Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00062
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/19/2008
PARCEL: 2S 102DB -00301
SITE ADDRESS: 13070 SW ASH AVE 1 ZONING: R -12
SUBDIVISION: ALDERBROOK APARTMENTS LOT: 008 JURISDICTION: TIG
PROJECT: ALDERBROOK APARTMENTS
Project Description: Installing 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:
GEORGE & GWENDOLYN CARNEY NORTH SKY COMMUNICATIONS INC
BY NORRIS + STEVENS REALTORS 11818 SE MILL PLAIN BLVD STE 4
520 SW 6TH #400 VANCOUVER, WA 98687
PORTLAND, OR 97204
Phone: Contact #: PRI 360 - 254 - 6920
FAX 1- 866 -530 -4325
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Reg #: ELE 17- 154CLE
FEES LIC 141171
Description Date Amount
[ELPRMT] ELR Permit 3/19/2008 $75.00
ITAX] 12% State Surch 3/19/2008 $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 questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: c ,// 7S c.//1/
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.
• 0 3 / 1 9 /20 0 8 WED 8: 5 8 FAX 120 0 2/ 0 0 6
.:. . r k . (,,, s .\ \\*14 C ) ' " , . - - • • . . • . , .. ...,..
tiectrical Permit Applicatiour p% -'.H. ,,,-..:-..--.-: FOR.OFFICE USE ONLY
\ C b • li
City of Tigard
.. ,t l .-rmit No.: F A A ,
. . 13125 SW Hall Blvd., Tigard, OR 223 '\.\\ i
11 . Phone: 503.6394171 Fax: 503.598.1960 6 c A I 1 a t a 1 B y : Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: Judy: gi See Page 2 for - •
TIGARD (c Notified/Method: Supplemental Information 1
• Internet: www.tigard-or,gov - oz),\ Noti
..'..::...'1',,,:.*:.. '':.-::..:.•,'..,...:::::
TYPE OF •.:-,.: -:."':
0 New construction ig Addition/alteration/replacement Please chuck all that apply (submit 2 sets of plaits wittems checked below):
0 Service or feeder 400 amps or mt.m 0 Building over three stories.
_ 0 Demolition 0 Other: where thy available fault current 0 Marinas and boatyards.
(iATE4ORY'QVCONSIltUUTION. '.. -:.:.'.:-..:,. 2.::1'. ...::::: "seeds 10,000 amps at 150 volts or 0 floating buildings.
. ' . less to ground, or exceeds 14,000 0 Commercial-use agricultural
0 1- and 2-family dwelling 0 Commercial/industrial El Accessory building amps for all other installations. buildings.
- 1 : Multi-family 0 Master builder 0 Other: 0 Fire punip. 0 Installation of 75 KVA or
• .. . , .... ,, , ..., , , .,.,.. 0 Emergency system. larger separately derived system.
..... . : • ....•,-...,.• .,•• , -. ' .. .
JOB.:SIIV INFORMATION:- AND.LOCATION ,..•., ..,.... y: . „ . • -..-... 0 Addition of new motor load of 0 "A". "E", "1-2", "1-3".
Job no.: Job site address: 13070 SW ASH AVE. 100Hr or more. occupancy.
In Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP' PORTLAND OR 97223 0 Ilealth•carc facilities. 0 Supply voltage for mote than
0 Hazardous locations. ti00 volts nominal.
Suite/bldg./apt, no.#1 -8 Project name: ALDERBROOK APTS. 0 Smits or feeder 600 amps or more.
•::.:::::::: .,- :':'..• • :.''.: .: -
FEE I SCHEDULE ::-...:.',-' l';'..1..' :., •.: -...„:1 ,
Cross street/directions to job site: 1/M61/11011 I Qty. J Fin. 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
- Ea. add' I 500 sq. 0. or portion 33,40 1
Tax map/parcel no.: -
Limited energy, residential
75,00 2
DESCRIPTION OF WORK (with above sq. co
INSTALL FIBER OPTICS FOR VERIZON Limited energy, multi-family , residential (with above sq. it) 75.00 2
Services or feeders installation and/or relocation _
200 amps or less 80.30 2
:',:•:.:,:,.:,::.,:'.:.:::', El.':P.ROPEtitY:.OWNER';':..i ,' : ..... ....• .: '...., :. - .0 : - .: ''''..: :.'..':.';; 201 amps to 400 amps 106.85 2.
Name: ( ci - • AA d - 401 amps to 600 amps 160.60 2
c.5( _ £' AAA*
601 amps to 1,000 amps
240.60
2
Address: Off ' 5 j- Sfrc, P_aci-t S 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
.' . .:.1 . - ., 1 : :: . :',. :1 .,: - -,:', lg CONTACT PERSON .' ".:: : ' S 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
Contact name: MONET VIVEROS first branch circuit fee, 46.85 2
Address: 11818 SE MILL PLAIN BLVD. STE 410 Each addl branch circuit 6,65 2
Miscellaneous (service or feeder not included)
City/State/Z WA 98684 Each manufactured or (nodular
90.90 2
dwelling, service and/or feeder
Phone: (360 ) 254-6920 Fax: : ( ) 1-866-530-4325 .... Reconnect only 66.85 2
E-mail: mviveros@northskycomm.corn Pump or irrigation circle 53.40 2
. ‘;:...,:-..'::.•:....:- ' ' . : .;•::........'.: TONTRAETOR . :' , . ' : ' . : . : ' : : : ::: . . . ' . • . ' . : : . : . . : . : . .' ,; : •i ; .::: Sign or outline lighting 53.40 2
Business name: NORTH SKY COMMUNICATIONS, INC. Signal circuit(s) or limited-
energy panel, alteration, or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Page 2 $75.00 2
City/State/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 (i hr min) 62.50
' .
CCB Lie.: 14117 Electrical Lic.1 7- 154CLE suprv. Lie.: 173LEB . Industrial plant per hour 73.75
-
.7 : l',: BLECTRICAU:PERMIr• FEES ',... ''": :, • .. - .:
Som. Electrician signature, required: Subtotal: $75
Print name: JACK CAGLE Date: 3/19/08 Plan review (25% of permit fee):
State surcharge (12% of permit fee): $9.00
Authorized sil, mum: . ._..-,'" -- . ...... ,.,_
TOTAL PERMIT FEE: $84.00
Print name: TERI A. MIKULIC Date: 3/19/08 This permit application expires if a permit is not obtained within 180
days after it hes been accepted as complete,
* Number of inspections allowed per permit.
INIttiltling\l"crmitsULLC-PertnitApp.doe 05/23106 440,16157(11/05/COMAVER
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CITY OF TIGARD
BUILDING DIVISION
PERMIT #: ELR200B-00062
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/1912008
Phone: (503) 639-4171 Tit
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 3/26/2008 TIME: 7:00AM PAGE: 35
SITE ADDRESS: 13070 SW ASH AVE 1 CLASS OF WORK:
SUBDIVISION: AWERBROOK APARTMENTS LOT #: 008 TYPE OF USE:
PROJECT NAME: ALDERBROOK APARTMENTS
DESCRIPTION: installing fiber optics for Verizon. Apartment numbers 1-8.
OWNER: CARNEY, GEORGE & GWENDOLYN PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-254-6920
Inspection Request Scheduled For: Date: 3/2612008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 067352-01 971-563-9326
Corrections/Comments/Instructions:
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ei PASS pi PARTIAL APPROVAL 111 CANCEL 0 NO ACCESS
n FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: G tet Date: 3' 24:r tYl Phone #: (503) 718- v1i16
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