Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
r X
COMMUNITY DEVELOPMENT Permit #: ELR2009-00169
• tidARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/30/2009
Parcel: 1S 136CB00700
Jurisdiction: Tigard
Site address: 8545 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 OA 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: 8- r
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 . .-
C ` ::'._:: FOR OilLCE USEONLY ,'.:;• _ . • - :: ..a`..,;c
CITY OF TIGARD • .. :: ... -. :
• -' City of Tigard IthrJ.
1
Y ).)aIJS : j NOM Holt Blvd., Tigard, o RRIIILDING DIVISIO Ian Hcvlo.v -� °� i .
�+ 13125 SW
1 cha ser 503.639.4171 pax: 503.598.1960
umcni O■bcr t'ccmiv
TIGARD Inspection Line: 503. 630.4175 DA: RcattyA)y: had 61 Ste P gc 2for
Internet: www.tignrd- or.50v Nu9fied /Menwd: Supplcmrnlnt Infnrn,aa tot
.. r1PF 6F WORK 'r:: : : PI„ tN REVIEW. •
El New construction El Addition /alteration /repincallent Plmoe Al that upply(iuhmit2 nt'plans a /iiemtsehcckoil t)closv):
0Scrvtee or(ceder Oa:0,psitmote 13 Ilona tog toter throesto ∎lei.
Q DCtIl101ittOtt 0 Other:
Miele t110 nvit;lAl,lc Il,ult cm mot ID Marina, :04 bnwy.oto.. • . .
CA I'I'( 0kV OF:CONSTRUCTION execds 10,000 xnry)s u1 ISO ,,,I hi or ❑ f7ua11ng bu'tdlugi.
■ Icst to ytound. or caeoedt 14.000 0 Cununerelat•uso ;Cc lcvlutrat
0 1- and 2- I'unlilydwelling ❑ Colnnnercinl /indwtrint ❑ Accessory building I mops for all cutlet' insudluduns. buildings.
GI Multi - family 0 Master builder ❑ Other: 0 f-Se pomp. p hw;dhaion of 75 KVA op
- .. '• JOB SITE INF.ORNIATION AND LOCATION (][nscrgasyston). agor;cpv;tmly<Wrivr
-- -- - (]Ad <lilinn t<y nr romrin:ulN ❑ l"r1 ""li "I•T "'Lt syslc
Job no.: Job site address: 8545 SW PFAFFLE ST I(M(Hr or mot. uccnparOY
❑ Sin or more fiSiticrni:ll tnlil5, 0 Rc to aloes! vclticte p;lu n.
City/State/ZIP: TIGARD, OR 97223 0 Hu facilitics. 0 Supply valulgo fn. more ,lint
.- ..._._._ . ❑ Hazardntn locutions. 600 von,. nmninn6
St11teibldg. /apt. 110.5:072.1 soon EVEN Project naive: THE GATE HOUSE ❑ Service or feedcr600 11111)/S ui more.
._-.-.,•.. _ .................__.... ..__
FEE SCHEDULE ';
Cross street/directions to job site: Or hit.,ii j 910. 1 NM. ) Two i •
New residential single- or mu lct - fanilly dwelling uuli.
Lutlutlus Munched garage.
Subdivision: Lot no.: 1.000 sq. It. or less 145.15 [ 4
Tltx 1111%0/parcel no.: - - f E;1. ad<I'150U sq. 0. or portion 33.40 I
1,.iutitcd crrergy, iesidonlial 75.00 2
DESCRIPTION OF WORK (with :dw,c ,q. ti.)
INSTALL FIBER OPTICS FOR VERIZON
Limited energy, mahl- t:anily 7500 2
residcodal (with Maws: wt. It.)
Services or feeders inslnllntlon,alterntion, rld/or rClnentlnn
200 amps or less 80.30 2
:. 'E) PROPERTY. . 'El TENANT " . 201 amps to400atips 106.85 2
Name.: 401 Amps to 600 amps !60.60 2
--- 601 amps to 1,000 amps 240.60 2
Addre s. Over 1.060 amps or volts 454.65 2
City /St:de /ZIP: Temporary services or feeders Installation, idler: lion, a silor
relocation
Phone:( ) Fax: ( ) 200 snips ot'less 66.85 I
Owner Instnilation: This instnllntion is being made on properly that I own which is not 201 maps to 400 150110 100.30 2
intended for sale, lease, rent, or ext:hnage, according lo ORS 447, 449, 670. and 701. 401 ;naps to 599 snips 133.75 2
_ ` -- -..-
Branch circuits - new. alteration, or extension, per panel
Owner signature: -Date: _
A. Fee for breach circui to )ri/fr
• ' 0 APPLICANT ' •' .., .: J - 0 CONTACT PERSON ' above service or (ceder fco, 6.65 2
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC, n. Pee for brtoldicircuil..
n 'idiouI 'service of fe eder ice, 2
Contact nano: ERIK SCHENCK 46.85
�._ im brooch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Fach add'l brunch cilctdt ---
6.65 2
-"--.' - Miscellaneous !serviceor feeder not ineluded)
eity/Statc /LIP: VANCOUVER, WA 98684 Edelt rnunnlhcwred or notiulur '
90.90 '2
Phone: (503 3 969 - 7729 J Fox: ; ( 866 ) 452 dwcIlinr„ ser vice and /or (ceder.
Reconnect only 66.85 2
Entail, mduarOnorthskycomm.com _ pinup or inigatiou circle 53.40 2
CON'I'RAUTOR • • Sign or outline lighting 53.40 2
Business tonic: Signaleircuit(s)orlimited-
NORTH SKY COMMUNICATIONS, INC. energy panel, ahcnuion,or
Address: 11818 SE MILL PLAIN BLVD. STE 410 exlensiorl.Describe: 1 Page $75.00 2
City /Stnte/ZiP: VANCOUVER, WA 98684 Each nddltionnl Inspection over allotrnblo In any of the above
Phone: ( 360) 254 -6920 Fnx: ( ) 1 -866 -530 -4325
Per tnepeu, 62.50
_ htvcsYigatlnnperhour b ?.St)
CcB Lie.; 14117 Electrical Lic.17 -154CL Suprv, Lic.; 173LEB I1tdn,,ui:d pl;lnt perlto to 73.75 _
Suprv. Clcclricinn signnatrc, regained: - ELECTRICAL. PERMIT PF-RS •..
Subtotal: $75.00
Print none: JACK CAGLE Date: 6/25/09 Phut review (25% of permit fee):
St ate surcharge (Iwo of !sunlit fee): ' $9.00
Authorized signature; r 0_14_
TOTAL PERMIT P6I.: $84.00
Print notac: ETHAN L PH Date.: 6/25/09 rot, ',milt uppftcnlluu osplrw if a pormu Is not obtained menu IRO
f"t• �� tlns%after II 1ros becu neceatod A. cmnplNe.
I:IOaI!uin•WUUI;,dI;I,C -14r „ in,11 n.r OV:StOO ° t/SUtnbvr of i17:peeltuusttltusved tier peruse.
b At 44Ir 461/'1''(1 I /D.CO.I000titl