Permit l
l� CITY OF TIGAR® ELECTRICAL RESTRICTED ENERGY PERMIT
n
• ` . -i a '' COMMUNITY DEVELOPMENT Permit #: ELR2009-00306
4'0 Date Issued: 10/02/2009
fT [CARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S134BC00403
Jurisdiction: Tigard
Site address: 12505 SW NORTH DAKOTA ST 501
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
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 wit
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: C Permittee Signature: \ p
►
_)
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 plicatig T 01 2009 .. • • ' : : . •
. . %.:, FOR; O USE ONLY. • : : .' .. `: •• ".
City of Tigard CITY OF TIGARD L '1 n,1 .
i r 131.5 SW Hall Diva" G; o � G DIVISION PI" D I "
(hone: 503.639.4171 OOd,cr Ncant!:
TIGARD fn s pueliou Line: 501.639.4175 l;ao Ready /13y: Mil la Ste Page 2 for
Intentcl: w■w.iigatd- or.gov Notified/Wilma: SupplentanInl tnfernmtlun
Q New WOsUUClion 1:1 Addition /alteration /replacement ultimo chock: 41 l hat apply (submit 2scw nfpihns w /itcwr .4, ked:x:kw):
0 Sc,vice or realer 403 ,mini or more ❑ !Wilding over th,ec fawns.
CI Demotilion _ Q Other: whe,0 dto availuhic 1411 cmtcal CI Harms and boatyards, • ;, : "....... '' CA'rEGORY•01'.CONS'1'LIUC'1'10N ''..r'•.::... '. :''.'...::. cacccds10,000amps ;a 150 fullsur 0 P,nwingbuildings.
Q I - and 2- S'mni)y dwellin Icu 50 yTQ4( , orexecedr 14,000 Q Coounarced•nro ngaculhtral
g QCommercinl /industrial 0 nmpr for all literh,slnunli„ns. buildings.
a] mum-enmit 0 Master builder 0 Other: 0 r•;,r ia,ny,. 0 1nn:dim:oa of 75 KVA or
? : > ,.; ., :r
' _ 0 Cmcrga,ey s)•x(o i. larger scpanueiy lensed yito
.. • •JOI) ' S ITE•INFORMATION AND LOCATION • :: :'•
... ❑ Addition ni new ma,sr lord of [J "A" Is "13 ", "1.3".
Job no.: Job site address: 12505 SW NORTH DAKOTA toOt+P or n0' 4. tn;anpuncy.
0 six an matt msidentiat uaiii. Q Rcenalianal vehic]t oaks,
City/State/ZIP: TIGARD, OR 97223 cl Hcahhamcrocn:,ier. 0 snl'pty , o , rs,ofo n,osc dtas,
0 Hn<a,dnus locution. 600 v.dls nuntinut.
Suite /bldg. /apt, no. 601-616 I Project name: MEADOW CREEK 0 SC( vico nrfccdcr600uwpsurmom.
-- --.. -. . :... .. c •. .. PEE 'SCHEDULE . .
Cross .s el /((irccIsoilti t0 job site: _ 3raedinhm 1 pis'. 1 N., 1 '0J14,._ New cesidcnt(ut single.. or 111u1t( -faintly dwelling utd1- i
Illchldua nitached gal:,gc. _
Subdivision: Lot no.: 1.000 sq. 0. or loss 145.15~ —. 4
Tux map/parcel sea: ; Ei. add'l 500 sq. It. or poninn 33.40 1
D6SCRIf ftON OF WORK Limited energy, residciuiai
(won:dx>ee sq, 13.) 75.00
INSTALL FIBER OPTICS FOR VERIZON t iIn11 r " " °Igy, "' °''`_" "oily
75.00 2 •
residential (wiat above %I. nJ
—
— Services or feeders inslnflntlon nnd/nr roldc,dlnn
200 alnps or Less 80.30 2
❑ PROPERTY 'OWNER - . 0 TENANT : 201 amp; to 400 amps 106.85 2
Name: 401 amps to 600 nny,s ! 160.60 2
•-- ._._.,_...... ' 601 now, to 1,000 Amps 240.60 2
Address: Over 1,000 amps or vnits 454.65 2
Ctly /Stoic /Z,IP: Temporary her V ic40or fccdera Inslallalfun, altar.,llon, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less MV 66.85 1
Owner installation: This installation is being 012(10 on properly that I own which is not 201 ampo Io 4001 "ups 100.30 2
intended for rule, lensc, rent, or exduutge, aecolding io ORS 447, 449, 670, and 701. 401 c to 599 antes 133.75 1
Owner signature: _- .__-__ __
brunch circuits - new. Idler :01o',or extension, per panel
A. 1 for brooch otroui is ;cid/
7-
0 APPLICANT r. ': -..; . . `•' [j ' CONTACT PERSON' hove scr vice. or feeder i'co, 6.65 2 •
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. D. Fee for branch circuits
Contact name: ERIK SCHENCK rimon /scrviee orFccdtrrec, 4685 2
i im branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 6achadd'I branch circuit I 6.65?
Misccilatteous (service or feeder not included)
Cty/Slnic /ZIP: VANCOUVER, WA 98684 Each rnunulacwrcd or modular I -
dival,ing, service and /or feeder 90.90 -
Phony: (503 ) 969 -7729 + t-ax:: ( 866 ) 452 -4853 Reconnect only 6685 2
L- mail: md ugretlorfhStSYCOmm-COm Pump or inignti on cirulc 53,40 2
CON'1'RACfOR "-- Sign or outline lighting 53.40
Signal circuit(s) a> ur son
Businoss name: NORTH SKY COMMUNICATIONS INC, or
energy panel, altcr;iliun, or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Page 2 $75.00 2
City /State/ZIP: VANCOUVER, WA 98684 Ench additional tuspectionover allowable, in Any of the a bove_
Per inspccitan 62.50
Phone: ( 3601 254 -6920 Fax:( ) 1-866-530-4325
hwcsligmiou )ter holy (i nr mine 63.St)
ccR sec.: 14117 Eletxrical Llc. 7- 154CL Suprv. Lie.: 173LEB industrial plait per hour 7335 -
•••• ELECTRICAL PERMIT t•EE ... ..
a
Suprv. Electrician signature, requital: �. .. Subtotal: $76 L7 8q
Print Iltn,3c: JACK CAGLE Date: 10/01/09 plan rayless (25% of permit (no): 1
_. .. -. State surchar (12% or• pcnnit feu): LQ,(ft� 8. ( 4
Authorized signature: �, 4 /-� // TOTAL PrOMI'r p $8.4„0.6 7 S . q 8
'+' portnit upplkauua 084104 lr a outwit Is not ob Mined tallith, 100
Prim nal�3t ETHAN A. pOl PH D ntc:1 0 /01 /09 ■Loss miler 111,:,. harm Accel A. “..1.1r1,•.
n N1.1011A:I of i,pcciluni idluwcd ptrpannit.
I0Ouh,fn44'cnnn alil,C•r,rm4 App.dac 092.003 rib 061540 ua000Mtnrilt