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Permit k n CITY OF TIG�IR® ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit #: ELR2009 -00305 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/02/2009 TiGARD P.,4!. rv;tkovja,sl'i Parcel: 1 S 134 BC00403 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 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: 4i) 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 PermitAnnlicatto 01 2009 POR pFocE IISE ONLY. :.• ::.::._<:':. ' ' :.: ::.:., City of Tigard CITY OF TIGARD � Permit M1,•: • • Cog - OM 4)S r 1312s sw 1 ©1�a., Tigartl ( 72�j�KrG DIVISION Phetc: 503.659.4171 Paz:7�j�J4T 1 odterPermit: TIGARD inspection Line: 503.0324175 Daio Rcat / 171 Sce rage 2 fo rntemct: wwtviiSa,d- or.8nv t4uIifred:MClhutl: In, Supplemo,nnl (nformnnun 0 TYN or WORK P1,AN REVILrw NewConsmo0liun QAddition /alteration /replacement f(casc dwck:11 not slyly (14 11113 sou or plans w /items checkedlclow): 0 Q SCr Ice or fccrlcr 4(38 motto nwrc ❑ finlSning over 'lice 010 t_t UG0101itiOn 0 Other: wisest the A:anahle f:,olt eunrcul Cl Murirus an•.I boatyards. CA fl( ORY or CONSII(3IJCIION .. oxttcds10,000 amps :it 150svtwu1 0 floating ,uildingi. i Ic,c to gr°uiN, or cxe4c4414,0(10 Q Conuuorcfal•uso agmcuhurnl 0 I- and 2- fancily dwelling ❑ Commercial /industrial ❑ Accessory building I mops fur All other iustnitntimn. buildings, 0 Multi • fancily ❑ Master builder ❑ Other: Omit p10(, 0 ln 4,110 ion of 75 KVA or (]Cn>crgeo4ysystont or largorseparuclydertvedsyamn .JOB SITE• INFORMATION AND LOCATION • . r ..,._ ... (]Additinu nl new mo 1,,,,I n ( ❑ "A" •, { ;• "1.2" •'I, �'. Job no.: Job site address: 12505 SW NORTH DAKOTA lomp of!Wm. ,w<npunky. - a Six or more resxlemi:d wort, 0 Itecrowiunal vchicio oar:% City/State/ZIP: TIGARD, OR 97223 0 lira IihcmC r,aciflh1». 0 supply •011g0 1 1 00,C 6,0 liaraal sio location. (00 volts nominal. Suite /bldg• /a(u, no, 501 -516 I Project name: MEADOW CREEK 0 Scrvico,n lotto-030 limps ornwro. .:.•`.,. ' ..:.• .FEE 'SCHEDULE Cross street/directions (0 job site: n. e..•dtunm ..1.-9.11:-.1- rrr• 1 _n ^nn_ -. "_ New residential single- or mulll•family dwelling unit, Includes attached gatago, Subdivision: Lot no.: 1.000 so. 11, or loss ' 145.15 4 - -1 Ga. ackl'I 500 sq. It. or portion 33. 1 Tax map/parcel un.: Limited energy, lositlunlinl DESCRIPTION OE WORK • (wan anovc m.11.) 75.00 2 INSTALL FIBER OPTICS FOR VERIZON ; Limi "`` cnorgy. "roll•) miIy 7s.00 2 ' revidcntcli (with olwve oasis.) Servkes or reodcrs inalnllntlon,Ulterallon, and/or rolocutlnn 2001nps or less 80.30 2 • `© PROPERTY 'OWNER . '.c TItNAN'f • ••••''• . 201 811114 lo40011/110 _ 106.85 2 • Name: 401 amps to 600 Hops 160.60 2 -- _.—. -- 601 + to 10)0 amps 240.60 2 Addross: Over 1.000 amps or vnits 454.65 2 City /State /ZIP: Temporary services or ("ceders Installation, alteration, and /Or relocation Phone: ( ) Fax: ( ) 200 amps or }too ' 66.85 1 Owner instullatton: This installation is being made on properly that I own which is not 201 'mi9s to 400 amps 100.30 2 intended for 3alc, lease, rant, or exchange, according to ORS 447, 449, 670. and 701. 401 amps 10 599 amps 133.75 I 2 Branch el real Is - new, tdtersitiou, or mossiest, per panel ' Owner Yignnturc_ �.Y, .__ "_•Dale: A. I:co for brooch ei'' 4 /, 0 APPLICANT . '0 CONTACT PERSON above service or feeder (Co, 6.65 2 each branch circuit flusinessmune: NORTH SKY COMMUNICATIONS, INC, D. Fee for branchehettns - Conmet Warne: without service or 1'ecttcr tee ERIK SCHENCK 46.85 2 _____ tits' brunch circuit Address: 11818 SE MILL PLAIN BLVD STE. 410 Each ndd' branch cites! it 6.65 2 Miscellaneous (service or feeder not included) City/Slate/ZIP: VANCOUVER, WA 98684 Each monufactnred or modular dwollioil, sorrier nod /or !ceder 90'90 2 Phone: (503 ) 969 -7729 I Fax:: ( 866 ) 452 -4853 Recanted only 66.65 2 G .1112 i 1 : mduarenorthskycomm, com Plump or i•igntiun circto - 53,40 2 • ' •• CON'T'RACTOR ' • • ' ' • Sign or 01161011(3111109 53.40 2 • Business name: NORTH SKY COMMUNICATIONS, INC. Signal De a> nr lir n i . r or energy panel, alteration, or Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Page 2 $75.00 2 City /Stato/ZIP: VANCOUVER WA 98684 Erich additionotluspection over al lownhioIn any of(heabove Phone: ( 360) 254 -6920 d Fax: ( ) 1 -866- 530 -4325 In v ins 62.50 rvcstigntiroltterhourp 62,50 CCB Lie.; 14117 Electrical Lic.47_154CL Stgnv, Lie.: 173LEB Induxlrial plant per hour 7 .•• • • • ELUCTRICA1. PERMIT PETS . , r Suprv. I lcctric €nn signature, « gtlirc(I: Subtutol: $ ' 1 -{ ( Print name: JACK CAGLE Dato: Platt revi (2594, of permit fee): 1 0/01 /0 a permit - 1 State surcharge (12% °f 'rani' fee): 0 8. 1 Aatltgfl %Cd signature: Ga/ � ., TOTAL PERMIT 11111: Itr: $64-O ? S. q [� C� Print n01710 Dntc: 10/01 /09 '1'b vomit u pp lh• n n un osplras (f a pvrma Ix not obtnhocil ulthln 180 ETHAN A. bQL PH soya after u bat: area ncewla•,, nr cvtultek•. Numin:r of (I p eeIluns allowed pre pcn nll. I,• \Onll,l8 4' ,mil4l ;I,C•'snail aps.dnc 0'043 ,03 s10- 441S1't1 1m.VCOatnvsin