Permit CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00450
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/12/2007
PARCEL: 25101 DB -00201
SITE ADDRESS: 07582 SW HUNZIKER RD 7 ZONING: C -P
SUBDIVISION: HILLCREST APARTMENTS LOT: JURISDICTION: TIG
PROJECT: HILLCREST APARTMENTS
Project Description: Install low voltage fiber optics for Verizon. Units 7 - 10.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA /TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: DATA : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
PETRUSHKIN, SUSAN RO SE NORTH SKY COMMUNICATIONS INC
7315 SW 27TH AVE PO BOX 87550
PORTLAND, OR 97219 VANCOUVER, WA 98687
Phone: Contact #: PRI 360 - 254 -6920
FAX 360 - 254 -5097
FEES Reg #: ELE 17- 154CLE
LIC 141171
Description Date Amount
[ELPRMT] ELR Permit 12/12/2007 $75.00
[TAX] 8% State Surcha 12/12/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
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.
i
Issued By. �� J1/ / 2 > 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.
12 /12 / 2007 WED 12115 FAX 0005/011
i 1 1 t'tb -1-6 q": Pir - \11t7ixtc)/ /-84:4- 5:40 -- ii .
Electrical Permit Applica'm
riECEIVED , OFFICE USE ONLY ..
City of Tigard Received p, Mr
Date/B : I L-- Permit No.: 1 2,14- -II
_ ... ..._,..
.14 is 13125 SW Hall Blvd., Tigard, OR 9722f3t EC 1 2 2007 Plan Review
Phone: 503.6394171 Fax: 503.598.1§L._ _ Date/By: Other Perntit:
Inspection Line: 503.639.4175 Date Ready/By: - 6 ,_ - li/
TIGARD CITY See Page 2 for
OF TIGARD
Internet: www.tigard Notified/Method: Supplemental Information
G * tihiA SI • - - • , - - . -
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0 New construction Addition/alteration/replacement Please cheek alt that apply (submit 2 sets of plans w)items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other:
where the available fault current 0 Marinas and boatyards,
tkiidthitii....;66Afiiii •,,:.:..,..: -.-,.:... efi.. ;•.:, exceeds 10,000 amps at 150 volts or 0 Floating buildings .
less to ground, or exceeds 14,000 0 Cosnmercial agricultural
I:I 1- and 2-family dwelling 0 Commercial/industrial [1] Accessory building amps for all other installations. buildings.
' Multi-family El Master builder 0 Other: 0 Fire puinp. 0 Installation of 75 KVA or
larger separately derived system.
4p4:Is7E:INP:9101Nrip..41,I,D: ,-: -- , ,„:.,: :..,., ..
0 Addition of new motor load of 0
00
1 1-1P or more. occupancy.
Job no.: Job site addres7T9gaSANUArocay'
. • I: Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: ----
vit(rA Oa61.-tsZ7- 0 Health-care facilities.
El Hazardous locations. 0 Supply voltage for more than
600 volts nominal.
Suite/bldg./apt. no. 3 4 -fri Project name: -0- \ Died Service or feeder ' 600 amps or more.
''.'
Cross street/directions to job site: 041C.Q..
Description I Qty. I Fee, 1 Torn t 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'l 500 sq. ft, or portion 33.40 I
Tax map/parcel no.:
. ntial
75 00 2
00 -'''• ''::•: :''': 'h' '':: (wills above sq fl) Limited energy, reside
. \ Limited energy, multi-family
lift9rldia. , c 1 \ Ocb I Veil/ 'iv residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
, " ...:".."...,, ITITROkERTY:'4:1YNgli. .'".:'.. ; ' 2 :":• .:1 "::",?.: . 1 ",- ,,. 1 ... f':,'"; ' : 201 amps to 400 amps 106.85 2
Name: 401 amps 10 600 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 10 400 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
.' • .' . : .: .'_::' ::::' 0 APPI...IGANT;•: ': -., '. ,: '.• : : : '• • )1(coNTAer • ..,, ' ;:, .„:,•: above service or feeder fec,
6.65 2
each branch circuit
Business name: hi Olt/ \ ( A/A (,,OWUtlil t A.AV, ( B. Fee for branch circuits
Contact name: \A 0 n( \\I -C
(\b (r) ' without service or feeder fee,
first branch circuit 46.85 2
r. , i
Address: 1 i (4 1 6 WA V\ a. ' Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Vovilti)J)V6/ SAI ik C,- Le < 1., - 1 Each manufactured or modular
90.90 2
dwelling, service and/or feeder
Phone: (a0())2 Fax: : (4,6 ) 530- L. 2.,.5 .
Reconnect only 66.85 2
E-mail: t 13 ucase nov A ,V.- uvom. C4.1,vv/\ Pump or litigation circle 53.40 2
•::-..:.:, ::-';,,:,,..:.':, ..',"::;,::!:::::-.,::?„,''.: ': .'".: E::: ';..,;.: OGNTRAGT It : ',. , ., - ::::•: . .1:,:.1,:..• :: : . : -.:-"::•,:.', '-',„•,::,., •:,:.:•.':::::' Sign or outline lighting 53.40 2
Business name: 0
0 0/1/Y1A -e,, b- 01)VP Signal circuit(s) o
' r limited-
energy panel, alteration, or
Address: 1 I S .6 y\k\ c7\ &i 9\ \f/J extension, Describe: Page 2 le 2
City/State/ZIP:anco\&V.e,y" \.k)4/\ 98(n 81 Each additional inspection over allowable in any of the above
I Per inspection 62.50
Phone: )2r-i..t -- 7i Fax: ( ly,,,O) -e..- 1 Investigation per hour ti lir min) 62.50
CCB Lie.: 141 \--1 1 Electrical Lie.: Suprv. Lie.: Industrial plant per hour 73.75
„ : 1 EIIG,TfiICAI.J:: : PtRIVOT4kEi;S:::.:..i';'.(Ft:
Suprv. Electrician signature, required:
Subtotal:
—
Plan review (25% of pennit fee):
Print name: Date:
--) State surcharge (8% of pennit fee): LO 6)
___Z
Authorized sign e.:,.'. .-'-'-'--A''e="-._-,1:-TZ'f,!-z'--,---- TOTAL PERMIT FEE: •-•-•
This permit application expires if a permit is not obtained within 180
Print name: - 1/vi . NI1 C. , c Date: ti. (2' 6 1
days after it iltIS been accepted as complete.
* Number of inspections allowed per permit.
I: \BuildingTermns\ELC-PermitApp.doe 05/23/06 440-4615T( 11/05/COM/WEB
," •
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007•00450
•
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1:// i mow
Phone: (503) 639-4171 t
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 12/28/2007 TIME: 700AM PAGE: 69
SITE ADDRESS: 07682 SW HUNZIKER RD 7 CLASS OF WORK:
SUBDIVISION: HILLCREST APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: HILL CRE APARTMENTS
DESCRIPTION: Install low voltage fiber optics for Verizon. Units 7-10.
. OWNER: PETRUSFIKIN, SUSAN RO SE, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-254-6920
Inspection Request Scheduled For: Date: 12/28/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 06223603 503-209-9546
Corrections/Comments/Instructions:
PASS pi PARTIAL APPROVAL Li CANCEL LII NO ACCESS
FAIL CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED
—
Inspector: C..1" W%'€) Date: VA-% - Phone #: (503) 718- 244