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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT P COMMUNITY DEVELOPMENT Permit #: ELR2009 -00168 Date Issued: 06/30/2009 TIGARD; 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S136CB00700 Jurisdiction: Tigard Site address: 8525 SW PFAFFLE ST Subdivision: Lot: 0 Project: The Gate House Project Description: Install fiber optics for verizon FEES Owner: Description Date Amount GATEHOUSE LLC 6310 SW BURLINGAME AVE Restricted Energy Permit 06/30/2009 $75.00 PORTLAND, OR 97239 12% State Surcharge - Electrical 06/30/2009 $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 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 5 1-0100. 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, 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. • - RECEIVED JUN 2 5 2009 Electrical Permit Application CITY OFTIGAR t •• • . FOx ;orrlCEOSoi :; . ;` ` :: : BUILDING DIVISI1. '`' • • City of Tigard 2-0 ` , -- 41 13125 SW Hall Blvd., Tigard, OR 97223 i. • Phone: 503.639.4171 Pax: 503.508.1960 o ('ev il: TIGARD inspection Lire; 503.6324175 Oats Ready/ay: NM la gee Page 2 for Internet: www.tigei d•or. ;nv Nutifrcdlhlelhud; Supplemallnl lnformnil(n • TYPE OF WORK .. • ': PLAN REVIEW ■::r'.: • ' 0 New coestnietion Q Addition /aitcra(ion /repla0Cmetlt Plow check :01111m apply Wilma 2 sets of plans Wilms eheckcd l,clow): ❑ Ucmoiiti0n []Other, 0 SClvke or ,Ceder 40:1 amp or row ❑ 0a11oins CYO' Unec,110,ICI. whore 4110 t.v,tilahic hull currmll Cl M owl hnury :ads, ..: ' ., CATEGORY OF CONSTRUCTION : ' . - _ : :'.'. : :, - w'ccds 10,000 amp<.n 150 tub ur ❑ flnmi001w dinr>. • I- an d2- I'mnil dwelling, lu.rtu ground.urcncccdr14,000 ❑Coimorc1d•um y I� y ❑ Commercial /industrial ❑ Accessory building tulips tornll olhcriun1411 iwn. kii4ingt, O Mulii•fuinily 0 Master builder ❑ Other: ❑rile platy,. Q loo ;d1al4,1 of 75 x VA ur :' ` "' '- JOB SiTB INFORMATION AND LOCATION f]en sys on larger s eparncly derived'yilely, (] Additirol ni ucw ro am In:1d of d "A" "tti' -0-.1.3-, Job no.: Job site ndttress: 8525 SW PFAFFLE ST 10x)HP or 0. occupancy. ❑ 51,( or 111010 reS1,1CIluil1 11011'4. ❑ Rcereallll nil vellll'Ic 1 ,.,,'RV. City /State/ZIP: TIGARD, OR 97223 0 Hcahh•caw ruiiilico. ❑ Sup0 voaage for more drat _ ❑ Haoal,luu, iot'utiunc. (,00 vale nonunni. Sllitc/bidg.0pt, 110.11072.t,000 EVI) Project 110110: THE GATE HOUSE ❑ Se,vteoill realer 6001011(11 ur nH , rc. ' ' . ' .Flee sch , ema . Cress street/directions to job silo: _ �_� u I qty. 1 F.,.. 1 'r.,.,1 1 • New reshlenthil single. or 1nu €tl•fanlly dwelling milt. ❑tchHius attached garage, Subdivision: Lot Ito.: 1.000 99.11. or less 145.15 _ I 4 - Tex limp/parcel no.: 1 La. add 'I 500 sq. It. or portion 33.40 1 I.11110cd eoort;y, revidcnlial 75,00 2 DESCRIPT OP WORK (will, above 'al. n.) INSTALL FIBER OPTICS FOR VERIZON Li ",it <l e "ol' "'alt /- 1't "n ;ly. 75.00 2 • I'evidcntcd (viol,o,c,; n.) Services or feeders inslnllatlon ned/nr iwlucntlnn 200 amps or less 60.30 2 '' © PROPERTY. ' 0 TENANT • ` . 201 amps to 400 01,130 10615 2 Name: 401 romps to 600 amps 1 160.60 2 ° " 601 alnpe to 1.000 ships 240.60 2 Address: Over 1,000 011130 or volts 454.65 2 Cit /Stole /ZIP: Temporary services or feeders Installation, alteration, and /o r relocation Phone: ( ) pox; ( ) 200 01110 or loss I 66.05 I t Owner installation: This installation is being made on property that I own which is not 201 Hmp010 400 an1os 100.0 2 intended for sale, lease, rein, or exchun e, accordin • to ORS 447, 449, 670, a and 701. 401 amps to 599 imps _ 133.75 j 2 Owner signature: _ Dale- Branch ell-cults - new, tiller: tlon, or extension, per panel — _ A.I'cc for brunch circuits with 1 � • 0 APPLICANT : ::j ' 0 - CONTACT PERSON ' above service or feeder fee, 665 2 • each branch circuit Business name: NORTH SKY COMMUNICATIONS, INC. n.Foo branch cilculu ' E RIK SCHENCK rirhoru`crvicc 4685 2 Contnct panto: n first branch circuit Address: 11818 SE MILL PLAIN BLVD STE. 410 Each add') brunch circuit 6.65 i 2 hiiseellaneous (service or feeder not included) City /State /ZIP; VANCOUVER, WA 98684 Each munulilctnrcti or modular I 9U90 0 ` Phone: (503 ) 969 -7729 I Fox:: ( 866 ) 452 -4853 dwalin service 44(1/46r feeder Reco only 66.65 2 E- mail: mduorenorthskycomm.COM Pliny orirrigationcircle 53.40 2 CON't'RAOTOR Sign or 011111110 lighting 53.40 Business 1191110: NORTH SKY COMMUNICATIONS INC, Si or liltlited� r energy paucl, ahcrdieu, yr Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Paget $75.00 2 City/State/ZIP: VANCOUVER WA 98684 Each additional fuspection over n1lnwnhta in any of lila above • Phone; ( 360) 254 -6920 Foe: ( ) 1- 866 - 530 -4325 Per ti g li vlion 62.50 IavcstigHtinn l>crhour(Ihr mtl) 62.50 CCB Lie.: 14117/ Electrical Lio .17 -154CL Suprv, Lie.: 173LEB hldust,iaipl.oilpc,- hoc 73.75 Suprv, Electrician slg fcb :> required: •7 /r /l / )/� r , • ' " ELECTRICAL PERMIT FEES ' Subtotal: $75.00 Print 111110 JACK CAGLE Date: 6/25/09 Phut review (25% of permit fee): State surChatge (12vo °I fee): $9,00 Aulhorizcd signature: D., TOTAL PERMIT PEE; $84,00 Print none: ' Mt vomit voit upplImiIon uxplr a If a poring is not termini! whine 180 ETHAN A. DOLPH D ate: 6/ 25/09 cloysnfier1111aw Won ;templed aronupkty, InM,IXtin u'tt�„UdrI,GP :r,u :,s doe acr)y05 ' Nunn,. or luapcclluns ullue'cu 1tir pev oh. C I r Jill .161 1'91 iatiCONV,00i11