Permit .
" RA- ° leCITY OF TIGAR®
ELECTRICAL RESTRICTED ENERGY PERMIT
'0: { q COMMUNITY DEVELOPMENT Permit #: ELR2009 -00302
�t �a
Date Issued: 10/02/2009
yT G1lR.D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S134BC00403
f ...4 pit?
Jurisdiction: Tigard
Site address: 12505 SW NORTH DAKOTA ST 201
Subdivision: Lot: 0
Project: Meadow Creek
Project Description: Install fiber optics for Verizon.
FEES
Owner:
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 $75.98
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
. days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 2- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: _(2.9 A PP -
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
RECEIVED
OCT 01 2009
Electrical Permit Applica$t t OFTIGARD : -. • FOR*OFFICE USE ONLY:' :.;',:'., :::.::.4.:, :
City of Tigard BUILDING DIVISION
13125 SW Hail Qlvd., Tigard, OR 97223
� : "� K �� Z
1111
r i ' • Phone 503.039.4171 151 503.598,196D plan Rcvloty
OmtclO Ot i'cnua:
f 1 GARD inspection line: 503.639 4175 0414 Rca &y /ny: LIZ cv l'ogc 2 for
Internet: wwtv,tignrd- or.gov Nudticd /Metbudr p rrtc°Int (nrornuulun
- :'— TYPE OF WORK';`::''' • ',:.. .. : ; • REVIEW. •; ••••:••••••:•• '.... . •
Q New construction 0Addition /alteration /replacetnent Pte: rsc chock : d, that apply (submit j>ett nrpt,.sv /c chc--kid'sdoav):
CI 0 setvtce oe (•edcr on annps Of nn>:e 00nlldiu over once A10
Demolition Q Others
where iho available I :te!I current 0 Ma nus and Aoatyards.
• CATEGORY or CONS'1'RU(.1'iON '.:..,..77
.,, .... exceeds ICON ,tnytc;g ISO sr >Iis°( f3 Floating b 11,11114.
iwt to Orlon&, or Moods 14.0(0 0 Coa°ncrclabuto +gdculuval
LJ I- and 2- family dwelling U Commercial /industrial Q Accessory building morn I0r,d1 o4,crintaaaiols. building.
CIMulti•fnn7ily ❑ Master builder QOther: C) pinepn4.. 0 hloantni oil of75KVAm
0 Cmcrgcu'mom. cy 'mom. larger anparatcly dotivcd ayitonl.
'''' . , ' .. '. S1TF.•INFORMATION AND LOCATION `
' , . .. ❑Addition nl utw ntnmrintl of [1 "A" "G •'I•T' •'I•Y`
Job no.: Job site address: 12505 SW NORTH DAKOTA )uorlP or mote rwurpnrn:y.
0 Sit or more residontial °,tilt. 0 Reercmivaal vehicle parks,
City /State /ZIP: TIGARD, OR 97223 a Hcalth.co.c facilitici. 0SIIlplyvolu:cc for u,orcd,an
0 Ha'tatduns lucolions. 600 voION nominal.
Suite /bldg. /apt. no. 201 -216 Project name: MEADOW CREEK ❑ scrvico or fccdcr 600 woos of maim.
..RI:E'SCIIEDULE •
Cross xtt'CCUdirectltlns (0 job site: V - - 0ocrlotlon ) Q. 1 I'o. 1 'n,hd 1 • '
New residential single- or nndd•farnily dwelling u
Includes attached garage,
Subdivision: 1 Lot no.: 1.000 sq. ft. or loss 145.15 4
La. ddd'l 500 sq. Ii. or portion 33.40 I
Tax 'nap/parcel no., Limited energy, resinential -
DESCPfI.ON OI'' WORI(' (will ,I,,vo',.11.1 75A0
RI
INSTALL FIBER OPTICS FOR VERIZON Liulitvdcna'gy,n,uld- r :11 „uy 75.00 2
PCti1t1L'll(lill ( \Yilll ilnll'r: Yl II .)
Se or less eders insinllati to Inn, }Oar relauttl ,
: r'...::• •0 PROpA:R'1'Y'OWNF,n .'' -
ono rat nn
:,. [] "FFNAN'f 201111111)1110400 MPS , 106.85
Nantes 401 amps to 600 nmps 1 160.60 2
001 amps to 1.000 amps 246.40 2
Address' Over 1,000 mains or lolls 454.63 - -� 2
City /State /ZIP: Temporary t:orvicou or foodurs Indullatlun, :Qtora lion, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 1111 66.85 all 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, rein. orezchnnge, according to ORS 447, 449, 670, and 701. 401 am 1c to 590 °inns IiiiiNaMIN a
Owner' signature: ��.....__, _ Date _ armlet, circuits — new, alteration, or extension, per panel
A. Fee for broach circuits' ndr7i
0 APPLICANT ' • '.. CONTACC PERSON • above service or feeder fco.
6.65 2
each brunch circuit
Rusiness name: NORTH SKY COMMUNICATIONS, INC, n. Fee ror brooch ciiei
,vfdlolr service or feeder (cc
46.85 2
Contact name: ERIK SCHENCK
lira! brunch circuit
Address: 11818 SE MILL PLAIN BLVD STE, 410 Each ad0'l branch citcoit 6.65
Miscellaneous (service or feeder not included)
City /State /ZIP: VANCOUVER, WA 98684 Each inonutachlredormodular
dw4linn. service nndlorfeeder 90'90 2
Phone,: (503 ) 969 -7729 I Fax:: ( 866) 452 -4853 Reconnect on ly 6685 2
E- mail: mduorenort skycomm,com Pomp or irrigationcicic 53.40 2
CON'CRA(TOR • • Sign or outline lighting 53.40 2
Sigunl circuit(s) or limited.
Business name; NORTH SKY COMMUNICATIONS, INC. energy panel, altcral ion. or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Paget $75.00 2
City /State/ZIP: VANCOUVER, ' W 98684 • Each atl dltionnlInspectionoven 'allownbloInan of the abo
' A Pot' tnspeet 02.50
Phone: ( 360) 254 -6920 Fax: ( ) 1- 866.530 -4325 lnvos(i per hour (Ihrmint 62.50
CCB Lic.: 14117 Electrical Lic.17 -154CL Stll)ly. Lie,.: 173LEB hlduslritnI plant per hour , 73.75
• • • •ELIi(71'RICAIa PERMIT RE1S • - • •••" •
Suprv. Electrician xlgnnattc, required: Subtotal: ' $ 1- ( / 4 c -7
, eq
Print name: JACK CAGLE Date: 10/01 /09 Phut review (2526 of permit fee): ���
State surcharge (1240 of per Q
permit fee): UO 8 • 14
Authorized signature: A. 0. TOTAL 1 P!!1: $r�' 7519 O
'1'h6, n o rm!! uppllcadun uxpltty 1r a ourrnh Is not obtMn Widdu 180 C7
Printnntnc: ETHAN A. DOLPH Date: 10 /01/09 d° yt offer H lop hem occenkal:.00n,1>lete.
Nutnixv ol'IulpccIon* allowed 1>4rpcnoa.
I: 10■d )1inya'cnu4,lp,C•P,•m,6App.ane 0403105 4a, 44151'(1 la(QCOt1AY1l11