Permit . CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 -00005
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/4/2008
PARCEL: 2 S 102 BA -02000
SITE ADDRESS: 12353 SW GRANT AVE ZONING: R -4.5
SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT: 045 JURISDICTION: TIG
PROJECT: GRANT STREET ELITE CARE
Project Description: Installation fiber optics for data.
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:
ELITE CARE NORTH SKY COMMUNICATIONS INC
2300 SW 103RD 11818 SE MILL PLAIN BLVD
PORTLAND, OR 97225 VANCOUVER, WA 98687
Phone: 971 -506 -0151 Contact #: PRI 360- 254 -6920
FAX 1- 866 -530 -4325
FEES Reg #: ELE 17- 154CLE
LIC 141171
Description Date Amount
[ELPRMT] ELR Permit 1/4/2008 $75.00
[TAX] 8% State Surchar 1/4/2008 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
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•
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
503.246.669• • 3 + 4
� 1
Issued : U GL-tAtolk.t) Per mittee Sig ature: 41- 7 r l " ( (
OWNER INSTALLATION ONL
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.
1/03/2008 THU 14:22 FAX 0 002/003
s' P l i l l . ( 1 S t - c � � K Y ) 7 C-' 1 . -34 , 4 5306 _ / :
Electrical Permit Appli i� CE WED • OFFICE USE ONLY
of !J
Clty Ol Tigard Date /fay: / ' ®
D p
Pr
13125 SW Hall Blvd., Tigard, OR 97223 (� Plan Review I )/ Permit No.: E4 arr.- d��
• Phone: 503.639.4171 Fax: 503.5980 U :'l 2 JUU Received Date /By: Other Permit:
TIGARD Inspection Line: 503.639.4175 TI � A p f t Date Ready /E3y: t See Page 2 for
luennet: www.tigard or.gov Ct - ty OF i }q+6 Notilied /Method: r J (/C..... S Supplemental Information •
DIVISION
TYPE" ., . - PLAN' REVIEW.'
❑ New construction Addition /alteration /replacement Please check all that apply (submit 2 sets of plaits wlletns checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: whew 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 ❑ Connnercial -usc agricultural
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building maps for all other installations. buildings.
Multi - family fl Master builder ❑Other: 0 Fire pump. ❑ installation of75KVAor
❑ Emergency system. larger separately derived system.
JOB (SITE 'INFORMATION -AND, LOC ATION r ❑ Addition of new motor load of ❑ " A' "0' " 1 -2" " 3"
Job no.: Job site address: 3 53 " _ � ,i ) 100HP or more. occupancy.
C :t��r } -1�
�, ❑ six or more residential units CI Recreational vehicle parks.
/State /ZIP: --' ❑ llenith -care facilities. ❑ Supply voltage for ore than
City/State/ZIP: ' ` � \,ri ,' Ci _I 7,2
I ❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. Project name: ) ° Service or feeder 600 maps or more,
g /a )t, 1 0,64it ( 4 (i�Lie 1 E I It. ( (l i /1/ ❑ P
FEC'SCHEDULC ::,,
Cross street /directions to job site: (4), ( "z I'1 no (;,)/eeliieL Description I Utv. l Fee. I Toni i . ;.:
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. h. or less 145.15 4
Ea. add'I 500 sq. fl. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
7500 2 •
..... ... .. :_ ;, - .... ..._ :.:DESCRII ?TION ; SOP) <s1'ORK ; :,. ?. ; ': ". (with above sq. fl.)
t Limited energy, multi - family
1k
' C l CI -S•l). .. 1� I ( l � ( ti t Ve 1 9.0 residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and /o• relocation
200 amps or_less 80.30 2
❑.: PROI ER'1':], .OIWNER':._' „,': r.. :', :: ❑. TENANT ` ' , .7 . 201 amps to 400 amps 106.85 2
Name: 401 snips to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 snips 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 snaps 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, Her panel
Owner signature: Date: _ A. Fee for branch cireuiis with
w..
CONTACT;'.PERSON above service or feeder fee,
6.65 2
I j (:`.)-11,,,,,t each branch circuit
I Business name: 7//\ ` (:,0'., "i,/ \ G .k )'r''i i. (0Al AV B. Fee for blanch circuits
Contact name: M614(4-' I without service or feeder fee,
Ctct a
�i\leAZ )--” fiist branch circuit 46.85 2
Address: tt t �? ( v'+ j� /° r t d Each add'1 branch circuit 6 65 2
S t' .? 1'i i V t l'' Y f!� 4' - � �. �� i. Miscellaneous (service or feeder not included
' City/State/ZIP: / �i / ` f (,/ r )
Y �(, /y \tr)j. A t „ T ( !) 7 1 Each manufactured or modular 90.90 2 •
. dwelling, service and /or feeder
Phone: (^ (0O) ( )
3'� 7� I Fax: 8� 2 32;5 Reconnect only 66.85 2
E - mail: .M\F\Vnc, n OgOn f "'l ( t11�1�\ 61 , M Pump o• inigation circle 53.40 2
.... .. -- ; CONTRACT R ',,.: ;:. ' ; . : Sign o' outline lighting 53.4
�. g n 11 i 0 2
Business name: p (� < J' Signal circuit(s) or limited-
( _ I) CJ ti 't , c^ • `, (l' O / -, energy panel, alteration, or
f
Address: t NI g \(\ \ �` /�t j /' 9 -A'01 extension. Describe: Page 16 2
City /State /ZIP: ,V', „, \ `f/ \/ s� p, n ifl Each additional inspection over allowable in any of the above •
�. E \ _ Per inspection 62.50
Phone: (7, ), ,I - - ( ( ,r' Fax: (y,,O) 2,f:�t-.i 7
� (} '( .�7 Investigation per hour (I hr min) 62.50
CCB Lie.: \ 4 1 �' Electrical Lie,: Suprv. Lie.: t I ndustrial plant per hour 73.75 •
! . :ELECPIRICAL :PERMIT :FEES' :. is ..r
Suprv. Electrician signature, required: Subtotal: — (6 • °C)
Print name: Date: l Plan review (25% ennit fee): f 0
/ o, ` y
Authorized sign tale suns large o of perms fee): q,
!v ° ! permit �l
at Bfe:;� .<.,:'i_^w._ '._ TOTAL PERMIT FEE Li •
Print name: ' °J'(i h ~ IM 1 �� -.�. _ - I N µw 1 1 • yN Date: 1 j Phis pe rmit application expires if a permit is not obtained within I �
•
c , ,\ clays after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\ltuiiding \Permits \ELC- t'eunitApp.doc 05/23/05 440- 4615T(11 /05 /COM+WEI
I .
CITY OF TIGARD ,..
•
BUILDING DIVISION PERMIT #: ELR2008-00005
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/4/2008
Phone: (503) 639-4171
. 7111 1 11lit
Inspection Requests (24 Hrs.): (503) 639-4175 ...,, -.......
INSPECTION WORKSHEET FOR DATE: 5/8/2008 TIME: 7:01AM PAGE: 21
SITE ADDRESS: 12353 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT #: 045 TYPE OF USE:
PROJECT NAME: GRANT STRE.L.1 ELITECARE
DESCRIPTION: Installation fiber optics for data. 5/7/08: Phase I West, Phase II East
OWNER: ELITE CARE, PHONE #: 971-506-0151
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #:, 360-254-6920
Inspection Request Scheduled For: Date: 5/8/2008 Pour Time:
Code # Inspection Description C6nfirm # Contact # Message
199 Electrical final IT 971-506-1973 . N
/........■•■••••••■■•■■■•••••• )
Corrections/Comments/Instructions: \ /
Tpok`T ■ esl... F.iv I\ 1, / WS'S"' 1,4 i 0 A1-1..,
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0, PASS APA F34APPROVAL El CANCEL 0 NO ACCESS
[11 CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED
Inspector: Cr l' Pe) t...- Date: 51 Phone #: (503) 718-1A)
— •• < - < _ • , - , .