Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00064
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/19/2008
PARCEL: 2S102DB -00301
SITE ADDRESS: 13070 SW ASH AVE 17 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
Reg #: ELE 17- 154CLE
FEES LIC 141171
Description Date Amount
[ELPRMT] ELR Permit 3/19/2008 $75.00
[TAX] 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: / f Permittee Signature: C 1 /- '7r Cv
is
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.
•03/19/2008 WED 8: 59 FAX 0004/006
A C C #C) g
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e lectrical Permit Applicati
1140 ‘ ; FOR OF rrc USE ONta�r ...
City of Tigard � G � 3 y: 3 / q U� � No.: h�
n 13125 SW Hall Blvd., Tigard, OR 97'223 � � inn Rcvicw
Phone: 503.639.417 ( I ax: 503.598. (960 ®N VIN Date /By: Other Permit:
Inspection Line: 503,639,4175 Date Ready/By: urds: 0 See Page 2 for
T I GA RD C?
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Internet: www.tigard - orgov Q\ Nobf'icd/Menwd: Supplemental Information
1-',....:::::. „..TYPE OF: WORiC .PL;AN..REVIEW:.
❑ New construction F4 Addition /alteration /replacement Please chuck all that apply (submit 2 sets of plans w /items checked below):
0 Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards.
CATEGORY ;OF:,CONSTRUCTION:'• : .: . exceeds 10,000 amps as 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 ❑ Conuncrcial• use agricultural
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
11 Multi- family ❑ Master builder ❑ Other: 0 Piro pump. 0 Installation of 75 KVA or
J SITE' I NFORMATION :AND LLOCATION'..L : .:': r. • ! :. : :: !'.;. , _ , OA mcr g ,encysystcm "A" separately t- ivedsystcro.
..-- �.',�.��...'..::::.�•.. �...� ❑Addit of new m otor load of 0 , "A”, "E",
� " "I -3 ",
Job no.: Job site address: 13070 SW ASH AVE. 100HP ormore occupancy. •
0 Six or more residential units. 0 Recreational vehicle parks.
City /State /ZIP:PORTLAND, OR 97223 0 Health•carefacilities. 0 Supply voltage for more titan
0 Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.#1 7-24 Project name: ALDERB ROOK APTS. 0 Service or feeder 600 amps or more.
..
Cross street /directions to job site: besecij+lon I Q7. I Fce. I Ton, j •
New residential single• or multi•family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. 0. or less 145.15 4
Tax map /parcel no,: fa. add') 500 sq. ft. or portion 33,40 1
Limited energy, residential 7500 2
DESCRIPTION,Ok. WORK. (with above sit. fl.)
Limited energy, multi - family 75.00 2
INSTALL FIBER OPTICS FOR VERIZON residential (with above 4n. 0.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
p }: PItOPE IiT. :OWNER :
.
: :: TENAN T : : ' ' _ '.•:,:. ';. , 201 amps to 400 damps 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 1
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. 40l amps to 599 amps 133.75 2
Branch circuits - new, alteration or extension, per panel
Owner signature: Date:
A. Fee for branch circuits with
.. '.❑ s,:' ;'., :I': .1:: ` 12 CONTACT.PERSON.. .: :'i, above service or feeder fee, 6.65 2
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. B. Fee forbranch circuits
without service or feeder fee
Contact name: MONET VIVEROS , 46.85 2
first branch circuit .
Address: 11818 SE MILL PLAIN BLVD, STE 410 Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP:VANCOUVER, WA 98684 Each manufactured or nodular 90.90 3
dwelling, service and/or feeder
Phone: (360) 254 -6920 Fax: : ( ) 1- 866 -530 -4325 Reconnect only 66.85 2
E -mail: mviverostnorthskycomm.com Pump or irrigation circle 53.40 2
CONTRACTOR: :. z ::..' `_ •::. •;:: }.:::i Sign or outline lighting 53.40 2
Business name: NORTH SKY COMMUNICATIONS energy Signal
erg y panel, , a altelte circuirlimited-
energration, or
Address: 11818 SE MILL PLAIN BLVD, STE 410 extension. Describe: 1 Page $75.00 2
t 1
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 (tour a hr min) 62,50
^
col Lie.: 14117 Electrical Lic..17- 154CLE Suprv. Lie.: 173LEB Industrial plant per hour 73,75
:- ELECTRICAL':PERMIT : FEES :
Suprv. Electrician signature, required: i11121_T" Subtotal: $75.00
Plan review (25% of permit fee):
Print name: JACK CAGLE Date: 3/19/08 Slate surcharge (12% of permit fee): $9
Authorized sig. TOTAL PERMIT FEE: $84.00
This p ermit application expires if a permit is not obtained within 180
Print name: TERI A. MI KU LI C Date: 3/19/08 days after it has ',unaccepted its complete.
4
Number of inspections allowed per permit.
tall kites \Pera,its\ELC- Pcrn,ttnpp.doe 05/21106 440- 4615TU I/05/COMM/ED
CITY OF 4'
~~. ~ . ~-. TIGARD
BUILDING DIVISION PERMIT #: ELR2008-00064
13125 SW Hall Blvd., Tigard, OR 97223 . DATE ISSUED: 3/1Ey2008
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 9/27/2008 ' TIME: 7:03A1v1 PAGE: 44
SITE ADDRESS: 13070 SW ASH AVE 17 CLASS OF WORK:
SUBDIVISION: ALDERBROOK APARTMENTS LOT #: 000 TYPE OF USE:
PROJECT NAME: ALDERBR00K APARTMENTS
DESCRIPTION:, Inslalling fiber optics for Vmxizmn. Apartment nunohe|S 1724.
OWNER: CARME-Y. GEORGE &E;WEMD(JLYN PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-254'6920
Inspection Request Scheduled For: Date: 3/27V2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 06799402 971'563-9326 M
Corrections/Comments/Instructions:
•
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GY
PASS PARTIAL �� �AN�EL �� NO ACCESS
/ / / /
U FAIL � CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
r --
|nopectoc O a te : ~ Phone #: (503) 718-
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