Permit r r Y A CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a ..� COMMUNITY DEVELOPMENT Permit #: ELR2009 -00320
I G A D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/02/2009
[Ot itl IV «,y Parcel: 1S134BC00403
Jurisdiction: Tigard
Site address: 12505 SW NORTH DAKOTA ST OFC
Subdivision: Lot: 0
Project: Meadow Creek
Project Description: Install fiber optics for Verizon.
Owner: FEES
Description Date Amount
BEL -EQR III LIMITED PARTNERSHIP
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.
Issued By: � Permittee Signature: �. : OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, tease 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.
N
RE CEIVED
Electrical Permit Applicati T O 1 20 09 ' .
FUTrOIrYi10EUSEUNLY':; : : • ':: ' •
City of Tigard CITY OF TIGARD cr,1, (4,,..
l 13125 SW Hall I31vd., Ti8 < / / al `� • �.
II , . D pli Rcvw
Pwtc: 503.639.4171 Fax: 5(TlS7� }�N I VIS ION Dlalclfl . io Other Pern,ia
Ti GARD W06011011 Line: 503.639A1 75 Dm RcadyltiY: BJ 5'CC 1' gc 2 Cor
Internet: www.tigurd -or. gov t 1f,W!Mcihu4: SupplemetgN Inrnrmnllen
. .. PL "view. ';.;.:::: .. -. .
0 New con, j ction Addition /alteration /rei)Inconlent lease check 41 till( ipply (submit 2 kit or peels wMcaw cheesed hck w):
a Scrvtce or (ceder 403 naps ur more Q (Wilding over rhioo.zloi les.
9 inolicon 0Other: where the available 'hull cams] QMnritus ;uldhnatyaras.
CATEGORY 000Y OF.CONS)RUC'I'ION , • •: •(:.' exceeds 10.000 maps ;4 150 ru11 or 0 Floating buildings.
I •and 2d.1111i1 dwelling tar m prevail, or esseet r 14.000 O Couamretd•uio agricuihual
0 Y g ❑ Commercial /industrial 0 Accessory building i mops ter All other it toI0iuns. bnildi
in Multi- funnily 0 Master builder 0 Other: 0 Pim mown. 01un:dlertun of 75 KvA or
latent • '• JOB SITE • INFORMATION AND LOCATION ` (] Em crgmlcy ryctmn. larger >cpataicly du,ived yt,mu, •
• • " 1 Addition of new atoms •". n,
CI „�.. "fin „ ,.,
Job no.: J ob sits: address: 12505 SW NORTH DAKOTA 1t0Hpun,anc. un,pancy.
0 Six ,Ir mace residential ingoi. 0 It0. o.'I anal vehicle parks.
City /State/ZIP: TI GARD, OR 97223 0 Hcnhh.e,ne r,cadmic,. 0 suppl 1•ollso for ,Here than
- .--.... ❑ Huanlour locutions, 600 voila nominal.
Suite /bldg. /apt. no. RECJOFFICE Project name: MEADOW CREEK ❑ Service or (ceder 600 naps or own.
FEE'SCITEDULE ..: :
Cross street/directions to job site: _ nracrrphm 1 Qiv. I roc. i 'Haul _ ■
New residential single• or intilti.hindly dwelling milt,
lncludus attached gatago.
Subdivision: Lot no.: 1,000 sq. It. or less 145.15 4
Tax m11p /parcel so.: 1 1.a.;Wd'l 500 sq. h. or portion 3340 1
•
L,imined energy, residential 75.00 2
DESCRIPTION OF WORK (with above vp,i.)
INSTALL FIBER OPTICS FOR VERIZON Limited energy, multi-family 15.00 2 '
n
1'esidsmin) (with shave, vs. n.)
Services or feeders instdlIntton,ofterntinn, n ld/nr relne,t9 n
200 ninps or loss 80.30 2
'0 PROPER'T'Y OWNER . O'TENANT 201 atupcio 400 nines 106.85 2
Nance: 401 nntps a +600 nnmps I [80.00 2
— 601 amps to 1,000 amps 240.60 2
Address: - Over IAN) 11114)6 or volis 454.65 w _ 2
City /State /ZIP; Temporary xcrviccy 0r (cedars InstullaUun, and /ot'
relocation
Phone: ( ) Fax: ( ) 200 amps or less _ 66.85 - '- I
Owner installation: This installation is being made on propcny that I own which is not 201 limps 10 400 lumps 100.30 2
intended for sale, lease, rein, or exchange, according to ORS 447, 449, 670, and 701. 401 1ut,))s to 59 '0 amp 133.75 2
Brunch circuits- new, ufteratiom,or cxtenslon panel er
Owner signature: Data _ P. P
. ._ A. 1' for brooch circuits Hid/
: ".• . 0 APPLICANT ”' - ' ' ' " 17' CONTACT PERSON ' shove service or feeder leo, 665 2 •
each hrin t:h circuit
Rosiness name.: NORTH SKY COMMUNICATIONS, INC, B. Fee for brnnchcircuins
Contact names ERIK SCHENCK n'itilour herviecor feeder fee, 46.85 >
..-. .,_ Ikn branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Eiachadd'l brunch elicit it 6.65
- -' " - • - hlisecllaneous (service or feeder not fit
City/Stale/ZIP; VANCOUVER, WA 98684 Each manufactured ormodular .
dsvalinr+„ service mutter feeder 90.90 2
Phone: (503 3 969 -7729 hex; ; ( 452 4853 _Reconnect only 66.85 2
Is- 11laii: • • 0) l •111 • ft it • 1l Yntnp orir+igation elect. 53.40 2
Sign nromiine � 53.40 2
Business name: Signnt circuits) or !limited-
NORTH SKY COMMUNICATIONS INC, energy panel, alteration, or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Page 2 $75.00 2
City /S(R(c/ZIP: V 1 NCO UVE • WA 98684 End nddhionni Inspection over allowable in any of the above •
Phone: ( 360> 254 -6920 Fnx; ( ) 1-866-530-4325 P" insparnion 6
Gnostigetlois 62.51) 51)
f?tetxricalLie.:17- 154CL SI,pIV.Lie.: 173LEB rldlol'io p11111 90)110111' ' 73.75
• i'�� � •• • PERMIT FEES •
,molls Subtotal: a _ g q
Print lltll, /o: JACK CAGLE Date; 10/01/09 Mtn review (2591, of pcnni( fee):
St .surcharge (12S'o of heroin fee): 439150 a (
�� ... � � —Tins TOT,1L PfiRhil'r I tali :0
i , Ip 75 98
Print " tulle: ETHAN A. DOLPH llnic:10 /01 /09 I ormit u > . 1)Re a us'phw If n permit Is Hal Mein d niiblu It40
.._�._.�. d ays oiler If h:11/ ()COI ncccpk All cougdctc.
In0,4knn , , . Nu ulnr u(i wpccduos slimes Ikr POMP, b4 a,nlalt ;l,C- R•rm3.y,p.dno 0Q 4, ,1,04 /VI 161Sr(1 u0.ac0aysmn