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Permit CITY OF °�°����® ELECTRICAL RESTRICTED ENERGY PERMIT 4 B ': COMMUNITY DEVELOPMENT Permit #: ELR2009 -00304 A 13125 S H all Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/02/2009 T F G D Parcel: 1 S134BC00403 Jurisdiction: Tigard Site address: 12505 SW NORTH DAKOTA ST 401 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 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: Permittee Signature: Q OWNER INSTALLATION ONLY Y U The installation is being made on property I own which is not intended for sale, lease orrent. 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 Application 20 9 ... - ::: FCiiiot llCEIISEONLY.,.; `. ,.';;,`..`::. ` ?:,:i; ...t Cit of Ti and 97LT 0 1 ��� 7 J � 0•Li Y t; Ytr,pit Nn.: _ i 131 5 SW Hail IIlvd., Tigard, )F T1G D 11 Phone: S01639.4171 Fax: 5 OIh4,rYCrnnt: TIGARD fnspscI,0llLine; 503.639A17S DIVISION Oal.Reatly /l ?y: 815ce1Mge2ror Internet: www.dgard or.gnv BU1LDlNG NollfrcdIMcthnd; Supptemcmnllnformndon :..; ;.::. .: ' ' � 'TYPE nN WORK "' : ' •.' pI 0Neweonstem:lion 0 Addifion /alteration /replacement Plc. ucchock a llth:n;tpply(suhn,it;souor a.i:0/ 00 1:cokc,I clew): [� l3VInQlItlVlt Q Olhcr: OSc ,vlceorfeederJOa :mildormot4 00nlldingoverthlveslmk5. u'Itaro dto nv,tilahle I'xull enuosu Mn6uus aea hnatyeo14. CATEGORY •01' CONSTRUCTION, . '. ' ' ' - 7 171 cucnls I0,060;nip:a 150wdtcnr 0P Inaungouildinps. .,, 600 to 4(001). er 4X4,44)0 14,0(10 0 Cueunooelal•uso ae<ICelucal —[] 1 •and 2- family dwelling ©Comnlercinllindustrinl ❑Accessory building 0 (0l'urnil othcriesnmtnlulls. balding. 0 Multi- falnily 0 ? aster builder 0 Other: 0 Pitc phew I� h,.udlo4on of 75 %VA or JOB SITR INf.UR1.1A'fION AND LOCATION ❑8ntcrgm lary41 tpa,tncly d4rivc4 rys et . ... - ❑ Addition nl new motor lout n( 0 "�" "li" .• I.2 ^, •`I.3 ", Jobno,: Job site address: 12505 SW NORTH DAKOTA IWNLormolt. ocenp;mcy. 0 Six nr 11101e resa(enlial ulliK. 0 itecreuauntl vehicle parim City /State/ZIP: TIGARD, OR 97223 0 Hcnuh•c:nc r..cirtie:. 0 S y ,pl y .•nnaec for 0 01011(011 _.._ - -�_ 0 Haranleus lucutimu. G00 volt,. rmuinnl. Suite /bldg. /apt, no. 401.416 Project name: MEADOW CREEK toServicoolfecdcr000unmpsutmom. - •PEE'SCIIEDULE • ' Cross sheet /directions to job site: __ ._ ONcrl111en 1 0ivr frr. I 'rulnt I ' -_ New rositicntiul single• or mutll•faal ty dwelling t,uil. Includes nttnched gat age. Subdivision: Lot no.: L001) sq. 1). or less _ 145.15 - -�- Q --- 111,. add'I 50014, li, to portion - 33.40 Tax map /parcel n0,: L,imitcu cu416y, resid4ul Al DESCRIPTION Of WORK (with:detvc5,.11.1 75.00 II INSTALL FIBER OPTICS FOR VERIZON Litnit4<lcnolsy,mullt- ren'ily IN 75.00 me ' residential (withstb v.1,4. Services or feeders insiallnt(on�uttern(Inn. rn )for reldent(nn t 200 amps nr Icss 80.30 2 ''0 PROPI:R'I'Y'OWNER .'I :, ..'CO'TINANT '` . 201atupsto400amps 106.85 7 Name; 401 Amps to 600 amps 160.60 2 -- 601 no1pK l,0(10 :unps 240.60 2 Atldress: Over I ,000 maps or vnhs 454.65 2 City /St110 /7..1P: 'ruusp< wary. servicesor fee de rsInstallation,:lterniton,a,idi ,• relocation Phone: ( ) Fax: ( ) 200 amps Or Iesc (14,05 ' I Owner instultation: This instnlhttion is being made on property that I own which is n0( 201 anops to 400 Amps 100.30 2 intended for sutu, lonn0, runt, or excliuuge, according to ORS 447, 449, 6670, and 701. 401 mupa to 599 amps 133.75 2 Owner signature: _._._._ __-. .Datc: _ (crunch circuits- new, Idlera(1oit, ur exlenslen, er noel - � A. I +cc for nlnnch circuils,ri /b • 0 APPLICANT ' ' • � ° O "CONTACP PERSON above service or (ceder l'ee, 6.65 2 each branch circuit Rusincss mete: NORTH SKY COMMUNICATIONS, INC. 1L ccl'orbrancheircuits _._ n lhooI service w feeder fc4. Contact nalnc: ERIK SCHENCK _ 46.x5 2 — lir >t 101.01 h circuit Address: 11818 SE MILL PLAIN BLVD STE. 410 Hach add'I bench circuit _ 6.65 2 Ntisccllaneous (service or feeder not included) City/Slntc /ZIP: VANCOUVER WA 98684 Gac1, nlunut ;tctttrcd or modulur 90.91) 2 dwatline, service neuter feealer Phone: (503 ) 969 -7729 I Fax:: ( 866 ) 452 -4853 Rccotalcct o nly 66.85 �� 8.111011: mduor . northskycomm.com Pump or itrigatiuncirc•ic 53.40 �0 CUN'fRA[rfOR • • . Sign or outline lighting 53.40 �� NORTH SKY COMMUNICATIONS INC, Stergypreel,(s)nrtia,lted l3uxinosx nattt0: , citerSY Punch altcrttiuu.Or Address: 11818 SE MILL PLAIN BLVD. STE 410 extension, 1 Paget $76.00 2 City/State/ZIP_ VANCOUVER WA 98684 860h nddllionallos .eclionoverallotableIn:n of the above Per inspection 62.50 �- Phone: ( 360) 254 -6920 Fax: ( ) 1 -866- 530 -4325 Snvcstigntion per hour(I hrminl 62.50 _ 1♦ CC& Lic.; 14117 J Electrical Lic.17 -154CL Suprv. Lic.: 173LE8 fndusuia1plantperhour 73,75 Rf.iCTRICAI. PKRMIT PEESS . , I Suprv, Clcctcicinn signntulc, Jtquitctl: Subuhsl: 1 L 7. 9 4 Prim natno: JACK CAGLE DaLo: 1 0 /01 /09 Pfutt review (25 %of permit fee): Sruc surcharge (1290 of pcnnil feu): •, A�jl . © 1 Authori'rcd signature: TOTAL ruxemrr rtiti; ' - e _ 7s. 9 8 s` .... 9'hts porndt uppllrntluu osrhvr Jf a purudt Is not ohtnbmA n5tb Itl0 Print nninCl ETHAN A,_DOLPH . -_� Dote: 10 !01 /09 llnyA after II has both acc'eltted AY complete. (401141x1 ul'luspcOduns,4lwred 1140 penult. 1:tOo lit ln4WCnultdliI,C•I64ied11p.,lnc 051'.W6 4411 46451'0 l /n,4C04Vw1(.0