Permit ir
/-2,-
711 4 CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 -00022
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/24/2008
PARCEL: 2S102BD -01001
SITE ADDRESS: 09975 SW WALNUT ST 1 ZONING: R -12
SUBDIVISION: WALNUT COURT APARTMENTS LOT: 007 JURISDICTION: TIG
PROJECT: WALNUT CREEK APTS
Project Description: Units 1 -5. 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 I7- 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 que ' ns to 0 NC at 503.246 6699 or 1.800 332.2344.
Issued By 4 Vl All cam-- - Permittee Signature: n etioy24
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.
'11/23/2008 WED 11:10 FAX 2002/005
Electrical Permit Application Fold OFFICE USE ONLY
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City of Tigard FIEC i,1 c ic1 i 0, R Nom L. ,• _ A-
• 1312 SW Hull Blvd., Tigard, OR ir. t. an Rcvi ,,,,,
' D
11 Phone: 503.639.4171 Fax: 503.598.1960 3 y� DaDam/13 : Other Perm:
I' I < A It U Inspection Line: 503.639,4175 JAN 2 3 L U li d Date Ready /By: 1wis: Si See Page 2 for
Internet: www.tigard- or.gov
Nutlfled /Method: Supplemental lnformation
- V Qtr. • ,; • ..;. ; TYP,E.OF, s: �: • . • +f �t • ..: PLAN •REVIEW.- • . • • •
I I i .1 I NIStO� Please check all that apply (submit 2 sets of plans whims checked below)
❑ New construction GI Addition/alter t4
❑ Service or feeder 400 amps or more ❑ Building over dace stories
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
. ' C CONSTRUCTION . - . ,' . • _ , mews 10.0110 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14400 ❑ Commercial-use agricultural
❑ I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
5 Multi- family ❑ Master builder ❑ Other. ❑ Pim pump. ❑ Installation of 75 KVA or
❑ Etnergaey system. larger separately derived system.
„•••,• ..• JOB.SITE INFORMATION AND LOCATION , • ,. ' . ClAddri ion of new motor lead of 2"
Job no.: Job site address:9975 SW WALNUT ST. I00HP or loon. otxmpancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP:TIGARD, OR 97223 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.BLDG 1 Project name: WALNUT COURT APTS. ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street /directions to job site: #1 -5 Description I Qty. I r«. I Total 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'I 500 sq. ft. or portion 33.40 I
Tax snap /parcel no.:
Limited energy, residential 75.00 2 • DESCRIPTION OF WORK . ' . (wi above sq. A.)
Limited energy, multi- family 7500 2
INSTALL FIBER OPTICS FOR VERIZON residential (with above sq. n.)
Services or feeders Installatio alteration, and/or relocation
200 amps or less 80.30 2 • [I' PROPERTY'OWNE • . . ❑. 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 maps 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 APPLICANT ' .j .' ' .. r . CONTACT PERSON - . . above service or feeder fee, 6.65 2
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. B. Fee for branch circuits
Contact name: MONET VIVEROS firs tb rr un c h c i r urfeederfee, 46.85 2
first branch circuit
r
Address: 11818 SE MILL PLAIN BLVD. STE 410 Each add'I branch circuit 6.65 _ 2
Miscellaneous (service or feeder not included)
City /StatefZIP: WA 98684 Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: (360) 254 -6920 I Fax:: ( ) 1- 866 - 530 -4325 Reconnect only 66.85 2
E -mail: mviveros@northskycomm.com Pump or irrigation circle 53.40 2
.. - 5 ' .. .' . • . • CONTRACTOR I . . .. • '. - - Sign or outline lighting 53.40 2
Business name :NORTH SKY COMMUNICATIONS INC. eiergypanel,(a)er►i,d:d-
COMMUNICATIONS, energy panel, 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 i o n 62.50
Investigation per (tour (I in lain) 62.50
CCB Lie.: 14117 I Electrical Lic.17- 154CLE Suprv. Lie.: 173LEB Industrial plant per hour 73.75
. ELECTRICAL PERMIT FEES '
Suprv. Electrician signature, required: Subtotal: $75,00
Plan review (25% of permit fee):
Print name: JACK CAGLE Dale: 1/23/08 State surcharge (12% of permit fee): $9.00
Authorized TOTAL PERMIT FEE: $84.00
Print name: TERI A. MIKULIC Date: 1/23/08
This p ermit application expires if a permit is not obtained within 180
days after it has been accepted ascomplete.
• Number of Inspections allowed per permit.
I:tnuiidineermiuOELC-Pettttitnpp dot 03/23/06 440.46 IST1 11/OS/COM/weo
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: EI_R200B -00022
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 1/2412000
Phone: (503) 639 -4171 Il
Inspection Requests (24 Hrs.): (503) 639 -4175 �__..
INSPECTION WORKSHEET FOR DATE: 2/1/2008 TIME: 7 :02AM PAGE: 66
SITE ADDRESS: 09975 SW WALNUT ST 1 CLASS OF WORK:
SUBDIVISION: WALNUT COURT APARTMENTS LOT #: U07 TYPE OF USE:
PROJECT NAME: WALNUT CREEK APTS
DESCRIPTION: Units 1 -5. Fiber optics for Verizon.
OWNER: k3LINE, RONALD 0 +, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360 2E46920
Inspection Request Scheduled For: Date: 2/1/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 0&1332 -04 971- 563 -9326 Y
Corrections /Comments /Instructions:
‘- l0
VLPASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION' ❑ ADDITIONAL FEES ASSESSED
Inspector: Qr ' M6 Date: 2 - - ` ' " V Phone #: (503) 718 - 00.