VANCOUVER, WA 98687
PORTLAND, OR 97210
Phone: Contact #: PRI 360 - 254 - 6920
FAX 866 -530 -4325
FEES Reg #: ELE 17- 154CLE
LIC 141171
Description Date Amount
[ELPRMT] ELR Permit 6/26/2007 $75.00
[TAX] 8% State Surcha 6/26/2007 $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 B . / Permittee Signature:
: / .PA, /-() alt f � m
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.
06/26/2007 TUE 13:09 FAX ID 021/038
k 1)� a5L - m-�1 - ' i - IND / 2/10 2`l -- DU
Electrical Permit Application FOR OFFICE USE ONLY
Received City of Tigard ,a / Permit No.:
p-'"' \ D ate / By: �I Z 1 ��-WT — W�9
Er 1 hone S50 Hall Blvd., Tigard, OR 9 . 016 L. . Plan Review
Phone: 503.639.4171 Fax: 503. 0.0160 IybO Date /By: Other Permit:
TIGARD Inspection Line: 503.639 JUN �)l / Date Ready /By: Ju ri See Page 2 for
Internet: www.tigard- or.gov N 2 u / Notified /Method: C Supplemental information
. TYPE : OF WORK! i,.:r . , - ]a" n- PLAN REVIEW
❑ New construction Addition /alt os c lacement
? nt Vt'AUs' Please check all that apply (submit 2 sets of plans m
w /ites checked below):
e'rali
on /rep
s.a o,dd ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
' • CATEGORY OF - CONSTRUCTION ' exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground. or exceeds 14,000 ❑ Com ereial -use agricultural
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
X Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ installation of 75 KVA or
. -. .. _ .. ❑
.. ' • JOB SITE INFORMATION' AND LOCATION Emergency syste m. larger separately derived system.
Addition of new motor load of ❑ "A" "E" "1 -2" "1 3"
Job no.: Job site addt' 3Bt' ,0 1 r ` e� Six or or more. occupancy.
❑
1 + `` ❑ Six or more resisi dential units. Recreational vehicle parks.
I City /State /ZIP: /� �� ❑ Health -care facilities. ❑ Supply voltage for more than
i 0 Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.0 Project name: 1rn W i � ❑ Service or feeder 600 amps or more. • • - FEE SCHEDULE •
Cross street/directions to job site: Description
Qro. j Fee. I Total
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'1500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
. DESCRIPTION OF WORK '. ' ' - . (with above sq. fl.)
�
(/ n i / ) (i!( "% Limited energy, multi- family
\'1/1 "1),..r..Q..I f - {.J✓ :� t:U.f. , s" i( ' v1 Q. s residential (wing above sq. ft.) 75.00 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
• ❑ :PROPERTY OWNER • • • • ❑ TENANT 201 amps 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 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 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with • ❑ :APPLICANT ( CONTACT PERSON above service or feeder fee, 6.65 2
r 1 1 each branch circuit
Business name: N D /A_ ( > ; ,t t s'1 1 t ° f 6 `� ' "P �t B. Fee for branch circuits
�t f i l.. / D i , 1 1n\ without service or feeder fee,
Contact name: r' r f•. El'/' ; ( ; f t ', . t ( I" t onC.`� V , \e v S first branch circuit 46.85 2
Address: i (' t r` / - ?. /' 1 r '4 1 V / \; ; : "' Each add') branch circuit 6.65 - 2
City /State/ZIP: \ ?. \ I \` (.. { ; t" / Each manufactured or modular
(service or feeder not included)
�,, � •• �n � ; / r•
�� ('t 90.90 2
V J 2
/ dwelling, service and /or feeder
. Fax: . ) . q
Phone: ( °� 7i Reconnect only 66.85
E -mail: / 5 rs I�/pi�'�'] cornrNl • C T?V7 _ Pump or inigation circle 53.40 2
:.. ` - :: :. . ` :.. CONTRACTOR , Sign or outline lighting 53.40 2
0 p / , Signal circuits) or limited -
Business name:
) G -e_. ( -, I )' p' -e- energy pane], alteration, or
Address: extension. Describe: ' Page 2 1 2
City /State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: V.....\, \ \- 1 Electrical Lic.: Suprv. Lie.: Industrial plant per hour 73.75
.... '. ELECTRICAL'`PERMIT - -FEES :.
Suprv. Electrician signature, requited: Subtotal:
Print name: Date: Plan review (25% of pennit fee):
State surcharge (8% of pennit fee): Uj ti)
Authorized signaatti'e:.'::,R - `r ' _:L ..- TOTAL PERMIT FEE ` i ■
1n This permit application expires if a permit is not obtained within 180
Print name: " f'� l (�` 4' 1 l l ...1A ,�; c. �; "� Date: � f-z, " Number of inspections allowed per pennit.
l:\ Building \Permits \ELC- PermilApp.doc 05/23/06 440.4615T( I I /05 /COM'WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007 -00239
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/2612007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 1 1,0
INSPECTION WORKSHEET FOR DATE: 7/9/2007 TIME: 7:02AM PAGE: 67
SITE ADDRESS: 14765 SW 109TH AVE 1 - CLASS OF WORK:
SUBDIVISION: TIMBERLINE APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: TIMBERLINE ARTS
DESCRIPTION: Install low voltage fiber optics for Verizon.
OWNER: TIMBERLINE APARTMENTS LLC, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360 - 6920
Inspection Request Scheduled For: Date: 7/9/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 051586 -02 503.519 -7466 N
Corrections /Comments /Instructions:
yj PASS I I PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: (A) Date: rt • e.' b1 Phone #: (503) 718- 100