Permit 4
CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00452
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 13 ZONING: C -P
SUBDIVISION: HILLCREST APARTMENTS LOT: JURISDICTION: TIG
PROJECT: HILLCREST APARTMENTS
Project Description: Install low voltage fiber optics for Verizon. Units 13 - 16.
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
Reg #: ELE 17- 154CLE
FEES 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 . estions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: � � �� �� Permittee Signature: kfie, /17,
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 12: 16 FAX 21007 /011
. , A
'*ECEIVLEID(4 CA 11 IXt / - 53'0
, . ..... ,, A
Electrical Permit Applicatio -.. ‘ OFFICE USE ONLY
City of Tigard DEC 1 2 2007 Received .
„zr All Permit No.: a- e)41 .2._
" 13125 SW Hail Blvd. Tigard OR y 42, „
• ° :
• Phone: 503.639.4171 Fax: ' 503.§I:6 . 16
7 1 OF TIGARD
Plan Review
Date/By: Other Permit
Inspection Line: 503.639.4175 Date Ready/By: fa See Page 2 for
TIGARD BUILDING DIVISION
Internet: www.tigard-orgov Notifted/Method Ju
: /Jer Supplemental Information
f : '.,..1Y,: :"...:'..:::.'';';..'::'',..:::::::;;'.:':'?
0 New construction jgAddition/alteration/replacement Please check all that apply (submit 2 sets of plans se/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition D Other: where the available fault current 0 Marinas and boatyards.
CATic6iWof'611AtiititiiON - :':-::,'.,-•'.:‘ r '' -:: s::,,...:. , :.. , • . exceeds 10,000 amps at 150 volts or 0 Floating buildings .
less to ground, or exceeds 14,000 0 Commercial-use agricultural
P 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations, buildings.
' Multi-family CI Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
0 Emergency system, ' : :". .... ':11 Mi - 4 ,5 *$.i TE :': 4 : 1 #.: 6 4.. 4 At#* ,., * 4 0::, '. .0.(AtiO.N::::,.V.::: - 0 Addition of „e„ motor load of 0 larger
" s e fa.f l at - e P ' 13
Job system.
Job site addrescrAYONer --it-: i 00HP or more. occupancy,
Job no.:
0 SI% OT more residential units. 0 Recreational vehicle parks.
City/State/ZIP: ----
wA 0 a 0 0 Health-care facilities.
0 Hazardous locations. 0 Supply voltage for more than
1 1 V
600 volts nominal.
Suite/bldg./apt. no. ikt;....i .. Project name: . • A , A .
0 Service or feeder 600 amps or more.
Atli
•,,.',: itE
Cross street/directions to job site: _Description I Qty. f Fee. I Total 1 • , .
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. fl. or portion 33.40
Tax map/parcel no.:
, , Limited energy, residential
,
75.00 2
. ;,': .': .;:; '-,. . - ..; : : :' ; ' ;:::l.l ' ; ':' : ': : Y ':4,:l.• - : ' ;' , :', '. l.l': ,; l'-'.: .-- ; :. .1; ' : : 00C 1 0...i.i*l . 0 : ":'*64: : : . .. : : ' ..:':.::.:1 . :.;.:.:•. - :''1,..: : :''' ' ':: :. „; : *:.:', '..; .. (with above sq. 11 .)
Limited energy, multi-family
11 1 \ ' 191 / 1 1_, l''r/ PA/ Q,,On residential (with above sq. tt.) 75.00 2
1 Services or feeders installation, alteration, and/or relocation
.. ‘.. ,‘ 200 amps or less 80.30 2 _
..': 2 ':'.i 1:3 ..::::i'.-1 .'• :'s 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, ier panel
Owner signature: Date:
A. Fee for branch circuits with
' • ': .'; "I .: .•. b .2,014 .-,,)yr.:.,;:.:j:,:i .,:.., `...-. above service or feeder fee,
„ .
6.65 2
each branch circuit
Business name: td.k.,h V;VA COM,41 J./I/U.' truh B. Fee for branch circuits
/ I . 1 without service or feeder fee,
Contact name: mone,-- Nwem)_c- first branch circuit 46.85 2
Address: i ( % ‘ 'i; ,;(> W61 t\.1) {1 ;' 0 Va. ' Each addl branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: \kv A. c ki, 1
, ..1 Each manufactured or modular
90.90 2
• dwelling, service and/or feeder
Phone: (b(D)2r..---)f (A 2,0 Fax: : (Vp6 ) 5? „, 0 ,- 4 7,.,5 Reconnect only 66.85 2
E-mail: mLizacefov/uAc3K\ict)vv\Ari. Gtavkii\ Pump or inigation circle 53.40 2
....,;.':':',•:..:;:-::, : ':":.l - .',. , :.,.„ . .' , ;.".....'btiNTit r AlCri30 . .....:::'; . :'.. -: :„.,:.'..,l: : ',,..'...,', :' .::.:: ', ,::.„...-- '....1: ' . : -: Sign or outline lighting 53.40 2
e
Business name:. 0 ()-.-% .v., Signal circuit(s) or limited-
_ energy panel, alteration, or
Address: SI e, \ V\ (do Q \ v extension. Describe: Page 2 1 2
City/State/ZIP: ancm \ / e ., \,( \joy\ 98 (,)81 Each additional inspection over allowable in any of the above
i Per inspection 62.50
Phone: (7,t/0 )2,1„-:)..1 20 Fax: ( V00) 2,GLI -- 1 1
Investigation per hour (t sr min) 62.50
CCB Lie.: \ 4 \ \ 11 Electrical Lie.: Suprv. Lic.: Industrial plant per hour 73.75 _
ELECTRWAIL:
Suprv. Electrician signature, required:
Subtotal: ._
Plan review (25% of pennit fee):
Print name: Date:
State surcharge (8% of permit fee): L 6 ' )
-.)
Authorized sign&k:,'7,.._*':::„,j:'-'-'m-t..F::M..,.,„„,------.-._ TOTAL PERMIT FEE:
Print name: <CA( 1_\ . NVi \/„.(,(1/1 C. , c - Date: 1:2_ 124 0 1 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
* Number of inspections allowed per pennit.
JAIMildingTermits\ELC-PermitApp.doc 05/23/06 440.4615T(11/05/COM/WEB
CITY OF ��nm m n�/n mo����ma�*
BUILDING DIVISION
PERMIT #: BR2007 00162
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1211212007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 12/2112007 TIME: 7:03AM PAGE: 61
SITE ADDRESS: 07582 SW HUNZIKER RD 13 CLASS OF WORK:
SUBDIVISION: M|L/_CREDTApARTK8ENTS LOT #: TYPE OF USE:
PROJECT NAME: H|) LCREST AP&NT*AENTS
DESCRIPTION: Install low voltage fiber optics for Vertzun. Units 13-16.
OWNER: PETRWSHK1N. SUSAN R0SE, • PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 560-264'6980
Inspection Request Scheduled For: Date: 12/21/3007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low 062012'01 603-969-5989 Y
Corrections/Comments/Instructions:
N
WY(
•
PASS � PARTIAL CANCEL I I NO ACCESS
/ . �� / .
| | FAIL CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: Date: 11114 in Phone #: (508) 718-
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