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Permit t +5 .,,' CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT t y 2 COMMUNITY DEVELOPMENT Permit #: ELR2009-00314 `'' 13125 SW H all Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/02/2009 T i G ARU Parcel: 1 S 134BC00403 Jurisdiction: Tigard Site address: 12505 SW NORTH DAKOTA ST 1401 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 58.14 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 1.800.332.23344.. Issued By: 41 1 Permittee Signature: v9"CY 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. . • , L RECEIVED Electrical Permit Applicatio T .... -." - Eo;e`or USE Oivl.ir. :'- .. •: ::. ; C City of'figard 1 2' 003 0 I O 't 13125 SW Ball Blvd., Tigard, U Plan Revio t i Phone: 503.639.4171 Fax: 5Mr I , b,OFTIGARD � Y1C / n : on,rr1( nail: TIGARD Inspection Line: 503.639 "41 BUILDING DIVISION B , 21 Sec pa iror lntmnot: www.tiguld- ur.gov 4. Supptctnentnt tnreraretleu TYrr 01 WORK :::.' ' . P1 tN RfV1Ew. ❑ New constn)otion 0 Addiiion/alterat /replacement Picnicehccl:; allh: uapply( suhnlit.; xen nr 'tilno%wlitenucbrctminclt>W): l.1 Demolition ©QIhCr' 0 Se,vleo or rcokr 408 mops ur two 0 nullding over thst ieeo:ics. u•Itc2lho availahle !hull cannot 0 Parlous out hnmyann. ^•., ::':: :•. ''. CATEGORY -OF .CONSTRUCTION c ` etttedx10.000amps:u (so volts or 0 Flo;xingb014iugs. - lu+s hi ground. or exccedr 14,01)0 0 CouuucrN:a -uso agrleunaral Di- and 2- ramify dwelling ❑ Commercial/industrial 0 Accessory building nrops lorall ethcelntluIUuiuns, buildings, 0 Multi-family 0 Master builder ❑ Other: ❑ rite puny,. 0 6,w;ala(100of75 KVA ot <' . QCn,Crgcncy xyxlo„t larset 5C pa,ately ae,iYe 1 xyslcni. .. . ' ' .. .• J M SITE• INFORMATION AND LOCATION .. 1 .. .. • .. • QAddilinunincw mow Iwo n( 0 "A" "11•• ° ,"I•3', Job no.: Job site address: 12505 SW NORTH DAKOTA ltx)HP or moth. «ettp:tnuy. ° Six or mere residauini oak. Q Seeremoml vcbictc veto:. City/State/ZIP: TIGARD, OR 97223 0 H r. cnith.enrc ,cili,ixi. 0 stl, ply voll:sp rnr n,orr 11,,.. ❑ Hara,dw» Iuculi°ns, 600 voila 110min111. Suite/bldg./apt, no, 1401 -1416 Project name: MEADOW CREEK 0 Servieo m feeder 600 moos or corn. FEE 'SCIIEDUILE Cross street /directions to job site: nr,er1g0 1 1 0ir. 1 Pee. 1 'Nut L. _ New residential single• or anal/ - family dwelling (11111. IncIntlus nitnched garngc. Subdi vision: Lot no.: 1,000 so. I1. or less 145.15 4 Tux mop /parcel 110.: •' P.a. add'I 500 sq. It. or portion 33.40 1 Limited energy, residential 75.00 2 DESCRIPTION OR WORK (wish Ni,tno sq. 11.) INSTALL FIBER OPTICS FOR VERIZON t ilni "<` ° " °rgy, mold- family 75.00 2 ' 1'ecidunial (,vial atrrvo, n.) Services or feeders invottlnt Ion, olternt and/or reluentln 200 amps or less 60.30 2 •0 pR0PER9'Y•'OWNER ` "1 . .•' • • . 201 amps to 400 amps 106,85 2 Name: 4 0 1 amps to 600 amps 1 160.60 2 -"-^- -- 601 amps to 1,000 mops 240.40 2 Address: Over 1,000 amps or v0115 454.65 �~ 2 City/State/ZIP: Temporary ticrvice$ or feeders Installation, ahertltoo,eudlac relocation Phone:( ) Fax:( ) 200 amps or Ices 66.85 I Owner Installation: This instnlinrion is being made on property that I own which is not 220) amps to 400 amps 100.30 2 intended for. Auk, Icnse, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 maps to 599 nnyts 133.75 2 Owner signature: Date: Branch circuits- new, alteration,, or extension, per panel A. Poo for brooch circuits with . 0 APPLICANT ' " . ''• a CONTACT PERSON ' abovescrvicu or feeder foe, 6.65 2 0,1011 hrnueh circuit Business name: NORTH SKY COMMUNICATIONS, INC, f3. Fee tor branch circuits -~ Contact name: ERIK SCHENCK „- irirolu wfcederfee. 46.85 2 first branch circuit Address: 11818 SE MILL PLAIN BLVD STE. 410 Each add'I Minch circuit 6.65 -- -- MlscNlaueous (service or feeder not included) City /State /ZIP: VANCOUVER, WA 98684 Oath tnunuIacturcd or modular w Phone: (503) 969 7729 I Fax:: ( 866) dwaliinn, service m,dror feeds' 90.90 2 452 4853 Rccomiccl only 66.85 2 E•nlail: mduorenorthskvcomm.com Pump or irrigation circlu 53.40 2 L'UN'I'RACro Sign or online lighling 53.40 2 Sigma circuits) or un,ike- Businoss name: NORTH SKY COMMUNICATIONS, INC. energy panel, alteration. or Address: 11818 SE MILL PLAIN BLVD. STE 410 °mansion. Describe: 1 Page 2 $75.00 2 City /Stalc/ZIP: VANCOUVER, WA 98684 EnchaddltionulInspectionovernito ,rnlit°tn of the ;Wove Phone: ( 360) 254 -6920 Fnx: ( ) 1-866-530-4325 _ Per impaction 62.50 .... Invesligndnn per hoar (l urMO 62.50 CCI3 Lie.; 14117 1 Electrical Lic. 17-154CL Suprv, Lit:.: 173LEB Industrial plant per hour 1111111=111111111 • SUM. Electrician signature, re Subtornl: "' • • , • 'ELECTRICAL PERMIT FEIS . ,. • / 0 `7 , Q X7-5110 1 d Prins Ilnn 10/01 /09 Pl review (25% of per f ee): JACK C AGLE Date: /� le Stale surcharge (129a of p°nnit fee): 00 g . 1 L Autlio,'ioed signnlurc: O TOTAL pentorr r•%r:: 9 po mill uppllr,H d u on vspl,ve If a vomit Is not obtnrne 18 q 0 5 . l 8 Print nnntc ETHAN A. DOLPH Date: 10 /01 / 11.4 d°yx 2100,• rt 1.n. Item nca•plte n. eou,ld<k. 0 Nuudkr ur oltuwcd Ir:r penal:. Ina.mrndu'c, stlt,C.loro Appeme 01177106 440J615•I'(1onsico.VWIii)