Permit -` ,
k - Olt CITY OF TIGAR
ELECTRICAL RESTRICTED ENERGY PERMIT
t. Permit #: ELR2009 -00311
a ` COMMUNITY DEVELOPMENT
yds. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/02/2009
Trt GA'R D. g Parcel: 1 S134BC00403
Jurisdiction: Tigard
Site address: 12505 SW NORTH DAKOTA ST 1101
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
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
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 wit 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 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: e . 5 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.
. . ,,
RECEIVED
Electrical Permit Application, FOX OFFICE USE ONLY : • •.
City of 'Ligon! OCT X 9 1 2009 i , v 7 Permit No.: S - (mil I
3,31_5 SW Hall 131rd., Tiourd, OR 97 - 1
IN Mow: 503.6.39.4171 j'i} .�Q$1' tIG ARD OIhert'ermii:
flat, RD inspection Line: 507.6 J[' U,lm R ca ly /I ?y: RI Sec ('age 2 for
rnlenIcII www.4 �9trnNG DIVISION Nuttfiee(MCrhud: Supplemenlot Information
. •TyPE or WORK ..:. :' . , PLAN REVIEW. .';.;
❑ New coostn Iion GI Addi lion /lhcrnlion/r0lllacemenl Plcsc chock alt lhu apply (submit 2 helr or elms w /itox,coIrctcd below):
0 Scvloc or (coder 402 mops in Hove ❑ (Wilding 00,:e lhnx xlodex.
(i Demolition 0 other: micro ikoay.lilahc I5u It corm! 0 td"r»tu: and hmayarm.
• CATEGORY OE CONSTRUCTION , czacds 10,000 ang1s:d 150,ollsur Q Molting builJingi.
3 lass to yrvwxl. or exceeds I4.000 QC: unarced•urc ag,lettflural
QI• and 2- t'atnilydwelling ❑Commercial /industrial 0 Accessory building m Din lirrnll°UmiimMahniuns. mdfdings.
[Ji multi-No-61 ❑ Master buildor ❑Other: Q ni,o joop. Q lnaailndva of7 of
" • • . "' . , Emorgency syment, for r (c vote( d erived ∎ Iem,
- JOB SITE• INFORMATION AND LOCATION ' ::? ' ' . . ge P Y r
,- -_ ❑Addition or IICW mom.. loin of ❑ "A' ", "I0",
till. o
Job no,: Job site address: 12505 SW NORTH DAKOTA 'furtP ° "'" x`'1110000'
❑Sio Of nlo(C (cskienliat unite. ❑ Rcoroutkmal vehicle 1 rkv.
City/Stnte/Z!P: TIGARD,OR 97223 0 Hcnhh.cn,cbcnitic:. 0SuppnyvdMso lc. °toro dtan
❑ 1(aza:donr Ioualinns. 600 vain nolttinnf.
State /bldg. /alt. no, 1101 -1116 Project name: MEADOW CREEK D Scrvico11( o cr(00mopsornmrc.
• t, ., •• F!iE SCIICDULYi ": •
cross street/directions to job silo: 11,__e. 1 4)1v. 1 rcr, 1 Too 1 ,_
New residential single• or u dwelling unit.
IOCIOIIus munched garage.
Subdivision: Lot l to. r I .000 sq. 0. or less 145.15 4
Tnx tnup /parcel ad.: Loa. ad(11 500 se. 0. or portion 33.40 I
I..ioitcd energy, residential 75,00
oescruPTION 0v WORE (win, skive ,ii, 1i.)
INSTALL FIBER OPTICS FOR VERIZON
Limited "'°rSY. » °''` -r; "oily 75.00 2 •
fccidoi(lal (with tdolvc st Al
Services or feeders inslailntl017 Ilerntien. nndler relocation '
200 atn(» or less 80.30 2
'''❑ PROPER'1'Y.'OWNER I :.. . . ' CI" TENANT • 201 amps to 400 amps 106.85 2 •
Nauru; 401 Amps to 600 amps 160x . _.._._..'.._.., 2
"' -- - ----" 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 ;imps or volts - 454.65 2
City /Stale /ZIP: Temporary services or (ceders Insluliallun, ;dim (ion, nod /m•
relocation
Phone: ( ) Fax: ( ) 200 amps or lees 66.RS 1 '
Owner instultnitun: This inslnlintion is being made on property that 1 own which is out 201 :,,u 10400!010 0 100.3(1 2
intended for Sate, Icnsu, rent, or exchange, according to ORS 447, 449, 670. and 701. 401 an, to 599 hops 133.75 2
Ownor signature: Date:
(bunch circuits - new,. alteration, or ex tension, Perpanel
-- - A. Fee for branch ciicui In: with
❑ APPLICANT ' ' "0 CONTACT PERSON above service or feeder 1'co, 6.65 2
each hornet) circuit
Business name: NORTH SKY COMMUNICATIONS, INC. 13. Fee for branch circuits
without service or !CC(Icr Igo,
COMM unn,c: ERIK SCHENCK 46.85 2
lint branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each ndd'I bttnchciscuit 6.65 2
- -- - Miscellaneous (service or fec0er not fuclu0ed)
City /State /ZIP; VANCOUVER, WA 98684 Each Inunuhtcmred or modular
('hate: dwclIine, service mtsl /or rceVcr 90.40 2
(503 ) 969 -7729 ( Fax:: ( 866 ) 452 -4853 RCCO1 only 66.85 2
Email: mduorc northskycomm.com Pump au irrigntioncirclo 53.40 2
CUN'I'RACf(1R ' ' • Sign or outline lighting 53.40 2
80 5 inoss name, NORTH SKY COMMUNICATIONS, INC, sieve' aa
r energy (r alteration. or
Address: 11818 SE MILL PLAIN BLVD, STE 410 cxlettiion.Describe: 1 Paget £75.00 2
City/State/Z!P: VANCOUVER, WA 98684 EnCil additional Inspection over allowable fit itny of the above '
Phone: (360) 254 -6920 Fox: ( ) 1- 866 -530 -4325 P01' inspcclion 6'so
luvcstignlion per hour (1 br min) 6. 50
CCB Lic.: 14117 Electrical Lic.y 7 -154CL Suprv. Lic.: 173LE6 hndusuial plant per (tour 1 73.75 1
• ELECTRICAL PERMIT FEES •
Suprv. Electrician slgnnnac, rcquirod'' Subtoial: W-(>6 7 - 84
Print Imo: JACK CAG LE Dalc: 10/01 /09 P13111 review (25% of permit fee):
State surcharge (12% or permit fee): g 1 14-
Authorized signmurc: /1 TOTAL P[intvtl'f PtiB; � 0 1 ` (
, 17,1., pormir nppnrmlun exphw it ti pormil le not all minet " i ` t ' nslhh ` 1 ' t30 7 5 . 4 8
Print 11 " 1 "" : ETHAN A. DOLPH D ate: 1 0/01 /09 days oft, I( !lax I ee,t necCOO AN eV°IpIC1¢.
+ Nurnt":r OI' hupccttuns t4lutvell (kr ponnl6
Ia0tdlaino 'o. il0lil•C.l5olle,tpp.dnr Oi(;Ar0• 71111615 /0.4COSN1IOII