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Permit M r CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT r; i $ " COMMUNITY DEVELOPMENT Permit #: ELR2009 00303 rW, . Date Issued: 10/02/2009 !Th ais. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 V7ViLli4.141 Parcel: 1 S134BC00403 Jurisdiction: Tigard Site address: 12505 SW NORTH DAKOTA ST 301 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 567.84 CHICAGO, IL 60680 12% State Surcharge - Electrical 10/02/2009 58.14 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, 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 ( AR 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. Issued By: 4 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' 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 A )Iicatlon . ., - .'._..:.: FOrt OFFICE USE ONLY • ..: ;,.:... :. ..'::': `. 0 City of'figartl 1 200 j Ycnni+No•: • 6 O ? Z 6 C 13125 SW Hatt Blvd., Tigard, OR 97223 / 3 1 : Phone: 503.639,4171 Fa xgry. OF TIGARD ESSIIIIIIIIIIIIIIIII Other P mlli; TI GA RD InspeetionLine.: 503.639.41 IrateReady /11y; 0 See Page Zfor Interlat: www,tignrd- or.SUILDING DIVISION NulfadlMedmd: En Supplemenlni Information TYPE OF WORK rt ,AN Rrvicw 0 New construction el Addition /alteration/replacement Pica(c check : 'hit aptly (suharh2 sou nfpfnn Alitcwsclu•t•keti :)Ctuw): 0 Scrvlce of feeder , 103 earns er me 0 Oonfili g avccg∎No. lo. lcs. Uc:In0lin0n ©Other: whom do avaitable IituII CnirClll 0 Mi onus and hnmy,rds. • . ... _ CA'EI:GORY OF.CONS•1'RUC'I'ION n: .. .. . meet!. 10,000 amps :n 150 v°11s nr 0 Plualinit buil4iogs, to" to ground, yr exceeds 14,040 0Cumo trvLd• agdenlnnal ❑ 1- and 24amily dwelling ❑ Commercial /industrial 0 Accessory building amps turn11 other iucnuhrio n. building,. O Multi-family ❑ Master builder 0 Other: 01'itn wino. 0 fna: of 75 KVA m . '• JOB SITE IN1'ORNIATION AND LOCATION DG :yawn. guscpmlct .. � .. � 0 Addilimn n new motor ln:nl of [] " "1 " >' a "13 ^ l,3 "'Id systc,n, Job no.: Job site nddress: 12505 SW NORTH DAKOTA 11i0Hf'u ' " set ° 0Si nr MOM rciit units. ❑ ltcucmioonl vchictc i :irkv. City/State/ZIP: TI GARD, OR 97223 0 Hnoth.c:' n fac14lien. 0 Supply vnlo250 fns owe than - -.— 0 Haz l tut, tucaliuns. 600 vahs 11011141UL Suite/bldg./NM. no. 301 -316 Projcet name: MEADOW CREEK ❑ Servicolv fecdcrOM mans o pore. ` ' FEE •SCIILDUI.E ' Cross street/directions to job site: ,._ ue,crywnn 1 Q. 1 r•1r. 1 'lo of 1 • • - .._' - Now residential single. or nullti•famlty dwelling unit. Includes attached gatage. Subdivision: Lot no.: 1.000 sq. II. or less 145.15 . 4 Tnx gulp /parccl no.: Ea. add'i 500 sq. 11. of 'wino 33.40 t L. 0,140 cnargy. ■csulential 73.00 DESCRIPTION OF WORT( • (wit6,nal,.o o, .O.) INSTALL FIBER OPTICS FOR VERIZON Lilnitatl "'argy, "'al+t- I'a,11iy 75.00 2 residentiat (wins ntxero ap 4.) Services or feeders installation, ultcrntlnn, and/or t'elondlon ' 200 amps or text 80.30 2 _- -__- 0 PROPIR't'Y.'OWNER :,. : •. '0' TENANT •• 201 mops 10400amps 106.85 2 • Nanto: 401 amps to 600 nn1ns - 1 (60.60 2 601 amps to 1.000 amps 240.00 2 _l______ Address: Over 1,090 amps or volts .,_ �� 2 City /Slide /ZIP: TcolParnry 001 01400 or feetter_n Inslullnllen, alterctllon, 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 sate, lease, real, or excitant:, according to ORS 447, 449, 670, and 701. 401 : to 599 amps 133.75 2 pwnw signature:. _Date: _ Brunch circuits - new. alteration, or a (elision, per panel A. roe for branch circuits 1, i/6 :: ` ' © APPLICANT ' • • ' :. " ' ' "0 CONTACT PERSON above service or feeder fee, 665 2 each branch circuit Rosiness name: NORTH SKY COMMUNICATIONS, INC, B. Fee Nu: branch circuils Coucnct name: nohow service cx feeder fee, ERIK SCHENCK rust tn,inct, cheek 46.85 2 Address: 11818 SE MILL PLAIN BLVD STE. 410 Each add] branch citcllit 6.65 — 7.- - -""'• - -- -- Mioecllaueous (service or feeder net it City /S1ata /ZIP; VANCOUVER, WA 98684 Each Inanulacturcdormodular Prone: (503 3 969-7729 Fax: ; dwelling, service nnrllor feeder _� 9U.90 2 ( 866) 452-4853 Reconnect eas 66.95 2 E•nnail: mduora7anorthskycomm.com Pnn,pariir;gationcircle 53.40 2 CONTRACTOR Sign or outline Epilog 53.40 - 2 6u,ino'„110414; NORTH SKY COMMUNICATIONS, INC, energy po energy pa nel, alteration. or Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 page 2 $75.00 2 City /Stato /ZIP: VANCOUVER WA 98684 Each nlidilional Inspection over allow rite In any of the above Phone: ( 360) 254 -6920 Fox: ( ) 1-866-530-4325 Per inspection 62.50 tuvcsligulinn per boor(' hr milt) 62.St) CCB Lit:.: 14117 Ell uicai Lie .17 154CL S nprv. Lic.: 1 73LEB I ndustrial plant per hour 73.75 "_— • •ELE,C,TRICAI. PERMIT FEES Suprv. Ldlcclricinn signature, required: Subiutal: $7,r„ f .p Print 0044: JACK CAGLE Date: 10 /01/09 Pl review (25 %ofpermit fee): State surcharge (12% permit fee): §• i0 8 . I Authorized signature: 0. TOTAL PfiRMI'r 1'lE1i; , S .10 -75 - 9 S name: Print nnc: Date: 10/01 /09 '('1,4 vomit upplkollen ospin: :If a vomit is not obtnlnal within 180 E TH A N A. pOLPH days after 1I has been Itec pteil ay Complete. • Numb t of In t per pcnnh. l0 tlin;Wav4,a6:LC.I41oldpp,dne 030.N04 a.lo. «.tort In1.VCONIA i