Permit "A ° 13.5 CITY OF °° 'GAR® ELECTRICAL RESTRICTED ENERGY PERMIT
I I 41.- , . 1 `. COMMUNITY DEVELOPMENT Permit #: ELR2009-00317
#TIGA D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 10/02/2009
, 2.V t,_ Parcel: 1S134BC00403
Jurisdiction: Tigard
Site address: 12505 SW NORTH DAKOTA ST 1701
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: (,.. 0 -- AW
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.
CEIVED
Eiectri Z Fcai Permit App Ica on 'OR;oi.I''ICE USE ONLY..,: `.. ,,;';: :•
city oftrigard nr � (}
t 1312 S W Han Dlvd., Tignrd. 200 �i J ,1 r� `a 17
laik : ' Phone: 503.G39A171 Pax: 503.59RJ960 rhnttCVic.V Oilier Penult; -
u;ncrfiy:
TI GAM] 1°4 4)9 Line: 503.039. ITy OF TIGARD UAte Roily /11y: 0 Sec Pow 2for
Internet: www.rignld•ur.^ Notified/Method; Supplemental Information
1 ' .vnrn * t m _ L '. - .. PLAN IlItAtiiW.` :::.
0 New constnietion 0 Addition /alteration /replacement Pleaiccheck: 41Iha4Apply( seht IIII2wrofplanerdlicfmtielle t'kcdaelow)1
-'' [1 Servlet or Cooler 403 mope or rune ID nondilW nvu•d,mn c!.
.dn•;
CI Demolition ID Other: mime ate svai bible (nit couch 0 Harm- 4n4 h4my..I .
..
caccc to 10,000.1*! I
. '.,'' : :.CA'fF:(iOkY- UJ':CONS17tUCTIUN ',: •: •. ':::.:' ::' '' is :' 150whe QtauannBbubJiug;.
tome h1 ground. or o 1 - cis 14.0110 Q Connnorcl:d - uso agdcnlunal
❑ I • and 2 -1 OI lily dwelling ❑ Commercial /industrial ❑ Accessory building slops for alt oilier iusutlmluns. buildings,
❑ Mtilti•fo 0 Master builder 0 Oilier: aph. 0mn\p. 0 inet„uaronof>S KVAor
•.. _ a.::i.::' : e •:: .. O Emergency syMCIO leryor separalcly derived ey;ienl.
• •JUB 'SITE•iNFORMATION AND LOCATION . -'
- ... Q Additinn Al new nlnmr n( 0 "A " "fi ""I•1"
Job no.: Job site address: 12505 SW NORTH DAKOTA or I00HP r< `- 1N1C1 m.7.
0 SiSix mote 2tnlenui ;d rats¢, 0 Rc,: apnea vehicle led,
City/Slate/ZIP: TIGARD, OR 97223 0 Hcollh.clic f0CiliIic;• i7 supply roh?gc Por more than
, 0 Ha4aalow lovotione. 600 volts nominal.
Suite /bldg. /alt. no. 1701 -1716 Project name: MEADOW CREEK 0 Scrviro Of feeder 600 unryuur move.
:.. :.• :.. -. •. . ' - .F1.E'SCHEDULE , • Cross Wm/directions to job site:
ono-100,g j 01v. 1 inv. I 'foil I •
New rtsidcntiul single• or nniItt- (nndty dwelling unit.
includes nitnched gatagc, ^�
Subdivision: Lot no.: (.000 sq. 0. or less 145.15 ' 4
Tux map/parcel no.: Ea. ;WW1 sq. 0. or portion 33.40 1 ,
• 1 „milled Cncxgy, res idential 75,00 2
DESCRIPTION 01 WORK (weiuhnlxrrc.q.bi.)
INSTALL FIBER OPTICS FOR VERIZON Limitc(I "'wtl- 1'mnily 7500 2
— resideutiad (wilt utxme oi. n,)
Services or feeders instxnetlon, niterndon, x id/nr rel °cmlinn i
200 amps or less 80,30 2
'''❑ PROPER'PY.'OWNF.R j . .0 TENANT .. 201 nmpoto400maps — 106.85 2 •
Name; 401 Amps to 600 amps 1 160.60 2
601 amps to 1,000 amps 240.60 _ 2
Addross: Over 1.000 nor or units 454.65 _ 2
City /State /ZIP: Temporary services or feeders Instullat100, alteration, and /o•
relocation
Phone: ( ) Fox: ( ) 200 unto or los's 66.86 1 100.:(0 1
Owner installation: This installation is being made on property dial I own which is not 20I amps to d00 amps 2
intended for sale. tense, rent, or exchange, according to OILS 447, 449, 670, and 70i. 401 amps to 599 limps 133.75 2
Brunch circuits - new, alteration, or extension, panel
Owner signature: .._. Date: C
A. I "cc for brooch cieeuits smith
• ❑ APPLICANT ' :.. : al ' ' '0 CONTACT PERSON above service or feeder Coo, 6.65 2
• •
each branch circuit
Hn4lncss NORTH SKY COMMUNICATIONS, INC, R. Fee for branch circuits
Contact name: ERIK SCHENCK
without scrvicc feeder fee,
46.85 2
lirsl bract circuit
Address: 11818 SE MILL PLAIN BLVD STE, 410 till Ch add'I blanch circuit 6.65 2
- - - - Miscellaneous (service or feeler not included)
City/State/ZIP; VANCOUVER, WA 98684 each manufactured or modular
90.90 3
dwelling, service and /or (ceder
Phone: (503 ) 969 -7729 I Fax:: ( 866 ) 452 -4853 Reconnect only 66.85 2
-mail: mduornp nothskycomm.com Pomp oci.d8ativii cileto _ 53,40 2
CUN'i'RACTOR • ' Sign or outline lighting 53.40 7
N ORTH SKY COMMUNICATIONS energy c i r c u i t ( s ) panel. l erat i on, or
Bu name: , INC. . cuergy p:nlcl, altcrdiwt, or
Arldrosn: 11818 SE MiLL PLAIN BLVD, STE 410 00000sion. Describe: 1 Pa 2 $75.00 2
City/State/ZIP: VANCOUVER WA 98684 Each additional Inspection 0001' altoatlblo In ;toy of the above —
Phone: ( 360) 254 -6920 Fax: ( ) 1 -866- 530 -4325 Per inspection 62.50 •
hsvecligadom per 11%1011 62.50
CCB Lie.: 14117 Electrical Lic.17 - 154CL Slpiv. Lic.: 173LEB Industrial plaint per gout. 73.75 I
• '•• - ELECTRICAL PERMIT PEGS
Suprv. Electrician signature, required: Subwlul: 176115 £.o - 7 • 8 1 4
Print mime: JACK CAGLE Date: 10/01/09 Plan review (25d% of permit fee):
State surcharge(12r/oofpermitfee): 6 e ( (4
Authorircd signature: �� TOTAL PERMIT PEE: $24;60 v
•ht% porolt upplita0uu osphva If A prude Is not oh W tnlned elm 184 �6
Printnntnc: ETHAN A. DOLPH Dace: 10 /01 Jay.. ofterluox Inv rnc«plcd utcvlllpltec, S
'1
• Nuntlrcr of inapcctlun, aboard per posit.
I4 0ollnin4 U'erotitAtil,C.ik^1re, \pp.nne 00,2.000 471141. I vosi000IAVr n