Permit * �, • CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
t
L a COMMUNITY DEVELOPMENT Permit #: ELR2009 -00310
"T Ia4 a1r Date Issued: 10/02/2009
kb 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1 S 134 BC00403
Jurisdiction: Tigard
Site address: 12505 SW NORTH DAKOTA ST 1001
Subdivision: Lot: 0
Project: Meadow Creek
Project Description: Install fiber optics for Verizon.
Owner: FEES
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: Av ' � J
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.
Electrical Permit ApjaclitEC EIVED ...„..,,,.:,,..„..,.. olrrtc> use ONLY
• City of Tigard n P enm i r N �
s 11. 1 :10
'
t 13125 SW Hall 131vd., Tigard, vRr1l12 In. 7 II Phone: 503.639.4171 tax; 503. )66Q 1 2 009 OlbcrYCrmil:
Inspection Lino: 501.639.4175 U:nu Roa nl
CIGARD Y y: fa See Page 2for
Internet CI T Y OF www.tignrtror.gov NusifredlhIchurl: Supplemcn(nllrfnrnwlor
IttirEftViesS DIVISION , PLAN REVIEW ';; ;.:. :: . •
0 New consuuction 0 Addition/alteration/replacement Pl (submit ;se+snl' plans Wei mnchn•Aed :>claw):
O Sollee or (coder 400 ;cups or more 0 Adding over um4 uo.leti.
CI DCIn01iool1 0 0II1Cr: whore 010 :Nailahlc fault cnrrcni 0 Miinius nod boatyards.
.. <. CATEGORY •or. CONSTRUCTION, ._ excecJx 10,00 amps ;1150 wslhnr 0 Phoning buildings.
Ictt to grown/. or c.tcccdt 14,0(x) 0 CumnscrVa4u4o agricultural
DI - and 2- !'amilydwelling ❑Conntercinl /industrial ❑ Accessory building mops for all airy insmltnciuns, buildings.
[Q tviulti- family ❑ iviawtor builder ❑ Other: 0 pi puny 0 to i:1166w of 75 KVA or
• ' ,JOB SITE • INCUR INFORMATION AND LOCATION 0 /114i11 sysimn. l scparotoly etcrived ■y,leni. • . 0 Addlinm a new motor load ar [) "A "'9' "1.1 "•'t•1
Job no.: Job site nd(lccss: 12505 SW NORTH DAKOTA wow or :xsro. ormsp:moy.
Q Si.c :r wore rctidcnliai unite. 1_)140: lional vehicle p rkv.
City /State /ZIP: TIGARD, OR 97223 011 o.lds•rno mdrtics, p ssyy,ly voicogo for ,ore d:n:
Q Harardglli Ioopti°Isti. 600 Valli Iloininol.
Suite /bldg./npt. no. 1001 -1016 I Project nalnc: MEADOW CREEK ❑ Scrvico_ or fccdcr600 'sow oni mro.
Cross street/directions to 'orb site: .. FEE 'SCHEDULE '
1 ne.crytm 2 per. idyl s
New residcnttut 510410• orr (mild-Wit ty dwelling nuts.
tncludus n(tnched garage. _ _
Subdivision: Lot no,: 1,000 sq. R. or Icss 145.15 4
--_ 1 La. addl 500 sq. li. or portion 33.40 1
Tnx utnp /parcel uo.: Limited energy, residential -
75.00 -
DLrSCRIPfLON OR WORK • (with nvire s9. ti.)
INSTALL FIBER OPTICS FOR VERIZON Litni "`` energy, multi- liirni'y 75.00 2
residential (With IIIMMI &IA.)
Services or feeders instislintlon,ultornti°n, m sd/nr t vi:mdln n
200 xinps or less 80.30 • .. 'E:1 PROPER'I'Y•'OWNER •• ' 0 TENANT • 201 an tx 400 ri;px 106.85 2
Name: 401 amps t o 600 nmp, I 160.00 2
-- —
601 .11A)) (0 (00 amps 240.40 2
—
Address Over 1,000 nntps or volts 454.65 2
City/State/ZIP: 'Collin wary xervicea or feeders Inslutlatlun, alterx0o), and/ 1.
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner Install Minn: This installation is being made on prop (hat 1 own wh i s not 201 tulips to 400 amps 100.30 2
intoide.d for sole, lose, runt. or exchange, according to ORS 447, 449, 670, ;Ind 701. 401 angn to 599 limps 133.75 2
ttruneh , circuits - new nlleratlou, or extension, per panel
Owner signature: __ ._Date: .
A. tees for brooch circuits rrirfr
. 9 APPLICANT' . '• :•1 ' • ` " (]CONTACT PERSON above service orIecdcrreo,
6.65 2
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. i }. Fee for brunch eircuits
Cnutnctnamo: ERIK SCHENCK vi/lroruscrviccorfeeilerfee. 4685 2
lint branch circuit
Address: 11818 SE M ILL PLAIN BLVD STE, 410 Each add•I branch circuit ] _ 6.65 2 -
Misceltaneous (service or (ceder not included)
City /State /ZIP; VANCOUVER, WA 98684 Each munul2icturcd or nodular
ttwclline, owl/or Redo 90'90 ?
Phone: (503 ) 969 -7729 Fox: (866 ) 452 -4853 Reconnect only _ 66.85 2
email: mduarenorthskysomm,com Pump or irrigation cirols: 53,40 2
CUN'1'RA4 t0R Sign or outline lighting 53.40 2
Business name: NORTH SKY COMMUNICATIONS INC, energy p
1 1818 SE MILL PLAIN BLVD, STE 410 energy p el, alteration. or
Address: expansion. Describe: 1 rase z $75.00 2
City /Statc!ZIP: VANCOUVER, WA 98684 Each additional Inspection ore, allowable In any of Inc above •
Per Phone: ( 360> 254 -6920 Fax: ( ) 1-866-530-4325 Inv s Investigation 62.50
i � iavcstigutio n per Slav (I hr mial 6_ St}
1
Cal tic,: 14117 Electrical Lic..17_1 Stipp?, Lie.: 173LEB ilsdnotrial plan( per how 73.75
• '•••t8.a.TRtCAL PERMIT FEES ...
Suprv. t?lcctricinn signnlurc, requited: Subtotal: $.7.1:01j Ce 7 - 0 ck
P0i111101110: JACK CAGLE Date: 10/01/09 Phm ruview (2541, of permit Ws): � �
State surcharge (129' of permit fee); • 1 0 Autboriicd xignnturc: �, 0, TOTAL PERMIT Pi ?Ls: $L9'UO (fs 7 S - e
10/01 /09 T1.6 pormlt duplication usphw if a porntlt Is not °Walnut militia 180 d
Print " ETHAN {AN A DOLPH Date: tiny; After a bars been nettptud CU1114 te.
0 Nunes of ui:pecduos spewed ter 200:11.
I:+1A I,C- R•msi,y,p.dnr 0i/3.006 JJe J613TU 1,11,4'CWIAYIilI