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Permit Y TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT I ll COMMUNITY DEVELOPMENT Permit #: ELR2009 -00171 K ,, ; Date Issued: 06/30/2009 :T. CARD; 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 . ,,. :. ,;, ; , I Parcel: 1S135DA00500 Jurisdiction: TIGARD Site address: 8585 SW PFAFFLE ST Subdivision: Lot: 0 Project: The Gate House Project Description: Install fiber optics for Verizon FEES Owner: GATEHOUSE LLC Description Date Amount 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 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, 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. 1 RECEIVED JUN 2 5 2009 CITY OF TIGARD Electrical Permit Applica �t��LDINGDIVISIO FOR011110E USE ONLY.': '. City of'fi and Resell ,.. t t 25 s 97223 Oatc/lly; /-'f Pcnuii Na.: ,e I_ I `2 . 0 0 / 7 i 131 5 SW Nall Blvd., Tigard, OR 1)223 Phu Review i t Pbunc: 503.639.4171 Lix: 50 3 . 598 . 1960 ua,crny: Other Vicel c Ti GARD Inspection Line: 503.6394175 Date Ready /oy: hni,: El See Page 2 Cot Intcnlct: www- tlgard- or.;nv Notified /Method: Supplemental Information ' TYPE Ol WORK ''::r' ' .. . . ... PLAN REVIEW ' }: • 0 New eonsinnnelion I:a Addition/alteration/replacement PIC::<e CiiCI iii tent apply(suhntit 2 call Si plant ,V/:lams checked :)Clow): 0 Sc)vtce fcc4cr4Va an,pt nr noes 0 0.1)10119 nvcr+b,¢c.tro,lev. ❑ t3Demolition © Oilier: or mu:it iiis avnllnhlc C,un canna ❑ Nunum and honly,,rut. .. , CATEG OC. CONSTRUCTION ...'. '1 ‘ encec•IIt 10,(0 imps ;II 15(1 trills or ID f lnanag buildiogi. tar in ground. ur m. cccdo 1.1,000 0 Cuunucrckd.utc igrlcullurat ❑ I• and 2- famnilydwelling ❑Commercial /industrial ❑ Accessory building map fur n1l other husidhniens. buildings, 1: Multi fly 0 Master builder ❑Ocher: Prim Puny,. ❑ hn5iiiiionof 75 KVAm JOB SITE 1NIORtfATION AND LOCATION a+ergalsysyan. law >cp.+nii lydelived • -^ ' " PAdni�i�nntnew 0 "A" "(f' "I• °" "I•S•, Job no.: lob site edclunso: 8585 SW PFAFFLE ST 1.1)OH2 or move. ocenparny. 0 Sin or inure re rilicnlinl units, 0 Hegel: I t 6\1 velflcic murkn. City/State/ZIP: TIGARD, OR 97223 O Hcaltlucnn facilities. ❑ Supply vntn :gc fur, norm than ) ❑ Ht'' /ar,1 Iocull011t COO 5 SuitC /bI(lg./7pt. n Project ionic: THE GATE HOUSE ~- 0Scrviconrfeedcrl00mosormitre. 1 "`- '." • -FEE •sCilEDULE . • • Cross stied /directions to job site: �. .4. nr■crgnton I qtr. I rm I 'IS,a,t I Now residential single- ornmlti.fnmlly rhrellhyh 111111. lnetudus nnnelled garage. Subdivision: Lm no.: 1.000 x51. f) or loss 145.15 4 Tax limp/parcel no.: - ' - ' --- I La. Jcld'1500 sq. 11. or portion 33.40 I Limited energy. residcuual 75.00 DESCRIPTION OF WORK (win, alxlvc rq. it.) INSTALL FIBER OPTICS FOR VERIZON Lim residc a nal ( umtd.l' 75.00 utiid (wiaud.)r,:ar Services or feeders inseatintlon muUor reluclttinn ) 200 amps or less 80.30 2 ❑ PROPER'I'Y'OWNER - -: .. . '13' TENANT ' • 201 amps to 400 amps � � 106.85 2 Name: 401 amps no 600 imps 160.60 2 601 amps to 1,000 pulps 240.60 2 Address: Over 1,090 amps or volts �___ 454.65 2 City /State /ZIP: 'funlparary ser viee4 or feeders Installation, alteration, and /o• relocation Phone: ( ) Fax: ( ) 200 amps or less ' 66.85 Owner instullntion: This instnlhuion is being 'node on property that I own which is not 20) maps 10400 amps 100.30 2 - intended for Sale, lease, rent. or exchange, according to ORS 447, 449, 670, and 701. 401 inun s to .599 amps 133.75 2 Owner signature: Date; _ Brunch chenille -new. inber;nion or ex)e stmt, per panel A. Fee for brooch circuits lw/s . ! ' 0 APPLICANT : ". :: • ...0 CONTACT PERSON • ubuve.sc1 vice of I'ccdcl 0.v' 6.65 2 each branch circuit Rusincspnalne: NORTH SKY COMMUNICATIONS, INC, n. Fee for branchci,cubs Concoct name: ERIK SC H EN C K -` mldtolrr service or feeder fee, 4685 lies( branch circuit Address: 11818 SE MILL PLAIN BLVD STE. 410 Floc, add') 6.6.5 2 Miscellaneous (service or feeder out included) 4 City /Slats /ZIP; VANCOUVER, WA 98684 Gaols manufactured or modular 90.90 Phone: (503) 969-7729 I Fax:: ( 866 > 452 -4853 dwdllinr„ service mul /or feeder 2 R econnect only 60.65 2 E•nlail: 1 • ! (i) II • II s • 11 11 • 11 Puunp or irrigation circle 53,40 2 CUNTRAOTOR • Sign or outline lighting 53.40 2 Businosname: NORTH SKY COMMUNICATIONS, INC. e anel clingy p alteration. 9r Address: 11818 SE MILL PLAIN BLVD. STE 410 cxtcnsion.Dcscribc: 1 Paget $75.00 2 City/Sta1. /ZIP: VANCOUVER, WA 98684 Each additional Inspection over allmrnhlo In any of the above t impaction 62.50 Phone; ( 360) 254 -6920 Fax: ( ) 1 -866 -530 -4325 li hacsligndnn per holm (I I:rmin) 62.50 CCS Lie.: 14117 G leclrical Lic.17 -154CL Snpt'v, Lie.: 173LEB 6iJuvlrial plane per hour 73.75 •" ELECTRICAL PERMIT PEES Suprv. Blcctricinn slgnnt(n'c, requimd' Subwtr4: $75m0 Print name: JACK CAGLE Date: 6/25/09 Phut review (25% of permit fee): Snits surcharge (1250 of (mail fee): $9,00 Authorized signnturc : y •,� / e _ TOTAL PERMIT t Gli; $84.00 _ DOLPH 'f , emit u , licntun ()Spiro Ira purndt Is not xbtnbua within 180 Print "mite: ETHAN A. DOLPH D ale: 6/25/ 1 say..( ,m,..1( Pax bccu navptcd as cvu ' Nu ultror or hispcculuns allu Ir,r pcnnh. 140u44tngv 'erml,dlii,C- Parm4Allr Jac 05121,04 44(1 46151'(1 l /Il.1vCOhtdn)ill