Permit CITY OF TIGARD ELECTRICAL PERMIT
q
71 PERMIT #: ELC2007 00246
COMMUNITY DEVELOPMENT DATE ISSUED: 4/18/2007 _
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S136CC-02100
SITE ADDRESS: 11744 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: VERIZON WIRELESS
• Project Description: Cellular equipment, site light, gen receptacle & T -1 line, DC generator
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: 1
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 3 W /SERVICE OR FEEDER: 4 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: • CLASS AREA/SPEC OCC:
Owner: Contractor:
GRUNBAUM, HANS H AND MARILYN K LEGACY WIRELESS SERVICES, INC
TRUSTEES 15580 SE FOR MOR CT
21390 SW EDY RD CLACKAMAS, OR 97015
SHERWOOD, OR 97140
Phone: Contact #: PRI 503 - 656 - 5300
FAX 503 - 656 -5305 •
FEES
Description Date Amount Reg #: ELE 37 -989C
[ELPRMT] ELC Permit 4/18/2007 $342.50 LIC 150432
[TAX] 8% State Surcharge 4/18/2007 $27.40 SUP -4,8+3.3,3- yI S S
Total $369.90 REQUIRED ITEMS AND REPORTS
•
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: v _ Permittee Signature: „al ( � ' M
/l ' 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- '07,.15:,30 FROM- Legacy Wireless 503 - 656 -5305 T -149 P002/003 F -517
Ir
1e ctrical Permit Application FOR (H.4'1( cm: oNi.)
RECEIVED t7at ReOeive
e/B d : �� i Pen�lit No
City of Tigard �
r • 13125 SW I-Iall Blvd., Tigard, OR 9 023iiL.v man Rav<a
>a Ph one: 503.639.4171 Fax: 503,598.1960_ m a n R ; Other Permit: -a -.90A
TIGAR 0 Inspection Line: 503.639.4175 AYR 1 6 2007 Date Ready/By: 55 See Pagel for
. Internet: www.tigard- or.gov Notified/Method: Supplemental Information
CITY OF TIGARn
TYPE OF %RIDING DIVISION PLAN REVIEW
® New construction ❑ Addition/alteration/replacement Please check all that apply (submit 3 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
D.Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 0 Commercial -use agricultural
❑ 1- and 2- family dwelling El Commercial/industrial ❑ Accessory building amps for all other installations. buildings. .
❑ Main- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. n
❑ Addition of new motor load of ❑ "A "E ", "1 -2 ", "1 J ",
.Job no.: Job site address: 11744 Pacific llHWY 100HP or more occupancy. reation
❑ Six or more residential units. ❑ Recal vehicle parks.
City/Statc/ZIP: Tigard, Oregon ❑ Health -care facilities. 0 Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: VZW Dartmouth ❑ Service or feeder 600 amps or more.
FEE SCHEDULE .
Cross street/directions to job site: SW Dartmouth Existing Cell Tower Description I Qty. I nee. I Total l + '
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less - 145.1 4
. Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above so. ft.)
Limited energy, multi - family 7500 2
New 200 Amp Seervice and Feeder to Verizon Wireless Cellular Equipment residential (with above sq. 4.)
Services or feeders installation, alteration, and/or relocation
Site light, Gen Receptacle and T -1 line, DC Generator 200 amps or less 3 80.30 240.90 2
ID PROPERTY OWNER • I ® TENANT 201 amps to 400 amps 106.85 2
Name: VERIZON WIRELESS • 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 5430 NE 122 AVE Over 1,000 amps or volts 454.65 2
City/State /ZIP: PORTLAND, OREGON 97230 Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 l
Owner installation: This installation is being made on property that 1 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
. ® APPLICANT . I ® CONTACT PERSON above service or feeder fee, 4 6.65 26.60 2
each branch circuit
Business name: LEGACY WIRELESS SERVICES B. Fee for branch circuits
Contact name: PATRICK LYNE without service or feeder fee. 46.85 2
first branch circuit
Address: 15580 SE FOR MOR CT Each add'l branch circuit - 6.65 2
- Miscellaneous (service or feeder not included)
City/State /Z1P: CLACKAMAS, OREGON 97015 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (503) 6565300 I Fax: : (503) 6565305 Reconnect only 66.85 2
E -mail: PLYNE@LEGACY- WIRELESS.COM Pump or irrigation circle 53.40 2
— CONTRACTOR Sign or outline lighting 53.40 2
— Business name: LEGACY WIRELESS SERVICES Signal p a nel t(a) or limited -
energy panel, alteration, or
Address: 15580 SE FOR MOR CT extension, Describe: I Page 2 75 2
T -1 LINE
City/State/ZIP: CLACKAMAS, OREGON 97015 Each additional inspection over allowable in any of the above
Per 503 656 - 5300 I Fax: (503) 656 - 5305 Investigation ion 62.50
Phone:
( ) ( ) Investigati on per hour (t hr rain) 62.50
CCB Lic.: 150432 1 Electrical Lie.: 37 - 989C I Suprv. Lic.: 4154S Industrial plant per hour 73.75
• ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: �� A.,....,g...0-- Subtotal: 342.50
Print name: PATRICK P. LYNE yyy ` Date: 04/16/2007 Plan review (25% of permit fee):
State surcharge (8% of permit fee): 27.40
Authorized signature: fiz- �,6,� y(,� 4--0---- TOTAL PERMIT PEE; 369.90
Print name: PATRICK RICK LYNE Date : 04/16/2007 This permit application expires if a permit is not obtained within 180
days at'ter it has been accepted as complete. _ _
Number of inspections allowed par permit.
4404613T(ll/05/CO
1: �8uitding ■pumitAGLC- Pem,itApp.doc 05/23/06 ra
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 -00246
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/18/2007
Phone: (503) 639 -4171 /��u.ti: .��(
Inspection Requests (24 Hrs.): (503) 639 -4175 F.
INSPECTION WORKSHEET FOR DATE: 6/13/2007 TIME: 7:01AM PAGE: 4
SITE ADDRESS: 11744 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: VERIZON WIRELESS
DESCRIPTION: Cellular equipment, site light, gen receptacle & T -1 line, DC generator
OWNER: GRUNBAUM, HANS H AND MARILYN K, PHONE #:
CONTRACTOR: LEGACY WIRELESS SERVICES, INC PHONE #: 503. 656.5300
Inspection Request Scheduled For: Date: 6/13/2007 Pour Time:
Code # Inspection Description Confirm# Contact # Message
105 Underground/slab cover 050156 -01 \ \, 971 - 255-7826 Y
Corrections /Comments /Instructions: " ('i\\W"
( 61\71\---
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C, N �� Date: 61, 3I1") Phone #: (503) 718- 100
i
CITY OF TIGARD
BUILDING DIVISION
A PERMIT #: ELC2007 -00246
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/10/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 _re _
INSPECTION WORKSHEET FOR DATE: 7/3/2007 TIME: 7:03AM PAGE: 3
SITE ADDRESS: 11744 SW PACIFIC HWY CLASS OF WORK: •
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: VERIZON WIRELESS
DESCRIPTION: Cellular equipment, site light, gen receptacle & T -1 line, DC generator •
OWNER: GRUNBAUM, HANS H AND MARILYN K, PHONE #:
CONTRACTOR: LEGACY WIRELESS SERVICES, INC PHONE #: 503 -656 -5300
Inspection Request Scheduled For: Date: 7/3/2007 Pour Time:
Code # Inspection Description (r Confirm # Contact # Message
1_
199 Electrical final 051404 -01 971- 2557826 N
. _
Corrections /Comments / Instructions:
U PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: . (' bb L- Date: 1 % tl Phone #: (503) 718- 1144110
CITY OF TIGARD
BUILDING DIVISION `" ,r PERMIT #: ELC2007 -00246
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/18/2007
Phone: (503) 639 -4171 q'�I
Inspection Requests (24 Hrs.): (503) 639 -4175
•
INSPECTION WORKSHEET FOR DATE: 6/8/2007 TIME: 7:01AM PAGE: 6
SITE ADDRESS: 11744 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: VERIZON WIRELESS
DESCRIPTION: Cellular equipment, site light, gen receptacle & T-1 line, DC generator
OWNER: GRUNBAUM, HANS H AND MARILYN K, - PHONE #:
CONTRACTOR: LEGACY WIRELESS SERVICES, INC � QL,,\ PHONE #: 503 -656 -5300
L
Inspection Request Scheduled For: Date: 6/8/2007 Pour Time:
Code # Inspection Description / Confirm # Contact # Message
empor, - service (I 049895 -01 971 -255 -7826 . Y
115 4 -Si i
Corrections /Comments /Instruction-:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: GM be• L G Date: G( 01 Phone #: (503) 718- lak