Permit CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
• COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00451
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 11 ZONING: C -P
SUBDIVISION: HILLCREST APARTMENTS LOT: JURISDICTION: TIG
PROJECT: HILLCREST APARTMENTS
Project Description: Install low voltage fiber optics for Verizon. Units 11 & 12.
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 • - - Lions to OUNC at 503. • ..6699 or 1.800.332.2344.
Issued By: 41C16,1 j i/ / I '/ Permittee Signature: Q� ,o
GCCG11 �
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.
?/12/2007 WED 12: 15 FAX J006 /011
i im • sh zit ti' YI Itb l v / 8 - 530 — i i Z
Electrical Permit Applicatio. ' "`°
PP ' OFFICE USE ONLY
City of Tigard DEC 1 Received S , A 1
V
1 3125 SW Hall Blvd., Tigard, OR 97223 2 00 DatelB : Vv /V Permit No.: E ` pi ...41 jr 5-
' 2s I TY OF TIGAR; Plan Review
- Phone: 503.639.4171 Fax: 503.598.19;1 rate /By: Other Permit:
TIGARI] Inspection Line: 503.639.417 B p� n �+4 ^- c Ready /By: lads_ El See Page 2 for Internet; www.tigard- or.gov BUILDING IJ ( . ified /Method: ^ / �I // Supplemental Information
K � - ' ' ALAN ]tEYIEW. ..
❑ New construction ,Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition ❑ Other:
❑ Service or feeder 400 amps or more ❑ Building over three stories.
C available fault current M
where the avail Marinas and boatyards.
i
t t s • ` ATEGORY' F CO■ exceeds 10,000 amps at 150 volts or ❑ Floating buildings-
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2 - family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
Multi family ❑ Master builder ❑ Other: 0 Fire pump. P ❑ Installation of 75 KVA or
- ,
,.,,...
;; JOB :SITE:INFORMATI: ON ::AND' ; = LOCATION. '=::::"'''''''-':-.:: ` ❑ A o new em tno o . o oa of ❑ I -2" " lar ,seB„ pa ratel derived system.
,
... ... .. .. .... ❑ dd A ttiohen o f
t ! d . I
no.: Job site address: SQ (� t/rJ � ,/ 100HP or more. occupancy.
Job
�„ ^ I, � ` r — � �r I-y�t ..Y ❑ Six or more residential units. 0 Recreational vehicle parks.
City /State /ZIP: i I 1(l(l (yA r (�� ❑ Health -care facilities. - ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal.
Suite /bldg. /apt. no. ( 4 p I - Project name:1 l ' 000t /� , \ ❑ Service or feeder 600 amps or more. .
LI V
~..:.. ?FEE : Selig - `,,: t :•. : :.
Cross street/directions to job site: Description I Ore. I Fee. _I Total
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add') 500 sq. ft. or portion 33.40 1
Limited energy, residential
,'.; ' ',:.l. : . ,- ,. : ',' ' : - ..:.' .: : < : 75.00 2
DESCRiI'TION,QF'.1WORh' : / z'.. • ; " ',.i ;;:.: ii `':::. -�' (with above sq. fl,)
1/ k
Q kid Q.. ,/ �`�-� 1 7 /� ) Limited energy, multi - family
( Q -''` ?/" D \ -- i` t., Ji'� V l r,( residential (with above sq. fl.) 75.00 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 8030 2
. , fl; PROPERTY .O.WNER',.. . __' ; :' ,; ': :.❑. TENANT .:- 201 amps to 400 amps 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. 401 amps to 599 amps 133.75 2
Branch circuits - new alteration, or extension, per panel
Owner signature: Date: p P
A. Fee for branch circuits with
. '::❑ .APPLICANT'. ' : ' :- CONTACT: PER above service or feeder fee,
1•4132),./11\ � , . r .r {l (jr'i i, r 1` n each branch circuit
Business name: � 6.65 2
(I /' 4 ( �t r t,r A t0, (i�'. %l1 T ` B. Fee for branch circuits
Contact name: \V\ 01'1td;� \\ , l ')1 without service or feeder fee, 46.85 2
first branch circuit
Address: y 4 i 1 ` i 1 i! 1 /0 i/: 1,/ 1 1't 1 \� V ' Each adoll branch circuit 6.65 2
1 Miscellaneous (service or feeder not included)
City /State /ZIP: V4KAi D'i �/ C�C( (e7, 1 �I/� tAj(Fax:: L 1 Y Each manufactured or modular 90.90 2
� dwelling, service and /or feeder
Phone: (b/J p) % x _ l4 2.0 1 ( ( (pl ) , / ' :.. (4 ��5 Reconnect only 66.85 2
E -mail: • Ili • ' , $ t n \ 3 Y.A.. J A/\ (. co tA'\ Pump or inigation circle 53.40 2
.. .......;; ... ...:. . :.::.:.. p :. Sign or outline lighting 53A0 2
Business name: c � u Signal circuit(s) or limited -
C J energy panel, alteration, or
Address: f 1 S I e, \/\/\\\\ `, \\ (\ ow ' 1 9 \ \ o. extension. Describe, ` Page 2 16 2
City /State /ZIP: (� \( o\n1 . ( \ j {/\ 98(b r b g1 Each additional inspection over allowable in any of the above
r ""l t `t1 i )\ _ Per inspection 62.50
Phone: (CJl,0) ) 1-7q j Fax: ( L( - �7 f Investigation per hour (i hr min) 62.50
CCB Lie.: \f,._\.` 1 I Electrical Lie.: Suprv. Lie.: lndusttial plant per hour 73.75
1 is ELECTRICAL ;:PERMIT: ;FFEES ;, ,'? -) _: _ '
^,: =:
Suprv. Electrician signature, required: Subtotal:
Print name: Date: Plan review (25% of pennit fee):
State surcharge (8% ofpennit fee): (p e)
Authorized signa�nce ;'`
"—,, ° "� µ=i-_ e
- ~--, "...�.,; -� TOTAL PERMIT FEE: }
Print name: <. f 4" I h; 1M, y „ (,1( - C t Date: This permit application expires if a permit is not obtained within ISO
�- . 2. -Q days after it has been accepted as complete.
e Number of inspections allowed per permit.
1:\ 13uilding wenxits\ELC- PermitApp.doc 05/23/06 440 - 4615'x(1 I /05 /COM(WEB
. ,
CITY OF TIGARD
BUILDING DIVISION • PERMIT #: ELR2007•004.51
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/12,0007
Phone: (503) 639-4171 Aseivil
Inspection Requests (24 Hrs.): (503) 639-4175 ,s:4
INSPECTION WORKSHEET FOR DATE: 12/28/2007 TIME: 7:00AM PAGE: 67
SITE ADDRESS: 07582 SW HUNZIKER RD 11 CLASS OF WORK:
SUBDIVISION: HILLCREST APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: HILLCREST APARTMENTS
DESCRIPTION: Install low voltage fiber optics for Verizon. Units 11 & 12.
OWNER: PETRUSHKIN, SUSAN RO SE, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-254-6920
Inspection Request Scheduled For: Date: 12/20/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 062236-04 503-209-9546
Corrections/Comments/Instructions:
4?“
PASS PARTIAL APPROVAL 7 CANCEL El NO ACCESS
fl FAIL 7 CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: is•) be) Date: a. -ea • ty-) Phone #: (503) 718- 2-94k
_ _