Permit �; ELECTRICAL RESTRICTED ENERGY PERMIT
� CITY OF TIGARD
�.
f' >- =� l: ' �: COMMUNITY DEVELOPMENT Permit #: ELR2009-00307
T1c J 13125 SW H all Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/02/2009
vTE Parcel: 1S134BC00403
Jurisdiction: Tigard
Site address: 12505 SW NORTH DAKOTA ST 701
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 $75.98
Intercom /Paging: N Landscapellrrigation: N Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or 4 work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.66 � or � 11.800.332.2344.
Issued By: Permittee Signature: `- AIN
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
CaII 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
RECEIVED
OCT 01 7009
Electrical Permit Applica q `:: TORO JC1. USEONLY :...:, ;...... ;?,:.
;
r City 1l and ��I� ING DIVISION .,4. Pc a No.: , • e 4 A . 40 7
I S1 SW W Il 13011 Tigard• I t all R cc$aW
i Ph ww: 503.639.4171 Fax: 503.598.1960 Daleln : Oder Permit:
TIGARD In Line: 503,639.4175 °at ReadYiliY: 0 See Lnge 2 for
Income ,vww.tigard -ur.gov Notifirddeledn(I: SupplemcninlInrnrmatlon
TVPE nlr WORK ...
0 New construction �].+ Addition /alleruUOnlrelllaCement Nose c,0c0 (11 that opp)y (submit lieu aviator whlems checked :)ctow):
f, Savicc or /coder 409:m,pr m nor,: 0 aottake over ill{ vx 110aes.
❑ Dcm011t1011 0 Oilier: wlme dm;,vailahlc 0t41 corrcn1 is Mamas and Muuy.uds.
CAt (ORY•U(:CUNSi'itUC'i'IUN_ ; eaeecds 10.000 rvih';or 0 Rotolnll 6vi14 .s.
1- and2 I'aanil dwelling "`•" INS togroetul.ore.teceJr 4,0110 C)Couuncrclal- ure ag,knhnral
❑ y g ❑ Comnercinl /industriol ❑ Ac cessory building amps lundl otherinsn,llmiwn. Wilding.
O Multi- 6w1ily 0 Master builder ❑ abet : 06;te puny,. Q Ioa;dln(iwr of 2S KVA 0;
-. `;<: ''. lr' aEitlti cnt,y systosn. larerac alalcl dedve4 deal.
- JOB SI INFORMATION A ND LO a P y y
.. �: :�. - ❑ Addiaina of Jim mom/ load of I] " A " "L3 °,
Job no.: 1 Job Site address: 12505 SW NORTH DAKOTA 11i0Hp °fmom. toms 'racy
Q Six or nom residcn11:1f 1011), a 12CUNJlirnlal YCIIielc parks.
City /Stele/ZIP: TI GARD, OR 97223 0 Hcanh.c,ro fxcinuer. 0 8op> (y ,on ,se for owm l,ao
0 1 111061/0V. ( ions. 6001410 nominal.
Suitt: /bldg. /apt. no. 701 -716 ! Project name: MEADOW CREEK 1] Ser'L'o or feeder600 mops or mom.
Cross street/directions to job site: no,srt 41,0 IIMSUI1 •
Nov residential single. or 1nu1t1. family dwelling unit.
lachulus attached gar age.
Subdivision: Lot no.. 1.000 sq. 0. or 1059 145.15 4
Tax ram / ,reel 114.: " -- I b.(, add'1 500 so. 11. or poninn 33.40
P P Limited energy, residential 75.00 ?
DESCRIPTION OP %YORK (wail how sq. it)
INSTALL FIBER OPTICS FOR VERIZON Liunita(1energy, n " ° "'- I:1n11iiy 75.00 2 '
I'tsidcntial(win,,,N, so. a.)
Services or feeders installation alteration, and/or nclocatinn
200 amps or less 80.30 2
' D PROPF:R'1'Y:'OWNER •.. '.Q TENANT • - ' 201 6411p410400nmps 106.85 2
Name; 401 maps to 600 amps ! 160.00 2
001 amps w 1,000 amps 240.60 2
Addres Over 1,000 amps or volts 454.65 2
City1S(atel7..1 P: Tumpnrary ser vices or feeders Installation, idler; don, and/or
relocation
Phone: ( ) Fox: ( ) 200 amps or less 66.85 I
Owner fnstut(ntfon: This installation is being made on property that I own which is not 2201 temps to 400 11101)0 100.30 2
intended for sale, lease, rent, or exch according to ORS 447, 449, 670, dad 701. 401 amps to 599 amps 133.75 _ 2
Owner signature: Date: liruneh ch•cnlls - nets. alteration, or extension, per panel
- - A. Foe for branch circa, n milt
EJ APPLICANT ' i ' • ' • ISVCONTACT PERSON . above service or feeder fco, 6.65 2 •
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC, 8. Fox for branchciouits
Contnctaau'o' ERIK SCHENCK nrilhour service or feeder No, 4(,,85 2
lint branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 h:tchadrl'I branch circuit 6.65
Miscellaneous (service or feeder not it eluded)
City /Statc(ZIP: VANCOUVER, WA 98684 Gach mundfacuaed 00100411160
Phone: (503 ) 969-7729 Pax: ; { 866 > dwellin -n., service and /o1' feeder 9u.90 2
452 -4853 Reconnect only 66.85 2
email: mdUOr'tC�northskycomm.Qom Pomp on :ridalloucircta 53.40 2
CON'I'RA(TOR • ' Sign or outline fighting 5140 - 2
Businass "me NORTH SKY COMMUNICATIONS, INC, e pa alt er 1110 lied-
or
energy panel, altardian, or
Address: 11818 SE MILL PLAIN BLVD. STE 410 e0I000ion. Describe: 1 Page 2 $75.00 2
City/State/ZIP: VANCOUVER, WA 98684 Each urldllional Inspection over aItmvnhIoin any of the above '
Phone: ( 360) 254 -6920 Fax: ( ) 1- 866 - 530 -4325 1 inrpcc 62.50
uvcsaigntinnllerh0urp Or min) 62.50
CCB Lie.: 14117 13 lcarical L Suprv, Lie.: 173LEB industrial plant per hour 73.75
' - ELECTRICAL. PERMIT PEPS ' •• 'f
Suprv. Electrician signnture, required: 4 0 Subtotal: $z5 > e p 1 . E3 4
Pries name; JACK CAGLE Date: 10/01/09 Plan 000(050 (2541' of permit fen):
/ State surcharge (1296 of pennit fee): $ g - 14_
Authorized signature: A .... ' ! TOTAL Pf•-RIvlI'f Pali: $8.446 S - 5j f,
Print nnlnc: Dour 10/01/09 'fits 'throat uopliennun (spiv / if a twain Is not obtained Mime 180 Zj
ETHAN A. DOLP tinya after 1( fax In. 0ccelacd Alf w■111,1,
0 Nulolxr ul'bupcetuni allwvcdd 04:r mooli.
190 „Ildlnsu'enohgl?6C•Rkrmanpp•doe 0: /31/06 1 40 461ST° nn1.4•f;u0Vo1111