Permit . C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' ° COMMUNITY DEVELOPMENT PERMIT #: ELR2008 -00020
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/24/2008
PARCEL: 2 S 102 B D -01001
SITE ADDRESS: 09961 SW WALNUT ST 15 ZONING: R -12
SUBDIVISION: WALNUT COURT APARTMENTS LOT: 007 JURISDICTION: TIG
PROJECT: WALNUT CREEK APTS
Project Description: Units 15 -18 Fiber optics for Verizon.
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:
BLINE, RONALD G + NORTH SKY COMMUNICATIONS INC
SAGUN, JUDITH L 11818 SE MILL PLAIN BLVD
2190 SKYLINE DR VANCOUVER, WA 98687
SEASIDE, OR 97138
Phone: Contact #: PRI 360 - 254 -6920
FAX 1- 866 -530 -4325
FEES Reg #: ELE 17- 154CLE
LIC 141171
Description Date Amount
[ELPRMT] ELR Permit 1/24/2008 $75.00
[TAX] 12% State Surch 1/24/2008 $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 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
41
Issued By: Permittee Signature: �"Y\ . C ... / . `
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.
01/23/2008 WED 11:12 FAX 2005/005
Electrical Permit Application OFFICE. USE' ONLY ,
Cit o Ti and Receive'-
�' g c ' � Date/El Vaf OE. i Perron ,0I ..--40110,7-72 13125 SW Hall Blvd., Tig s ''' S' V Plan Revt w
I ' Phone: 503.639.4171 Pa t. • 1.1 60 5p A t : ' 3 Dato/B : Other Permit:
1' 1 GA A R O Inspection Line: 503.639.41 5 N Li a� 13 Date Rentiy /By. lath.: RI See Page 2 for
Internet: www.tigard- or.gov J t° (s I Notified /Method: Supplemental Information
TYPE.OFl
❑ New construction Addition / r��� 'PLAIN REVIEW ;.
- • • w ppll acement • Please check all that ): (submit (subt 2 sets of plans w /itentc checked below +j y e
❑ Service or (ceder 400 amps or store 0 Building over three stones.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
•,: -% - :. ' • :' ... " CATEGORY,OF CONSTRUCTION exceeds 10,000 amps at I50 volts ur ❑ Floating buildings. • — loss to ground, or exceeds 14.000 ❑ Commercial - use agricultural
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
G Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB _SITE INFORMATION AND LOCATION _ - . ` ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A" "F" "1.2“, "1.3",
Job no.: I Job site addressit)1$1911315:81N WALNUT ST. 10014P or cal occupancy
❑ Six or more a tesxlentud units ❑ Recreational vehicle parks.
City /State/ZIP:TIGARD, OR 97223 9%4 I ❑ Hcalth•care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal.
Suite/bldg. /apt. no.BLDG 4 \ Project name: WALNUT COURT APTS. ❑Service or feeder 600 amps ormac.
FEE SCHEDULE •
Cross street/directions to job site: 15 -18 / Description I Qty. ► Fee. I Total I •
New residential single- or multifamily dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 l
Limited energy, residential 75.00 2 • . ' DESCRIPTION OF - WORK , , (with above sq. ft.)
Limited energy, multi - family 7500 2
INSTALL FIBER OPTICS FOR VERIZON residential (with above sq. ft.)
Services or feeders installation and/or relocation
200 amps or less 80.30 2
'••, ❑',PROPERTY- OWNER - • - . ‘' 'I -'.. `. • ❑ • 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: A. Fee for branch circuits with
' ' . . . ❑ APPLICANT .. ' • : 1 ' - ' o 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,
Contact name; MONET VIVEROS first branch circuit 46.85 2
Address: 11818 SE MILL PLAIN BLVD. STE 410 Each add'l branchcitcuil 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP:VAN000VER, WA 98684 Each manufactured or modular 9090 2
dwelling, service and/or feeder
Phone: (360) 254 -6920 Fax :: ( ) 1-866-530-4325 Reconnect only 66.85 2
E -mail: mviveros@northskycomm.com Pump or irrigation circle 53.40 2
. . . , • .. ., ,• CONTRACTOR .. : . • ' • ' , , . Sign or outline lighting 53.40 2
Business name: NORTH SKY COMMUNICATIONS, INC. energy panel,(a)ertion,or
r energy pone /, alteration, or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Paget $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
oon on per hour (l hr min) 62.50
CCB Lic.:14117 Electrical Lic.17- 154CLE Suprv. Lic.: 173LEB Industrial plant per hour 73.75
• ELECTRICAL :PERMIT FEES' - ' '
Suprv. Electrician signature, required: � Subtotal: $75.00 i ta
Print name: JACK CAGLE Date: 1/23/08 Plan review (25% of permit fee):
State surcharge (12% of permit fee): $9.00
Auchonzed sig, TOTAL PERMIT FEE: $84.00
This p ermit application expires If a permit is not obtained within 180
Printnatne: A. MIKULIC Date: 1/23/08 days after It has been accepted as complele.
• Number of inspections allowed per permit.
I Vnmldingi PermasSELC•Perm 05/11/06 440.46151111 /05 /COMAVEI
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR201) 13-00020
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1r2412008 Phone: (503) 639- 4171i�
Inspection Requests (24 Hrs.): (503) 639 -4175 s' W ^_
INSPECTION WORKSHEET FOR DATE: 2/1/2008 TIME: 7 :02AM PAGE: 68
SITE ADDRESS: 09961 SW WALNUT ST 15 CLASS OF WORK:
SUBDIVISION: WALNUT COURT APARTMENTS LOT #: 007 TYPE OF USE:
PROJECT NAME: WALNUT CREEK APTS
DESCRIPTION: Units 15-10 Fiber optics for Verizon.
OWNER: BLINE, RONALD G +, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360 -254 -6920
Inspection Request Scheduled For: Date: 2/1/2000 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 064332 -02 971-563-9326 N
Corrections /Comments /Instructions:
. V1A' \
i
n PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ( � N � Date: Zi Phone #: (503) 718-