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Permit ow • - ` K ;' CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT ,I pl ,� • COMMUNITY DEVELOPMENT Permit #: ELR2009 -00170 ;'` `� 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/30/2009 g TIGARD Parcel: 1 S135DA00500 Jurisdiction: TIGARD Site address: 8565 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: 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 95 01 -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: I —Cii—A- 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 N 2 5 2009 Elects•icaL Permit ApplicatieliTY OFTIGARD Fox;orrtC1+; :,:':.; :;.'':::. <:; ; City of Tigard BUILDING DIVISION 'tactual V j bite /il F+� VClllli+ No.: L U/ C� t ?"17 ,1 13125 SW Hall Blvd., Tigard, OR 9722.1 plan R v iew ! I lk t • ' P11onc: 503.939.4171 F,tx: 503.590.1900 Od,vr l2rmic 1T,nc /ny: TIGARD lnspcetiol Lice: 503.639 4175 Date Ready /ay: haic B1 See Paget for Internet: www.d,urd -oreoe Nmlficd/Mmtmn: Supptemeoinl tnfoestaOxu . `. TYPE OF WORK . • . .. :'PLAN REVIEW. '; ::r El New COnnItUCliUn Addition/alteration/replacement pie;Osc chcek:dl lha( apply(suhmil 2;eo OI 00 ems dcekcJ:clow): El Demolition (] Other: 0 Sclvtco or Coact 41y) amili ur olio,: ❑ 6allli1 overuuca010 : ICS. mate 11,5 available lull current CI womb anti homy:1NR, ` "" '''" • CA'fI'(;ORY or.CONSh•IfUC'1ION .. :"•:i .. caccedt 10,000 amps al150vohvur ❑ Noting bultJiogi. - .rid - rntnil dwelling le.sIngromxi.oreneeilv14.090 ❑Cn ❑ 1 Y d g ❑ C0t51ncrcinl /ill(luxtrinl ❑ Accessory building mops fur oll otter immtlhnions. bnildinge. 511 Multi. family 0 Master builder ❑ Other: 0 6ite founts. 0 Iii lluGw1 of 75 KV,S ul • J'OB SITE • INPORIviATI0N AND LOCATION '1. xyalo hr sepsi y t1v s it •n l . . -- ----• ... ❑ Addition nl y new nm . mr lout n( ❑ ^q" •'14' .,I•'Ytcl •, I•i" at Job no,: Job site address: 8565 SW PFAFFLE ST 101/HP or omit. ror:tnvy. 0 Six or more re doily, ❑ Rarculiu reline prkv. City /State /ZIP: TIGARD, OR 97223 ❑ 11ca llh'c:■c rxcilitici. 0 Supply voluwgc fox More Iron , ❑ Harortcln Io;•ulicot. (1(10 volts ncnlinul. Stilts /bldg. /apt. 110,.11o22.t1o4O€vEN Project name: THE GATE HOUSE 0 Cervicoor feeder 600towsornone. FEE 'SCHEDULE '': Cross r IlceI/dircctions 10 job site: nncrgmr,n I ouy. I I'm I • f.I.i_t ) New restdcntiol single• or tnultl•fnnilly darcllhlg milt. Includes attached garage. Stibdivieiolt: Lett no,: 1.000 so. It. or lob' 145.15 4 L•';1. add'I 500 sq. It. or portion 33.4U 1 Tux auto/parcel no.: l..imitoe enorgy, rc,ittcnlinl • DESCRIPTION OP WORK (Md I 3bucc or. ft.) 75.00 '2 INSTALL FIBER OPTICS FOR VERIZON L;Inilatl° °orgy , mn)tI- 1it111i1y 75.00 2 residendai Neinl lJx,va al, Ill Services or feeders inshulntIOn, alteration, and/or relocnllon ' 200 amps or less 80.30 2 `❑ PROPERTY: ... . .. .. '- D'TENAN'f • . 201 uu to 106.85 2 - _ ....._.._ 4666 _ _ Nance: 401 ntoiw to 600 snipe 160.60 2 °'" - 601 stops to 1,000 ;mums 240.60 2 Address: Over 1,000 ampe or onus _ 454.65 2 City /State /ZIP: Temporary services or feeders Installation, alteration, and /or relocation Phone: ( ) Fox: ( ) 200.5590 or Ices 66.05 I Owner installation: This insmllntion is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for Sale, tense, rent, or exchange, according to ORS 447. 449, 670, and 701. 401 amps to 599 amps 133.75 _ 2 Owner signature: Date: Branch clrcults new. alteration, ur extension, per panel A. Fee for branch circuits trial ' ' El APPLICANT ' • • : ::f • . ' © CONTACT PERSON ubovc service or feeder t'ca, 6.65 2 each branch circuit Businessnome: NORTH SKY COMMUNICATIONS, INC, 0.reorbrbnmchcitcttit, Concoct name: ERIK SCHENCK __ - u'irhontscrviccor 4685 2 first branch circuit 46_85 Address: 11818 SE MILL PLAIN BLVD STE. 410 bachtldd•I brunch citcnit 6.65 i 2 - Miscellaneous (service or footle r not included) City/Slate /ZIP; VANCOUVER, WA 98684 Gant InanitGantlrcd or tnodulur E dwelling, service mulfor (ceder 90.90 2 Phone: <503 ) 969-7729 I Fax:: ( 866) 452 -4853 Rccamccroul 53 2 &mail, • t ntt•ll .ycomm,com _ Punt9orinigativncircle 53.40 111111111 2 CON'1'RACfOR Sign oruulline lighting 53.40 2 Business name-. Sigurd circuit(s) or liulilcd• NORTH SKY COMMUNICATIONS INC, energy Noel, altoratimn . or Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Page 2 $75.00 2 City /State/ZIP: VANCOUVER, WA 98684 Doh additional Inspection over Allow In any of the above Per inspection 1 62.50 Phone: ( 360) 254 -6920 Fax: ( ) 1 -866- 530 -4325 hwestigntIon per hoar (i 1-r mini 6230 1 COB Lie.; 14117 ElectricalLic.:1 -154CL Suety.Lic.:173LEB rttdttsnt,t plant per hour 73.75 i . . ..CLEC'RICAI. PERMIT FEES -- ... • Sum. Electrician signature, re.quirrdf stubtanl: $75.00 Print nntno: JACK CAGLE Date: 6/25/09 PIes, review (25% of permit fee): Suue surcharge (12% of pertnit fee): $9.00 Autt1 iiicd signalurc: TOTAL PERMIT PEE: $84.00 'r vomit u , p Print onto : ETHAN A. DOLPH Date: 6 /25/09 I t 9sc after os x IA.•. l ht accepted Is not ol nnt med of ISO dnyc after It flax bc�tn nttcplatl my cumplck. e Nulnbar et Impccllmli nllowctl Inr pcn In .;;;;f hO'dtog,,, ,C• 5,0u5 ' 05(7705 islm_w1,5'1 Ir11.9coot cvm:It