Permit r" , CITY OF TIGAIRD ELECTRICAL RESTRICTED ENERGY PERMIT
iti 1,1
a :' COMMUNITY DEVELOPMENT Permit #: ELR2009-00301
nTrfil Q 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/02/2009
;1.:44 m',r' 'S,g*i;; Parcel: 1 S 134 BC00403
Jurisdiction: Tigard
Site address: 12505 SW NORTH DAKOTA ST 101
Subdivision: Lot: 0
Project: Meadow Creek
Project Description: Install fiber optics for Verizon.
Owner: FEES
BEL -EQR III LIMITED PARTNERSHIP Description Date Amount
BY EQR -REAL ESTATE DEPT, PO BOX 87407 Restricted Energy Permit 10/02/2009 $67.84
CHICAGO, IL 60680 12% State Surcharge - Electrical 10/02/2009 $8.14
PHONE:
Contractor:
NORTH SKY COMMUNICATIONS INC
11818 SE MILL PLAIN BLVD, SUITE 410
VANCOUVER, WA 98687
PHONE: 360 - 254 -6920
FAX: 1- 866 - 530 -4325
Type of Use: MF
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: y Fire Alarm: N
HVAC: N Instrumentation: N Total $75.98
Intercom /Paging: N Landscape /Irrigation: N
Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, Stale of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the 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 a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
P
Issued By: - (�� �, X l j' 4 1 �j ).'9A,C) Permittee Signature:
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' - ' Q y ` �1- ` 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.
RECEIVED
Electrical Permit AimNegl ih 01 7(?('- .. >ro>Ei;prytCE USE ONLY .,.. : : :.•. .: .;; :. :
City 'Tigard / �� Penns, No.: • P2c2c. .. 0 i • y 13125 SW W Hall Blvd., Tf ,4C. fcjtltl9OF TIGARD
II , ' Phone: 503.639.4171 11IVIS S 0aterl'erook
TIGARD Inspection Line: 503. Om:: Ready illy: fa See Page E for
Internet: www.tigaal or.gnv NwlficdrMothud: 111M Suppicntcnlnl [orona:Won
❑ New conslttletion 0 Addition /alteration /replacement pl ease chcck :43 Satanttopty(subutil3 :as . nstvii1cotscltcckcil5cluw):
0 savlcc o? render 400 :tutpr or mom p gunning aver 100 x10,300.
Q DC.t1,011tiOt Q Other:
where no ay.lil.,hle 0 Marinas4n1 hn :nyanIs,
CATEC.ORY -01? L'UNS1'IOUCTION, ; '. exceeds 10,000 moos at (50 ttt(tx to ❑ Pluming bu(IdingO-
Suit to drotnnJ. ur month 00,0110 ❑ Cunuerchl-ueo 0ydctiiimi
❑ I - and 2- tautly dwelling ❑ C0minercial /incingtfial ❑ Accessory building mops I'urntl alter inslnllmiuns. buildings.
Q Multi-family ❑ Master builder ❑ Other: : ❑ Pitt pimp. a (ngannlicn of 75 KVA m
'JOB SITE IN1UR11AT10N AND LOCATION ❑Emcrgatcysyslot ». largersepartelyattired1.y . lem.
. QAd mini ns C2 "A", •'1S' "11" "1•3"
Job no.: 7 Joh site address: 12505 SW NORTH DAKOTA IuuHp nt.tnp. "nay.
❑, - Six W I N (C6110461 Oak, ❑ Inc el'alitnLtl vtilide p:Ift(r.
Cily/State /ZIP: TIGARD, OR 97223 C2Hcallh'c:,le ❑ Supply vott::de for mom titan
- 0 Ho,zol u0 lucuti000. MO 00110 Iwminnl.
Suite /bldg. /apt, no. 101 -116 Project mune: MEADOW CREEK ❑ SerVic0 feeder 600 ramps or more.
Cross sh'CCIldirCClipn.4lo job site: . ' ` PEE'SCHEDUI,E i .
i)
- A > ,i Lm 1 Qtr, 1 ho. I . 0.1..1 ] t ......
New residential single. or m ply duelling unit.
Istchalus attached garage.
Subdivision: Lot no.: 1.000 sq. 11. or less 145.15 ...-_- 4
Tnx nUtp /parcel no.: -'- La• add'I 500 sq. ti. or portion 3140 1
!,unite( ridgy, rcsidcotiat
75.00 ?
DESCRIPTION OF WORK (w ,liloiocoq.li.)
INSTALL FIBER OPTICS FOR VERIZON L't " " °`I ° °rsy "' °'`' `` °I "(y 75.00 ,
residential (with Mitre ■tt, (1.)
Services or seeders installation, alteration, and/or rclucntfon
✓ 200 amps or less 80.30
'❑ PROPER'i•Y . ❑' TENANT ' amps lo a 1o400 +m,ps -+ 106.85 2
Name: oatps 10 600 omits 1 160.60 2
- 601 amps to 1,000 iinj» 240.60 1
Address: Over 1,000 mans or vnitx 454.65 2
City/State/ZIP: Tempo rary 8 en- feeders I oriel lotion, :iteralion, and /a'
relocation _
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner instullntlon: This installation is being made on properly that 1 own which is not 201 amps 10 400 wraps 100.30 2
i ntCndecl for sale, lenge, rent, or excl tu,gc, according to ORS 447, 449, 670, and 701. 401 naps to 599 amps ^ 13175 _ 3
Owner signature:
. _. _._. -. _ Dale: Rrunchclrcutls - uew.tpt rallon,urcxtcnslon , perpnncl
A. ('cc for broach circuits Irish
0 APPLICANT . .;1 ' . n CONTACT PERSON above service or feeder I'ee, 6.65 2 •
each brunch circuit
Rtivinoss ":one: NORTH SKY COMMUNICATIONS, INC. I3. Fee for brooch circuits
tviihour s ervice or feeder fee,
Contact (15010 ERIK SCHENCK 46.85 2
cast brunch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each ndd•1 branch circuit -_ 6.65 2 .
-- ivlisecllnncous (service or feeder not included)
City /Stale /ZIP; VANCOUVER, WA 98684 EJelt manufactured or modular '
(Smiling, .Service and /or (ceder 90.90
Phone: (503 ) 969 -7729 J Fax:: ( 866) 452 -4853 Reconnect only 66.85 2
E -mail: mduoj(7Q f10rthskyccmm. com Pump or inigaion circle 53.40 2
CON'1'RACr0R Sign or outline lighting 53.40 2,
Busincsti NORTH SKY COMMUNICATIONS, INC, en
SY Panel, :Monition, or
Address: 11818 SE MILL PLAIN BLVD. STE 410 cxtension. 1 Paget $75.00
City /Steno /ZIP: VANCOUVER Each additional Inspection over ullswnble In an of the above
WA�
Phone: ( 360) 254 -6920 I Fns: ( ) 1- 866- 530 -4325 Per ingpoaioo 62.50
fuvcxligulinn per hour(10rmin) 62.50
CCB Lie.: 14117 electrical Lic.17 -154CL sllply. Lic.: 173LEB Industrial phut imi. hour 73.75
. .' •ELfECTRICAL PERMIT FEES ... :...'.
Suprv. Clcclrician signature, required: Subrolal: . $7.401, (p7-
J ACK CAGLE D ate: 10/01 /09 P lan r eview 25r>f, of unit fee
Print name: ( pc : )
• Slate surcharge (12% of permit fee): G• 1 I-
Authorircd signature: 0,, TOTAL Ptinivll'r tail;: y @ +� j ' y � ��� 7 5 • Qt Cd
ETHAN DOL PH Loma 10/01 /0 This p or ndt uppHrnitun oxylrol If a vomit Is not olitn ¢d uttr situ ltl0 6 CJ
Print " A. dnyx tiller II has boon nccopled Av vumplete.
' Nomnixt 01'1114m:tluns altuwcn per math,
Im,.o lnE J'enu :telil,c.1' one Alin . 00 Ot0Ven 430..J(44''(( IlI.4'CO\IAY
6 vi V e._4" -P h 1 l 1 1 105