Permit •
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1111 ° COMMUNITY DEVELOPMENT Permit*: ELR2009 -00269
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/18/2009
Parcel: 2S 110AB00100
Jurisdiction: TIGARD
Site address: 14020 SW 112TH AVE 52
Subdivision: PARKWOOD COURT APARTMENTS Lot: 0
Project: Parkwood Court
Project Description: Units 52 -59: Installation of data /telecommunications.
Owner: FEES
Description Date Amount
Restricted Energy Permit 08/18/2009 $75.00
12% State Surcharge - Electrical 08/18/2009 $9.00
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 $84.00
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 R 952 -001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6899 or 1.800.332.2344.
Issued By: Permittee Signature: ebv ',w%o - "nU1 �
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 603.639.4176 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
AUG 1 7 2009
CITY( I,- , ..0
mer vicly
Electrical Permit Application l _RO�i' d3i
• • City of'1'igard Dw. .. r / 14 Tani, t4r,.iEGQaa0 —Do02 69
' 11 ." 't 13125 SW Hall Blvd., Tigard. OR 97223 Da R : I ' Phone: 503.639.4171 Pax: 503.590.1961 (' OiIwcPcmdl:
nlcfny:
TI G ARD In oii One: 503.639.4173 N o t i i e d /m I(. J`���
Internee 1 a s . rage 2 for
m m ci:' tvww.l iieI•utgnV NurlfiednslNl Su tementnl Inforninllun • ... TYPE OF WORK "'.;. :' :.i.• .. • :'pLAN REVIEW. T :; ' '.. •. . • ❑ New cunstnlet ion 0 Addllion /nheralton /rcplacement ('(talc check all that apply(iuhmu 2 sets of tins %MimsebeeJSd Wow):
Se1Vlce or Ruler sue or nwec ❑ nnllnin aver tluvo stades.
❑ DCt11011t1011 ❑ Other: a
__ -- whew 00 wailab(e fault curfeul Q Marinas wed booty:vds.
. . ' •: , CATEGU RY•UFCUNS"1'ItUC'1'IUN; • ': . , '. "::;.
•.:•.' :.' exeoedslO ,tJUOnnyrJ:uISOnJts°r
., . .. .. • .. ❑ Floating buildings.
lea to spend. ore /weeds 14,000 Q Cunlm nel :d•uso agdcWuml
❑ I - and 2- (runny dwelling ❑ Colmnercinl /induatrinl ❑ Accessory building amps ror nil oilier hmn(Intimn. buildings.
o Mtdti•fnmily (1 Master builder 0 Other: ❑ Phepump. Q1anallnniouof75KVAot
.'•'JOB SITE•INFURMATION AND LOCATION ::. ❑.,7KrSonryayrte,n• lalgurseparalulydari.eday.lcw,
'� ❑AJdilina nl'nuv m,wnr loan( of ❑ "A " "li ", "I•'+'•'Y•3'•
lob no.: — 1 Job Kite nda'ets: 14020 SWII2TH A V E ❑ nr IWxp or m o m . ❑ occupancy. a'vetncl.ek�.
Six more residomiul °oily,
City /SlOte/ZIP: TIGARD, OR 97224 1/ ❑health•carofacilities. ❑ Supply voltage, for mote dtao
❑ Xuvtluos luculiuns. 1100 vane ('minims(.
Suite /bldg, /alt. no.$ - 1 Project name: PARKWOOD COURT O Service or feeder GOD tllnpsurmum
..A.,.: ..PIM .9CIIEDUI.Q ... ' • • •
trrons xlleel /((IfCChORx to job she: � Ilnerylnun I Qlr, I Fm. I WO I .
New residential single. or nndtldamlly dwelling null.
Inclntlus Mulched garage,
Subdivision: Lot no.: 1.000 sq. R. ur less 145.13 4
Ea. ndt11 500 sq. li. or portion 33.40 1
Tax afar /Pasco( n0.:
!jollied cow
0ESCRIP'r[oN Or WORK ( milb:dene cq. Il.) 75.00 2
INSTALL FIBER OPTICS FOR VERIZON L;mitetlenergy, l,mh1.lhlnily 7500 2 •
fcsidcnlial (widud.n•Sn 0.)
Services or feeders ins'InllgtlonolternUnn. and/or reluadlnn
200 amps or test 80.30 2
.•'❑ PROPP.R'I'Y.OWNER .' .'I :, .. .. 13 - TRNANT " 201 maps lu400 106.85 2
Name: 401 chops a1 600nmp: 160.60 2
601 amps to 1.000 amps 240.60 _ 2
Addruaa: _ Over 1,000 angst or volts 454.65 2
City /State /ZIP: Temporary services or feeders Installation, :Mendip's, and/or
relocation
Phone: ( ) J Fox: ( ) 200 snips or less 66.85 I
Owner InshdtatIon: This inslnllntion is being made on properly that I own which is not 201 amps (0400 inapt 100.30 2
intended for sole, lease, Pent, or exchange, according to ORS 447, 449, 670. and 701. 401 amps to 599 limps 133.75 _ 2
Owner si S nMUre: _.Dale: Brunch circuits - new. aflcrttlou or extension, per panel
__. _
' — A. Pee for branch circuits with '-
' to APPLICANT . . . ::I ' ' ' +❑ CONTACT PERSON ' above sea vice of feeder fco, •
6.65 2
each brunch circuit
Rosiness name:
NORTH SKY COMMUNICATIONS, INC, O. Fee for branch circuits
Contnctname: ERIK SCHENCK waho,n wild ce or realer rec. 4(85 2
first brunch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 li :tcll ndd'Ibrianchciretut I - 6.65 1 2
!YUMA mucous (service or feeder net included)
City /Stow /ZIP: VANCOUVER, WA 98684 Each tnenuiacturcd or modular
dwellinn, service and /or (ceder 90.90 2
Phone: (503 ) 969 - 7729 I Fax: : ( 866 ) 452 - 4853 Reconnect only 66.85 2
13.inail: mduarna northskycomm.com Pump or ii notion circle 53.40 2
CON't'RA(7(1R Sign or outline lighting 53.40 2
Business name: Signal eircuit(s) or limited.
NORTH SKY COMMUNICATIONS, INC. energy panel, alteration, ur
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Page 2 $75.00 2
City/State/ZIP: VANCOUVER. WA 98684 Erich additional Inspection over allownhlo In an of 11w above •
Phone: ( 360) 254 -6920 I I Fax:( ) 1-866-530-4325 l cstignt inspection igut 62.50
l per hour (I hrmim 62.50
CCB Lie.: 14117 I ElectricalLic.17- 154CL: Stgnv, Lic.: 173LEB ludasirial plant per hour 73.75
• ••ELECTRICAL PER FEES ..
Suprv. Clcctricinn Kignnttirc, requited: i'���" Subtotol: $75.00
Print OHM: JACK CAGLE Date: 8/17/09 Phut review (25% 01 permit (cc):
Slue surcharge (12% or permit (cc): $9.00
Authol .cd signn(urc:
/ TOTAL PER bar $84,00 _
II'f l l li:
Print unmc: ETHAN A. DOLPH Date: 8 /17/09 art, permit uppticnnun oxpwt If a (math Is not obtnlnul uSUdn 110
days once 11 haulm oerepled xs complete.
19WdWirpWa ,°NrUi6C•I @mrr.tpp.dn: OW.VaG • Nuu or Inspection: mllutved'Kr Ronda,
IJ II. nGlsn I IwbCO11AV00
fiV /s59Y y