Permit '` w ELECTRICAL RESTRICTED ENERGY PERMIT
' CITY OF TIGARD
wri r
71
a ,?k. COMMUNITY DEVELOPMENT Permit ft: ELR2009-00308
«gay ,t c xr 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
v i Date Issued: 10/02/2009
T GAR'D Parcel: 1S134BC00403
Jurisdiction: Tigard
Site address: 12505 SW NORTH DAKOTA ST 801
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 1 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 OA 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2466 6699 or 1.800.332.2344. (')
Issued By: Permittee Signature: �-,/ \ S] � EEJ
OWNER INSTALLATION ONLY '` \\ 11
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.
. ...■.
EIectrical Permit A 111icaRt 1 YED : : ' - 7 ' IFUMOiFICJ USE ONLY : • ::•"` ,',•."
City oi Ord � Ruch
Permit No.: Q f
y 9J t Dace /0y: .
Cltf T Z
131 -5 sw Kai Blvd., Tigard, OR. !02¢3 I O 1 4 0 09 Hon Ituvic,v ` `�"` � Q. CO
_ �' Phun 503.619.4171 I;Ix: 503.598. OmclOr OdicrPenulc
TIGARD inspe.:lion Liao: 503.639 1175 CITY OF TIGARD ((early/By: J "u'' O'tic ((early/By: Sec Pogo t for
Internet: www•rlgard- ur.sov Notified /Menod: `t I 1 ® Supplcrncnlnl tnfm•ntailon
❑ New consttttebon Q Addition /alteration /replacement Picric check ;ill ilia( :unify (suhmil 2 sets n( plan: w /ircrosvhccl:cd 9clo\vy:
0 Service or feeder 4011 amps to mow 01101(10v aver limn sroacx,
[] Demolition ❑ Other:
where nu hvailahlc I'xuh cuncm ❑ M and No/yards,
:'. ;:. ;, CA'(F:CORY•or CONS'IKUC'1'tUN ; . .... ' '::;:''.:: atacedr 10,000 amps :11 ISO (0 r ❑ rimilny buihnuyi.
len to ground. or exceeds 14.000 ❑ Cun nyricunural
❑ 1 - and 2- Faintly dwelling ❑ Commercial /industrinl 0 Accessory building mops for all oifcrhlautihniu,n. buildings,
I] Multi - family ❑ Muster builder ❑ Other: a 000 p cj 1.,.\:Jl110 0,, r(70 kvA or
• „• a Emergencysy$COM. loo r scpnaac:yderivediyslc,u,
' " " .. -J01I SITE INFORMATION AND LOCATION •?• '• •
..---- -..-.- ..- ❑ N
Additinu of new mannad of 0 "q•' •'p;' ••14! ", .•1•t"
Jobno.: Job sitenddress: 12505 SW NORTH DAKOTA loorlp or mOte. occupancy.
0 Six nr Mott /evidential uniN, t0 ltcen:oianal vehicle ',ado:.
Ciry/Stale/ZIP: TIGARD, OR 97223 17 Hcahh•r.nc facilities. 0 Supply voilgc for more Wu
0 Nxvaoloua tucndunv. 600 volts raroinul.
Suite /bldg. /nit. no, 801 -816 I Project name: MEADOW CREEK °Service or (ender 600 l of io,re.
.' ,.... - : J '- . FCL'SCIICDULR •
Cross street /directions to job site: nnsanu.,n 1 01r. 1 um 1 'Baal 1
New residential single. or n u ld.femlly dwelling null.
fuciudus attached gar mute
Subdivision: Lot no.: (.000 so, 0, or less 145.15 4
•-' 1 Ea. add'f 50U sq. 1ition 33.40 w i
Tax mop /parcel no.: . or portion
1,,i ante(' coorgy, resitlwuia( 75.00 ?
DCSCRIIvrION OP WORK (with::hom sq. l't.)
INSTALL FIBER OPTICS FOR VERIZON
Limited cnoryy,muhblu'nlly 75.00 '
residcnlial (with Any.% Al. 0.)
Service,' or feeders installation ulrorntfon, nnd/nr veraeuton
200 emir or less NM 80.30 MI 2
10 PROP) R•1'Y'UWNF,R "I :.. .. ' 0' Ti'ENANT " ” , 201 wow; it, 400 amps 106.85 MI 2
Name: 401 amps to 600 nm m 1 160.60 2
- ----' 601 mops to 1,000 unyn 240.60 2
Address: Over 1,000 amps or volts 454.65 _ 2
City/State/ZIP: 'rompurery services or feeders Installation, attention, and /or
relocation
Phone: ( ) Fox: ( ) 200 anq>s or less 66.85 1
Owner installation: This installation is being «lade on property that I own which is not 201 amps to 400 amps 100.311 2
intended for sate, lease, reel, ur exchange, according w ORS 447, 449, 670, and 701. 401 ; to 599 Mops 133.75 '!
Brunch circuits - new,nitcratto«, , perp«nel
Owner signnturc:_ __- _..-______Date:
A. Foe for brooch circui If writ,
'' . . 0 APPLICANT Ca•CONTACr PERSON above service or feeder ego,
6.65 2
each branch circuit
ansirrrss nu mu: NORTH SKY COMMUNICATIONS, INC, R. Feo tor brand) circuits -
E RIK SCHENCK niUlorrr service w !'ccdcr fee, 4685
Contact name: hest branch circuit 2
Addres 11818 SE MILL PLAIN BLVD STE, 410 8achndd•l brunch ciicui —� 6.65 2
tvtiscella«eous (service or Feeder not included) -
City(S1late/Z1P: VANCOUVER, WA 98684 6.Jch Inunui:rcatrcd or modular '
dwelline, S el'vice mnator (ceder 90.90 2
Phone: (503 ) 969 -7729 I Fax:: (866 )452_4853 Rcconuccl only 66.85 2
E-mail: mduojenorthskycomm,corn Pump orinieotionci,clu 53,40 2
CON'1'RACfOR Sign or outline fighting 53.40 2
Businogo name: NORTH SKY COMMUNICATIONS, INC, energy cireui alt er smitcd-
r cncrgy panel, akor;dian, or
Address: 11818 SE MiLL PLAIN BLVD. STE 410 extension. Describe: 1 Page 2 $75.00 2
City/State /ZIP: VANCOUVER WA 98684 Each additional lioopctionoiei'aItoovou!olo (0 in oldie above •
Phone: ( 360) 254-6920 t Fnx: ( ) 1-866-530-4325 Per inspection 62.50 MI
bwosfig«dot)lcrhour(I hr mi n 3 1111i®
CCB Lie.: 14117 Electrical L10.17-15401_ Suprv. Lic.: 173LEB industrial plant per hour �i ® �
� 1 LCCTlt1CAl, PERMIT FEES
Suprv. Elcctricien signntcue, required: Subtotal: - 35 - 0 t . 8(4,
Print mane: JACK CAGLE Date: 1 0/01 /09 Phut review (25o /e of Permit roe):
Slate surcharge (12% orperunit fee): Y� �b 8 ` (_(
Authorized signalure /� / /f o
TOTAL Pf10/WI f FEE: swcr
Thh poendt upp3fcntluo OapINY if a penult is not oblnined ufiltln 180 5 - l o
Printnamc: ETHAN A. DOLPH Dote: 10/01 /09 day afterItWmbeMrnvevororl ler,
° Nuolbcr ufitmperllun, allowed (KT NOME
I: \Danuia0Pera 0■2,808 .Jn4161S'r 1058COM/WGII