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Permit { CITY OF T9G14R® ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit #: ELR2009 -00316 ti ! Date Issued: 10/02/2009 ir .rn RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S134BC00403 Jurisdiction: Tigard Site address: 12505 SW NORTH DAKOTA ST 1601 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: `� Q 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. CaII 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 APPli n f i r, .. :: Fois.oirrrcirUSEOvw .; ' : ` : :':. ; : : : City of Tigard 1111111111111W P "'" 4 °`'.: • 206q 0 4 (o -- rr 1305 SW (call nhvd., Ti t • I Phone: 503.639.4171 IL/11015W ; IGARD Efflii OhcrVCrmic 7IGARA inxpl:eli011l.Ine: 503 DIVISION DmaReady /BY: Ea see (ngc 2 for Interact: w ww. d gard Naiftcd /Mcbud: Supplcnanollntormaliml TYPO nF WORK ;t::.:' P)..tN Rr•,v1QW " \'' ° ? :; i` 0 New vow:unction 51 Addition /alteration /replacement Plrnsc chccc an that apply (suhnh 2 sea (e' 'Alms wiicemsehrekca scl<nv): 0Selviccor (ceder 400 amp nr nn,e 0 n < a lning.,ver nuocsre;cc. ©UcmOlitiOn ❑ Uthcr whew dw available Mal Cermet 0 Marines and tus y:uds, • CA t (iORY•01C.CONS'1'RUCT1ON ,. ..• exceeds1QW0 :taw is150 .011sce CI ntoting buildiq, 1 -and 2-family dwelling less se ground. ercxn'cdr 14,000 0 Coi i ci lal.eio a4alcuhurat Q y g ❑ Commercial /industrial CD ru ups finial other iusm@niwrs. buildings. Q Multi- family OMasterbuilder ❑Other: 0 fi,ep,my.. 0 l,),,Il iunof70 " •• `:," ., .. , (] G uergm<ay yste,. hr6 r >cpaalcly derived hyrtcm, . JOB SITE INFORMATION AND LOCATION • " ' � �Addilin of newmnlnr l�adof [] " °13 " "I •,,•', Job no.; lob site address: 12505 SW NORTH DAKOTA 100HP or e,we, occupancy. 0 Six <x more rcsklemi+l unite, 0 Itcomalianal vehicle parks. City/State/ZIP: TIGARD, OR 97223 0Hcauh.c:ne f4Nline,. 0 SupplyvuIec IN snore 1110n 0 11a'ca1tlous locutions. 600 voila nnnunul. Suite /bldg. /apt, no. 1601 - 1616 Pro MEADOW CREEK CI Service or reciter 600 mops or more. Cross street /directions to job site: FEE SCIfEDULIs _ SCHEDULE ' nr>rrlp,0n 1 Ow.. 1 rm. 1 '1'.,1 t Now residcntlut single. or nndtldnn111y duelling unit, Includes n(tnched garage Subdivision: Lot no.: 1.000 sn. 0.01 less 145.15 1 4 To map /pascal no,; I3a, ndd't 500 sq. li. or Portion 33.40 i Limited energy, resitictslia1 75.00 DESCRIPTION OF WORK (with A.., sq. 1t.) INSTALL FIBER OPTICS FOR VERIZON L ;mitcl energy, muln r " " snY 7500 2 residcnti :d (with above lg. 0 L Services or feeders installittion nnd/nr retacutinn , 200 amps or Ices 80.30 2 • '0 PROPR.RTY. •• • • .. •,• " D TENANT 201 amps nh 400 amps 106.85 2 Name: 401 amps to 600 amps (60.60 2 601 amps to 1,000 amps 240.00 2 Address; Over 1,000 amps or emits 454.65 __ 2 City /Stale /ZIP: Temporary ser vices or feeders Installation, alteration, end /or relocation Phone: ( ) Fax: ( ) 200 amps or leas 06.1(5 l Owner instaNntlon: This installation is being made on property Mal i own which is sot 2 0 1 amps to 400 amps 1000 2 intended for sole, tense, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 099 mnsps 133.75 7 Brunch circuits - new, alteration, or extension, per /hind signature; Date: _ — '-- — A. I've for brooch eircuiu with E) APPLICANT " : ". . '..i] CONTACT PFRSON " abovcservice or feeder fro, 6.65 2 • catch Mulch Circuit Business name: NORTH SKY COMMUNICATIONS, INC, R. Fee far branch eliclitx ERIK widlbaf service or feeder fee, 4685 Concoct name: !lost branch circuit Address: 11818 SE MILL PLAIN BLVD STE. 410 t:acha06'1branch — , -- 61 - 5 - ---. Miscellaneous (service or Feeder nut included City' /StaleiZ!P; VANCOUVER, WA 98684 Each manufactured ormodular 1 90.90 2 d)vlliefl, service nod /or seeder Phone: (503 ) 969 -7729 Fax: ; ( 866 ) 452 -4853 Reconnect only 66"85 2 - email; rnduor northskycomm.com Prm,poriiii 53.40 2 CUN'CRACfOR . • Sign or outline lighting 5140 ' • • Bus ;nossnm,l0: NORTH SKY COMMUNICATIONS, INC. energy , • , energy pinch :Mortifies, r Address: 11818 SE MiLL PLAIN BLVD. STE 410 exidosion. Describe: 1 p,ge2 $75.00 2 City /Sento/ZiP: VANCOUVER, WA 98684 Each additional ins ection over allowable in as of the above Phone: <360) 254 -6920 Fax: ( ) 1- 866530 -4325 Per il ( ( ion 62 50 w tweestigm hour (1 bro ;m milliMilm CC8 Lic.: 14117 — 1 Electrical Lie.1 -154CL Suprv. Lie.: 173LEB rndllyn'inl plant per hotw 73.75 .... .0:MCTRiCIA!. PERMIT REFS - .. • Suprv.I:icctricinn signature, required: Sebago!: _" . jP7. 1 0/01 /09 Phtn roview ( 25% of permit reo): Print mane: JACK CAGLE Date: r ' r Sole surcharge (12 of pcnnil rco): �9 Authori::ed signature; �� 0, TOTAL PERMIT ME: 0 Date: 1 0/01 /09 '1'ALs porn& uppliroduit vxnhvd Ira purn,lt Is not climb n1 01 � 6� ( '-t !80 . Printnnlne: ETHAN A. DOLPH toys aftern :tabassnAcv,nte<t ' m.o., of inspcctluns altuwed ter WW1. i1, 1s64.1fairbv0 oua0li.C.l'or O,y,p.dnr osn.uo6 101 661611 unOCoswvl;n