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Permit +' . ELECTRICAL RESTRICTED ENERGY PERMIT q CITY OF ° TIGARD , COMMUNITY DEVELOPMENT Permit #: ELR2009-00312 ft r , h � Date Issued: 10/02/2009 yT;iGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 _ 3144; Parcel: 1S 134BC00403 Jurisdiction: Tigard Site address: 12505 SW NORTH DAKOTA ST 1201 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 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 503.246.6699 or 1.800.332.2344. Issued By: Permittee Signature: A). 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 FOR OLIiCE USE ONLY.;.:' :- :'.:`'''.::'c • - City of Tigard � � T 01 2009 iiisii L , Permit (4,,.: • � asa CO 12 "I 13125 SW Hall Blvd., Tigard, OR 97 2 ? ° i Phune: 503.639.4171 Fax: 503.598.1 Odrerlenuic d Inspection fine: 503.639.4175 C ITY OF TIGARD D :ae Rcad /l3 TIGARD Y Y NM Suppl up pi e c scat ol 2 for Interact: Information wtnv.tigai•or.gev I nficmnlcdlon: Splrno4 lnf _ _ . p1ALG DNISION No ..,. PLAN REVIEW `;. -., ,,,. • .,. 0 I`:ow C0i1 \tenon 0 Addition /alteration /replacement PIc''c clrcck:ll that apply (submit 2sets nfpinns Wilc,ns ultracd 8clow): 0 0Serviceor reader 4116amps 0 (Wilding over ill= . do. res. DetoOlitiOn 0 Other: whore dm (wailahle'huII curra 0 Manias nets hn:d)nk, " <• (.4 f (TORY •Ur CUNS'1'RUCTiUN. , . : meccas 10,000 ;toys :,t 150 rx its ❑ planting buildiuys. Is to gram?. or exceeds N,000 0 Commercial -ate a4'icuimral Q I • and 2- 11unily dwelling 0 Commercial /inctustrint Q Accessory building maps for otfrcr hlxed( buitdingr•, L7{ Multi-family 0Maslorbuilder []Other: 0 rim vamp 0 Iso:dlwiudol75 KVAct JOB SITE. INrOR'ulAT1ON AND LOCATION 0Cmcrscncysyscmn• targetacpnraIclydedvedsysicm, (DA,kiitinnorWewn,nlnrin:ulnl ❑ ",t" "i °' "1.2" "I.1" Job no.: - I Job site address: 12505 SW NORTH DAKOTA 1001.4, mom. ocvnpuHey. t0 mwac Six or rc,klowi:d "oil;, 0 Rccrealiunal Matto p:14N. City /StnIC /ZIP: TIGARD, OR 97223 0 Hcr,trh.ea.Sra.cahier. ❑ Supply vofni6ororinorc4,,,, ...__..._,, 0 Woalliura i0cnliuni. 600 WIN nasioul. Suite /bldg. /ap(,no, 1201 -1216 Project mime: MEADOW CREEK 0Scsvico feeder 61)0 was ormin. -.. . • • " ...FEE 'SCHEDULE Cress street /directions (0 job site: " Or.olpinn 1 Oly. I Fa% 1 'N al J• '._ �..... - New residential single. or mut tt•fnndiy dwelling unit, _- Includes oltachcd garage. Subdivision: Lot no.: 1.000 sr'. I1. or less 145.15 _• 4 -- - -1 Ea. add' 1 500 sq. ft. or portion 33.40 I Tax instp/parccl neat 1,imitcd energy, residential DESCRIPTION OF WORK; • (wish Atom sq. 11.) 7500 ? INSTALL FIBER OPTICS FOR VERIZON Liu,iteaanorgy , matd (sanity 75.00 2 residani:d (with Wlx,ed Sq. n.) Services or feeders inslnllnlion,ultcrn(lon, and/or relocation ' 200 amps or less 80.30 2 © PROPI RTY.'OWNER •1 .. '.O" TENANT . 201 sinpi lo 400 loupe 106.85 2 Nalnc; 401 amps to 600 am i 160.60 2 _. - - ". 601 amps to 1,000 amps 240.60 2 Address: Over 1,001) amps or volts 454.65 2 City /State /ZIP: Temporary avrvices or feeders instullatlun, alteration, audfoe relocation Phone: ( ) Fag: ( ) 200 amps or lexs 66.96 ( • Owner installation: This installation is being made on properly that 1 own which is not 201 05»115 to 400 amps 100.30 _ 2 i mended for ult.:, tens :, rent, or excllango, according 10 ORS 447, 449, 070, and 701. 401 naps to 599 limps 133.75 2 [crunch cl•cults - new, »Iterattoo, or extension, per panel Owner signnttu'c: � __,__",_• Date: A. 1:0t for broach Oircuirs WW1 u • 0 APPLICANT : 7 ' CONTACT PERSON above service or (ceder 18e, �6.G5 2 each branch circuit Business name: NORTH SKY COMMUNICATIONS, INC. 13. Fee for branch circuits -- withorr service or fccdcr fee, Con(ncc name: ERIK SCHENCK 46.85 3 1161 branch circuit Address: 11818 SE MILL PLAIN BLVD STE. 410 Etch add'l brunch circuit ^ m 6.65 2 Miscellaneous (service or (ceder not included) City /Slate /ZIP: VANCOUVER, WA 98684 Each manufactured or modular ' Phone: (503 ) 969 -7729 _ I Fax:: ( 866) 452 -4853 Itco nq, c service mtdlor (cede, 90 - 2 Rceo only 66.65 2 Email: mduorlangrtbskysswarasaro Pomp or irrigation cirelo 53.40 2 CON'I'RACC(1R Sign orvottinolighting 53.40 ' 2 Business lame: NORTH SKY COMMUNICATIONS, INC. energy p ei`(.) `rr iir"itai• aergy panel, ahcrdieu, ur Addrexo: 11818 SE MiLL PLAIN BLVD. STE 410 ChletISIO n, Describe: 1 Page 2 $75.00 2 City /State/ZIP: VANCOUVER, WA 98684 Ench additional Inspection over allowable fn any of lite above P Phone: ( 360) 254 -6920 Fax:( ) 1- 866.530 -4325 invca5pcesligntioon 62.50 nn per hour (I be 0566( 63.50 CC& Lic,: 14117 Electrical Lie.17 -154CL See v. Lie.: 173LEB hldllslrialPbmC per hour 73.75 I ELECTRICAL PERMIT FEES ' •.'" - . 5 Sum, Electrician signnttlre, required: Sub(abd: an rev 91, o pp (117. 8 P riot Homo: 10/01 /09 Plan (25f f ee): JAC CAGLE Data: perm State surcharge (13 of pcnnh s feu): g 1 n Authorized signature: /7 filtvl!'r 1 $84�J0 75 , 9 Q 'ilk, permit application osphvs if a permit Is not ohtnlue4 411,1,, 180 Print nnrne : ETHAN A. POI-PH Da(o:10 /01 /09 dnyc otter• a liav been ncolif0 av euatdei . + Namtscr urinspccllons ulluw•cd txr peru4l. l: to 'a,n56w<raditaILC"vrnWa,y,p,anc 052006 420 41y10 I /11.VCO5Uwlill