Permit n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
111 a COMMUNITY DEVELOPMENT Permit*: ELR2009 -00270
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TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/18/2009
Parcel: 2S110AB00100
Jurisdiction: TIGARD
Site address: 14030 SW 112TH AVE 44
Subdivision: PARKWOOD COURT APARTMENTS Lot: 0
Project: Parkwood Court
Project Description: Units 44 -51: Installation of data/telecommunications.
Owner. FEES
ALRANCO, INC Description Date Amount
BY JOHN R RICHES, 2601 ORCHARD HEIGHTS Restricted Energy Permit 08/18/2009 $75.00
RD NW 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
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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 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: �t y 01 Perrnittee Signature: '1/ .,c' `/ 27 0
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.
a..
, ' RECE E D
AUG 1 1 ?Prig • Electrical Permit Application . F6R - OFF ICE 1 1S CQ ∎ : L Y : .... ; ,: '; ` ':' .' `li�l "�
City of Tigard netelKr.1
's 13125 SW �ii7� li 5n11.\°
(call Olvd., Tigard, OR 97223 Dalepl i1 l / i
t � . Phone: 503.639.4171 Etc 503.578.1960 1111 OdwrPcntd.:
TIGARD inspection Line: 503,639.4175 UntoReady /fy: RI Sec Page 2tor
internea twvw.dglu•d or.gov NuilficJ(Mcslnd: 111M. Supplcmenlnllnform:oleo
TYPE, OF WORK "•":::•-• ;,. :: • •••.' PLAN REVIEW. ';i: :':;'•: • '.::: : • •
❑ New constmetion O Addition /alto' utiolt/rcplacement Plnnra cheek n11 Mat dimly (submit 33 sets nrptnnswri .om,ultrohrdbelow):
❑ UCtn0111t011 ❑ Other: ❑ SWAG or feeder 400 coops u mot.: O nanny OW nine xtorle'S.
where no avatl.thie nosh enema 0 Ammo and bautyuds.
` CATI eORY or LONS c
exceeds 10/.010: ups in ISO trshsnr 0 Malin tailings.
El I - and 2 dwelling kn to gonna'. or exceeds 14.0(10 Q Commercial-use agrIcuhunl
I- C ❑ Commercial/industrial ❑ Accessory budding amp, lentil otherhnta8mions. bnlwinps,
a Multi- family 0 Master builder ❑ Other: Q lire pu Q i tstaamion of 75 KVA ur
. . • . r0eueysyaant. y :rscparote ly c7e
"' ••"•�'= '''''� �.'•JUD SITF. INPURMATION AND LOCATION ` :: : • ' � Gem
.. ' . � � .. ❑Adrlillnn of nett' ntnmr lnxJ o f ❑ "larA ", °G', "1.3 , •�dI.1d'•, d
Job no.: I Job site nddresa: 14030 SW I12TH AVE IWHPu usratpancy,
❑ Six or more orc residential mile. Q Rcumuiional vehicle palkv,
City/State/ZIP: TIGARD, OR 97224 11A% Q Ncxlth•cmcfacilities. QSnplOyvoulgnfw oleic Matt
❑ for onloro locutions, (00 volt,. nondnul.
Suite /bldg, /apt. no.yy -s/ 1 Project mne: PARKWOOD COURT 0Scrvtco feeder 600 amps or mom
' SP?tSCIIEDUI.Q "• •
Cross strum/directions to job site: - - _ nc.erbnwn l Otr. I ree. [ •i1t i l •
New residential single- or snulll•fnndly dwelling uu11.
Includes attached garage.
Subdivision: I Lot Ito.: 1.000 sq. O. or loss 145.15 _ � 4
Tax map /parcel Ito.: , Ea. add'I 500 sq. Ii. or poninn 33.40 I
Limited energy, tesi[luminl 75.00 2
DESCRIPTION OF WORK (with alone nit.)
INSTALL FIBER OPTICS FOR VERIZON Litn;te[lenOfgy,1 "e111•iittnlly
75.00 2
scsidatliai (win. 0,.. a n.)
Services or feeders inshdlntlon aad!or relecttllon
200 MN or Ions 80.30 2 • ❑ PROPERTY 'OWNER 1
'El' 201 amps to deli amps 106.85 3
Name: 401 nays to 600 amps 160.60 2
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Address: 601 amps to 1,000 amps 240.60 2
Over 1,000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders installation, :filer :nlon, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.8$ I
Owner instidinlion: This insmllnlion is being made on properly that 1 own which is not 201 limps to 400 amps 100.30 2
intended for sale, lease, rein, or exchange, according to ORS 447, 449, 670, and 701. 401 amps [0.599 limps 133.75 2
Owner signature: _ -.. _. -_D te: Brunch circuits - new, Merade 1, or ex'elision , per panel
A. Fee for branch circuin with
❑ APPLICANT ' • ... • • ' ".:;ij ' • CI CONTACT PERSON ' above xervict[ or i'cder Co, •
6.65 2
each brancheircuil
Ritincs name: NORTH SKY COMMUNICATIONS, INC. B. Fca for branch ellen its
Contact name: ERIK SCHENCK without service or feeder fee 46.85 2
lint branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each WWI branch chalk 6.65
- hliseellancous (service or lceder not included)
Cily/Siato/ZIP: VANCOUVER, WA 98684 Each munttOcturcdormodular I -
dwiilinn, sewscc a (ceder 9090 2
Phone: (503 ) 969 -7729 I Fax: : ( 866 ) 452 -4853 RecomicGt only 66.35 2
E-mail: mduorenorthskvcomm.com Pump ori filiation circle. 53.40 2
CUN'PRA(JTOR • • Sign or outline lighting 53.40 2
Business name: NORTH SKY COMMUNICATIONS, INC, energ y panel. s) or llndlcd-
energy ahct[diun, ur
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Page 2 $75.00 2
Cily/Slale/ZIP: VANCOUVER WA 98684 Each o[WitionalInspection over lsotrnblo of the above
Ph o n e: I
Phon ( 380) 254 -6920 Foe: ( ) 1- 866.530 -4325 Per inspection 62.50
I
6 / brvcsligmionper hour(Ittrmin) 62.50
MB isle.: 14117 VI Ciccirical [ ic.17 -1 54CL st.ptv.. Lic.: 173LEB ( ad u cirial plant per hour 73.7$ 1
• 'ELECTRICAL PERMIT FEES ..
Suprv. Clcctricinn aignnture, requited: sm $75
Print mmme: JACK CAGLE Date: 8/17/09 Phut review (2596 of permit fee):
Slum surclut[gc (1256 of permit fee): $9,00
Authorized signature:
TOTAL PERMIITPEE: $84.00
Print "me: ETHAN A. DOLPH Date: 8/17/09 'rhtstwcmu mmo plIvr IIatwantI s noto:iInhc4um[ntn180`
days niter 11 has been melded as ample v
• Number urlosncedot» ul lowed per penult.
tSaulkti.tivkrmbsuit,C•tomoArp. ins 0[1)3/06 440 441ritt lmvcw[AY JI
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