Permit CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00088
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/18/2008
PARCEL: 1 S135DC -03000
SITE ADDRESS: 11575 SW GREENBURG RD 6 ZONING: R - 4.5
SUBDIVISION: FOUR OAKES APARTMENTS LOT: JURISDICTION: TIG
PROJECT: FOUR OAKS APARTMENTS
Project Description: Units 6 -9: Installation of 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:
KEN CONDO'S LLC NORTH SKY COMMUNICATIONS INC
16835 SW IVY GLEN ST 11818 SE MILL PLAIN BLVD STE 4
BEAVERTON, OR 97007 VANCOUVER, WA 98687
Phone: Contact #: PRI 360 - 254 -6920
FAX 1- 866 -530 -4325
FEES Reg #: ELE 17- 154CLE
LIC 141171
Description Date Amount
[ELPRMT] ELR Permit 4/18/2008 $75.00
[TAX] 12% State Surch 4/18/2008 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: O / j/Gie--T70N
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
04/16/2008 WED 12 :15 FAX CITY OF TIGARD 2)004 /009
Electrical Permit Appllica5 i... .. JI USE O Nl u
City f Tigard
ar (1 11 Receive) /O. PermN N0.
Y ® Date/B : Y /, i, LiedZeta d00cPS
Other Pcrmi
tt 13125 SW Flai Blvd.,'figard, OR 97223 r �t�A� Plan Review
3 '.' Phone: 503.639.4171 Fax: 503.5�I OI'• i � � eceiv : c
TIGARD Inspection Line: 503,639,4175 V t O�� IS Iatc Ready /By /uric: ® See Page 2 for
Internet: www.tigard - or.gov B y" . O U " Notified /Method: i Supplemental Information
` • TYPE .OF: WORK . PLAN.' - REVIEW .:
Please check all nun apply (submit 2 sets of plans w /items checked below):
Q New construction si Addition /alteration /replacement
0 Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards.
.,,:,..,:_.. ,: ., ... ATEGORY'.OF: CON$TRU.CTION.:.: "` ` exceeds 10,01l0 amps at 150 volts or Floating buildings.
"� , less to gram), or exceeds 14,000 Q Cou agricultural
Q - and 2- family dwelling p Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
a Multi - family ❑ Master builder ❑ Other: 0 Fire pump. 0 Installation of 75 KVA or
. . 0 Emergency system. (urger sepantety derived system,
. J033.:SITE''' INFORMATION `AND : LOCATION:..'. :':','...... ' . • . 0 Addition of new motor load of 0 "A" "E", 4 - "1-3",
Job no.: Job site address:11575 SW GREENBURG RD 1(IOHPormore. occupancy.
0 Six or more residential units. 0 Recreational vehicle parks.
City /State /ZIP:TIGARD, OR 97223 0 Health-care facilities. 0 Supply voltage for more titan
0 Hazardous localism, 600 volts nominal.
Suite /bldg. /apt. no.# 6 -9 Project name: FOUR OAKS APTS. 0 Service or feeder 600 amps or nor c.
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Cross street /directions to job site: ucsc,:paon 1 Oty. I Fee. I Tot 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 I
Tax map parcc no.: —_
Limited energy, residential
. -; :.:'..'.' DESCRIPTION :OF • , : (with above sq. (l.) 75.00 -
Limited energy, multi - family 75.00 2
INSTALL FIBER OPTICS FOR VERIZON residential (with above sq. ft.)
- Services or feeders installation alteration, and/or relocation
200 amps or less 80.30 2
PROPERTY;'''OWNER.':..: El .TENANT .` :, '::. 201 amps to 400 amps 106.85 2
Name: KCjJ '(oP.{io S (-LC- 401 amps to 600 amps 160,60 2
601 amps to 1,000 amps 240.60 2
Address: 1 (era 5' 514) i vy Gc fo4 s ' Over 1,000 amps or volts 454.65 2
City /State /ZIP: 13 E't'N/E TD" ` 0 �- q '700 7 Temporary services or feeders iustallalion, 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
',.I :APPLICANT • .. t.:. . 0: CONTACT PERSON.. c i 3 '. :.,'.. above service or feeder fee,
each branch circuit 6.65 2
Business name: NORTH SKY COMMUNICATIONS, INC. B. Pee for branch circuits
Contact name: without service or feeder fee, 46.85 2
MONET VIVEROS firstbrnchcircuit
Address: 11818 SE MILL PLAIN BLVD. STE 410 Each add'/ branch circuit 6,65 2
Miscellaneous (service or feeder not included)
City/State/ZIP:VAN000VER, WA 98684 Bath manufactured or modular
90.90
• dwelling, service and /or feeder
Phone: (360 254 -6920 Fax: : ( ) 1 -866- 530 -4325 Reconnect only 66.85 , 2
E -mail: mviveros @nolthskycomm.com Pump or in'igation circle 53.40 2
....;:2••:,' ..,...,•:.,.:.,'•, ' •CONTRACTOR :t; ..' `:'.. "' : .., : . :: ... ' • . •• •••'; .` ` Sign or outline lighting 53.40 2
Business name: NORTH SKY COMMUNICATIONS, INC. energy p alter 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 (1 ttr min) 62.50
CCB Lie.: 14117 Electrical Lic.17- 154CLE Suprv. Laic.: 173LEB Industrial plant per hour 73.75
ELECTRICAL`PERMIT: a
Suprv. Electrician signature. required: Subtotal: $75.00
Plan review (25% of permit fee):
Print name: JACK CAGLE Date: 4/16/08 State surcharge (12% of permit fee): $9,00
Authori sit k i ,.►. •.^�~ ..w _. -- TOTAL PERMIT FEE $84
This p ermit application expires if a permit is not obtnincd within 180
Print name: TERI A. M I KU L I C Date: 4/16/08 days after it has been accepted as complete.
* Number of inspections allowed per permit,
Lam. tiding \ Permits \ttLC'Pennit 05 /2v/05 4404615T( 1 1105 /COM/WF0
CITY OF TIGARD
BUILDING DIVISION A
PERMIT #: ELR2008-00088
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/18/2008
Phone: (503) 639-4171 *Olt
Inspection Requests (24 Hrs.): (503) 639-4175 MJ'
INSPECTION WORKSHEET FOR DATE: 4/24/2008 TIME: 7:01AM PAGE: 14
SITE ADDRESS: 11575 SW GREENi3URG RD 6 CLASS OF WORK:
SUBDIVISION: FOUR OAKES APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: FOUR OAKS APARTMENTS
DESCRIPTION: Units 6-9: Installation of fiber optics for Verizon.
OWNER: KEN CONDO'S LL.C, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360
Inspection Request Scheduled For: Date: 4/2412008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 008854-03 503-333-8888
Corrections/Comments/Instructions:
vvr
PASS 0 PARTIAL APPROVAL El CANCEL fl NO ACCESS
FAIL CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED
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Inspector: Z t / 93 Date: Hi 1-- Phone #: (503) 718- • ,4 gto