Permit E u r
ELECTRICAL RESTRICTED ENERGY PERMIT
71 fi s CITY OF TIGAR • ,
a COMMUNITY DEVELOPMENT Permit #: ELR2009-00313
�3= Date Issued: 10/02/2009
pTF,GAAD, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
.,,t lv , , t Parcel: 1S134BC00403
Jurisdiction: Tigard
Site address: 12505 SW NORTH DAKOTA ST 1301
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
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 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. 1 I
Issued By: `.4L,D Permittee Signature: 0110—.(2 AQ()
OWNER INSTALLATION ONLY R' 1
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.
i.
RECEIVED
Electrical Permit Application :: : FOICOE USE ONLY...: � � n 01 2 009
- ° City of 'Tigard .. n Permit No,: r? • • co ' t 3
't 125 S W Ha 1 0 8 4 1 1 ' 7 " 1" T' f�j rr q p
t 1 't 503.63 0.4171 I t )'�IGARD EffilliM1111111 Olb"Pcnnhu
f1GARp inspection Line: 503 1 , 5 D1NG DIVISION OatoR`ady / 65 Ste Voge2for
lnrcntct: wwwdlgnrl - r,,,, fyutificdlMcduul: �' Supplcmooiol infnrnmtiun
0 New constatetion CI Addiuon /nitcrution /reptucmcnl Plco'.c duck ; that ; was) (what 2suoof plans wtitcuuchcckcdbclawl:
y--� 0 Smvlce or fecder 400 ap1
m0( muo 0 8ulining over n ,a
eeaics.
t._! 1.30010111 f(511 0 Other: whore t1l0 u0ilahle li,ull etment 0 Manua. one hnaty.rds,
. • (AUGURY iOr CONSTRUCTION , .. •
... era'ls I0,000 amp .:1 150+0,11, or 0 Homing buildings.
los to gtvoIK1. er FCCredr 14,0)0 ❑ Coumlorclalase NvIC11iu1(5)
[] 1- and 2-faintly dwelling ❑ Comntercinl /industrial 0 Accessory building 01)11 futon otllcriustaulnte»s. bit lei 1 o,
0 Multi- family 0 Master builder ❑ Other: > . ra 0 c•mer Giw pony,. 0 b,wd rion of KVA or
. AM - J SITE INLORMATION AND LOCATION ` . 6elicy 'Y'°'". far 0f11(
go0 0(11ydorlve4
";. : Q L Additionnrn ow mow lir lof ❑ "A" °pJ "1.2" •1•1"
Job no.; � Job site address: 12505 SW NORTH DAKOTA lota4pOC 11000 `"'c0p"n<'y.
0Si.x or owe resaknlial oak, ❑ itcm.tiunnl vehicle p :aks.
City /State/ZIP: TIGARD, OR 97223 0 Hoalnt•cm° tncilnios. 0 Supply 0011060 for „lore Om
0 60000 lour locoliom. (110 vnl0 non,ird.
Suite /bldg./apt.no. 1 301- 1316IProjcctna111e: MEADOW 0 Oservico or feeder(OOmnls01 Min.
-.., _ :, , • ,. • • ..Fr•.e'SCll DULE i• : .
Cross sweet /directions to job site: ^^ 0r,erlawat LQ1AJ_...t_rc�_J_ Ieki!_..J�-,
New resi<icntiul single• or ntnitt•fnmily dwelling twit.
Iodides nitached garage
Subdi vision: Lot no. r 1.000 sq. 11. or less 145.15 4
wt
Ins ma r / lrcci 1)o.: - - Ea. ad <I'l 500 sq. li. or portion 33,40 j .- I
DLSCRn°rtoN OF WORK L.i wi eucrgy, residcudol 75.00 2
(wilt, energy,
ssi. Ii.)
INSTALL FIBER OPTICS FOR VERIZON Limited ciio:gy, I „a111- I;tmily 7500
residcnliai 6,60, atanc a n.)
Services or feeders insinfintlen,nitern len, m,d/nr Inlucntlnn
200 amps or less 80.30 2
"' PROP1sWL'Y.'OWNER . i . . •0'TENANT ' •: 201 Hops to 400 amps 106.85 2
Nance: 401 ramps to 600 amps 160.00 2
601 coups 10 1,000 amps 240.60 2
Address: Over 1.000 Damps or units 454,65 2
City/Stale/ZIP: 'fumpnrnry services or feeders Inslullallun, ;dterat)on, 01111/00
relocation
Phone: ( ) Fax: ( ) 200 amps or less i 66.85 I I
Owner instnlintion: This installation is being made on property that 1 own which is not 201 unsps to 400 amps 100.30 10 0.30 2
intended for side, lease, rent, or excir,u,ge, according 10 ORS 447, 449, 670, and 701. 401 amps &O.59 amps 133.75 I 2
Owner signature: Date: _
(truth circuits - new, 011erattou, urextensioy ter panel
A. Fee for branch circuits with
0 APPLICANT ' . • '0 - CONTACT PERSON ' above service or feeder leo,
6.65 2 •
each brunch circuit
Rosiness name.: NORTH SKY COMMUNICATIONS, INC, 13. Fee for brand] 01,0000
ERIK SCHENCK nir/rotrf scrviro or fccaerrcc' 4685 2
Contact name:
-._. first branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 (inch add'I brunch 0100010 6.65 ?
M)Scetlatteous (service or seeder pot iueluded)
Ci,yIStatc/ZIP: VANCOUVER, WA 98684 Each taamtlilcblred - 9090 2
dwalinn. service 01111 /or feeder
('hose: (503 ) 969 -7729 1 Fox:: ( 866 ) 452 -4853 Reconnect only 6685 2
n'mail: mduorl norths} Pomp or irrigation cirek: 53.40 2
CQNY RAC f0R Sign or outIuo lighting 53,40 2
Sigurd encuit(s) or Iilitcd-
L3usinessn0dlc: NORTH SKY COMMUNICATIONS, INC, energy panel, alleral ion. or
Address: 11818 SE MILL PLAIN BLVD, STE 410 exlensinn. Describe: 1 Pogo 2 $75.00 2
City/Sta VANCOUVER WA 98684 Erich additional h tspecliono vet idiom nhioht any of the above •
Phone: ( 360) 254 -6920 M
Fnx: ( ) 1-866-530-4325 P inspection 62.50
tnvesti L•rnrinl 62.50
CCs Lie.; 14117 1 Electrical Lic.rl 7 -154CL = suety. tic 173LEB Industrial plant per hour 73.75
EL C,('RtCAI. PERMIT FEES •• ` •" •
Suprv. ,cctricinn signature, miniver!: miniver!: i ,
L" .w. Subtutul: $ 5 ( /
P - 7 . a<-/
Print name: JACK CAGLE Date: 10/01/09 .)nu review (25% of petmit fee):
Srue surcharge (12 of permit fee): $.9'(/U 8 _ I i
Authorire<Isignature: /.61e._ ,A • Cl/
/
TOTAL PfiRMl'r $ � � , G G .
This punk appllc4nun (Arlon I r a purmtt Is not (Winkled 1)111111) 180 J I
Printnnne: ETHAN A. DOLPH Date: 10/01/09 anyt Attar It bog boon ncrcnl <ta.0+1,100,
° Nu1bcr of impcc0ons slowed per permA.
I :16nlhrngu•crnrldG ,(0 10 0 0212.1/01, 001161M Irnv0o51AV1ill