Permit CITY OF T I R ® ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00055
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/14/2008
PARCEL: 2 S 102AA -03400
SITE ADDRESS: 12375 SW HALL BLVD 3 ZONING: CBD
SUBDIVISION: TIGARD TOWNE HOUSE APARTMENTS LOT: JURISDICTION: TIG
PROJECT: TIGARD TOWNHOMES
Project Description: Install fiber optics for Verizon. For Units 1 - 7
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:
TIGARD TOWNHOMES INC NORTH SKY COMMUNICATIONS INC
PO BOX 2907 11818 SE MILL PLAIN BLVD STE 4
POULSBORO, WA 98370 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 3/14/2008 $75.00
[TAX] 12% State Surchai 3/14/2008 $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 fog] in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503.246.66 - or 1.8 332. 344.
Issued It 4 Permittee Signature_,
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.
03/13/2008 THU 8: 16 FAX U002/ 004
Electrical Permit Applit' rt��z OFFICE usi. oivi Y
City of Tigard
n PntmitNo.: F�,,Q, -�
13125 SW Mall [ilvd., Ti ard, OR 1 (U Q1her Permit: a Phone: 503.639.417 ( tax: 503.59 Dale/B
TIGARD Inspection Line: 503.639,4175 CITY 01-[Ir 41D DateReady /By: ME to Sec Page 2fur
Internet www,tigard- ot.gov 1 Notificd/Method: Supplemental informat
...: TYPE PLAN_ REVIEW
Please check all list apply (submit 2 sets of plans w /itmns checked below):
❑ New construction Ur Addition /alteration /replacement
❑ Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
'S.-..f.',:.1.' i'.. A a or exceeds O,U(k) „sat I50 vu Floating buildings.
` ' ':G fEGORY `UF ,CONSTRUCTION '' `' ' ' I amps lts �
1 - and 2-family y dwellin Commercial/industrial .
P O g
less to ground, or exceeds (4,000 (`onuncrcixl -use agticulnval
❑ dwelling ❑ LI Accessory building tulips for all other instalkisons. buildings.
G Multi- family ❑ Master builder ❑ Other: D Fire pump. ❑ Installation of 15 KVA or
y
Emergency system. larger separately derived system,
-. : JOB::SITE :INFORMATION : - AND :LOCATION . -,' j.:: : .•.'., - ': ❑ Add ition of ncry tnotvr load of
Job no.: Job site address:12375 SW HALL BLVD I0011Pornwro. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: PORTLAND, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for mere than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt, no. #1 -7 Project name: TIGARD TOWN HOUSES ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street /directions to job site: Description i qty. I Fee. I mu 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' 1 500 sq. ft. or portion 33.40 1
Tax map /parcel no,: Limited energy, residential
. _ , , - DESCRIPTION OF:. WORE • ' ., • - - (with above sq. n.) 75.00 2
Limited energy, multi - family 75.00 2
INSTALL FIBER OPTICS FOR VERIZON residential (with above so, ft.)
Services or feeders installation, alteration, and/or relocatio
200 amps or less 80.30 2
:..;' PROPERT.Yr- :QWNER ' . ' .. o - .TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
/9- 2 �dGC J 14e) /—/. S ' "' C ` 601 amps to 1,000 amps 240.60 2
Address: P -7-2„, K . a c,0 7 Over 1,000 amps or volts 454.65 2
City /State /ZIP: PO et L 5 -020 O l - 9337e 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. 40t amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, Lrer panel
Owner signature: Date: A. Fee for branch circuits with
:.` Cr - APPLICANT : ''`::: r i s El :CONTACT. PERSON.`..`; •_.. 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 fee, 46.85 2
Contact name: MONET VIVEROS first branch circuit
Address: 11818 SE MILL PLAIN BLVD. STE 410 Each add'l branch circuit 6.65 1 2
Miscellaneous (service or feeder not included)
City /State /ZiP:VANCOUVER, WA 98684 Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: (360) 254-6920 Fax: : ( ) 1- 866 - 530 -4325 Reconnect only 66,85 2
E- mail: 113viveroS@northSkycomm.cotll Pump or itt•igation circle 53.40 2
::CONTRICTOR.'. ?: ::. Si or outline lighting _ 53.40 2
INC. energy circuit(s) alter limited-
Business name: NORTH SKY COMMUNICATIONS, energy panel, alteration, or
• Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 page $75.00 2
City /State /ZIP: VANCOUVER, WA 98684 Each additional inspection over allowable in any of the above
Per Phone: (360) 254 -6920 Fax: ( ) 1- 866 - 530 -4325 Investigation 62,50
nvn per hour (t hr min) 62.50
CCB Lie.:14117 Electrical Lic.17 -1 4CLE Suprv. Lie.: 173LEB Industrial plant per hour 73.75
:- - ELECTRICAL:PERMIT."_FEES . ' • .
Suprv. Electrician signature, required: Subtotal: $75.00
3 /13/08 Plan review (25% of permit fee):
Print name: JACK CAGLE Date: State surcharge (12% of permit fee): $9.00
Authorized sic ' • • . ..A!01!!!" -` TOTAL PERMIT FEE: $84.00
this p ermit application expires if a permit is not obtained within ISO
Print name: TERI A. M I KU L I C Date: 3/13108 days after it has been accepted as complete.
° Number of inspections allowed per permit.
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BUILDING DIVISION ' PERMIT #: BR2008-00056
| 13125SVV Hall B|vd, Tigard, ORQ7223 DATE ISSUED: 3/14/2008
Phone: (503) 639-4171
Inspection Requests �4Hmj:�Q3)839'4175 "���' "���
INSPECTION WORKSHEET FOR DATE: 3/21/2008 TIME: 7:01AM PAGE: 38
SITE ADDRESS: 123T68W HALL BLVD 3 CLASS
SUBDIVISION: TIGARD TOWNE HOUSE APARTMENT LOT #: TYPE OF
PROJECT NAME: T|GARDTOWNMOMES
( . L.- - r s
DESCRIPTION: Irisl fiber optics for Verizon. For Units 1'7
OWNER: TlGARDTOINNHOhNESINC, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICMIONS INC PHONE #: 360-2546920
Inspection Request Scheduled For: Date: 3/21/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 067104-01 Y
Corrections/Comments/Instructions:
.
��RART�LAPPR�VAL — — CAN{�EL ri NC�ACCESS
n FAIL 0 CALL FOR INSPECTION 111 ADDITIONAL FEES ASSESSED
Inspector: ~" ' Date: Phone #: (503) 718-
.