Permit i
!P a CITY O F T I G A R D ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00052
r I c A R D 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/19/2009
PARCEL: 2S 101 AB -00801
SITE ADDRESS: 12332 SW 72ND AVE 111 ZONING: MUE
SUBDIVISION: HAMPTON PARK APARTMENTS LOT: JURISDICTION: TIG
PROJECT: HAMPTON PARK APARTMENTS
Project Description: Install fiber optics for verizon.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
HAMPTON PARK LLC NORTH SKY COMMUNICATIONS INC
BY WEST COAST MORTGAGE 11818 SE MILL PLAIN BLVD
4000 KRUSE WAY PL, BLD 1 STE 2 SUITE 410
LAKE OSWEGO, OR 97035 VANCOUVER, WA 98687
Phone: Contact #: PRI 360 - 254 -6920
FAX 1- 866- 905 -4907
FEES Reg #: ELE 17- 154CLE
LIC 14117
Description Date Amount
[ELPRMT] ELR Permit 2/19/2009 $75.00
[TAX] 12% State Surch 2/19/2009 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: VirStasiNo d4 [ it f Permittee Signature: Q g_ \ % � OA
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'N: 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.
w
Electrical Permit Application RECEIVE P
kUli OFFI(;,� UbE ONLY.
City of Tigard Received a - 18 ....: FA ezc�R • 0onez-
Y FEB 18 2009 Datv/r)y: O q Pcm,it No.:
Er 13125 one SW Hall Blvd., Tigard, OR 97223 Plan iv e d .
None. 503.639.4I7I Fax: 503.598.1960 Datel0y: Omer Permit:
TIGARD
Inspection Line: 503.639.4175 CI OF TIGARD Oat Ready /Oy; ltui,: Si ®e Page 2 for
Internet: www.tigard•or.gov NotifiedlMethod: • .( G Supptemenlul Information
TYPE Olr „WADING DIVISION
PLAN REVIEW •
❑ New construction MI Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items clacked below):
❑ Demolition ❑ Other' o Service or reader 400 amps or mans ❑ 11 ildin over awe stories-
• When the ;IV11itab(C % a tl CUIxC01 0 Marinas and boatyards,
CATEGORY OF CONSTRUCTION exceeds 1 0.000 amps at 150 volts or ❑ Bloating buildings.
less to ground. or exceeds I -0,000 ❑ Commercial -use agricuhuot
❑ 1- and 2-family dwelling ❑ Commercial /industrial ❑ Accessory building onq» for an other installations. buildings.
o Mutti- family ❑ Master builder ID other: O fire pump. 0 Installation ul•75 KVA or
0 Emergency system. larger separately derived system.
JOB SITE, INFORMATION AND LOCATION
• . ❑ Addition or now :moor load of '
Job no.: Jab site address: 12332 SW 72ND AVE. MU uAHP occupancy.
❑ Six or M residcmial units. ❑ Rocmalionnl vehicle parks.
City/State /ZIP: TIGARD, OR 97223 O Hcaiin.c;trc I'acililics. 0 Suppiy vohngo for inure than
❑ Hozardocs locations. Ii)0 volts nominal.
Suite /bldg- /apt. no.: BLDG 2 Project name: HAMPTON PARK o se'vice or feeder amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description l Qty. 1 F. 1 Total t •
__._._....___ ....... ........_ New residential single- or inulti- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. 0. or less 1 45.13 4
Et. ndd'I 500 sq. 0. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK 75.00 2
(,rill above sq. Il.)
INSTALL FIBER OPTICS FOR VERIZON
Limited residential energy, (Milt multi-I,n,a. n 75.00 2
residential livid, alwvc sal. 0.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I • ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: I l •'
601 amps to 1,000 amps 240.60 2
Address: _....__.. _..._...._...- _...-_ -.
Over 1,000 imps or volts 454.65 2
City /State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation _
Phone: ( ) Fax: ( ) 200 dittos or less 66.R5 1
Owner installation: This installation is being made on property that I own which is not 201 amps w 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according 10 ORS 447, 449, 670, and 701. 401 ;Imps 10 599 amps 133.75 2
Owner signature: -- -- ---•• Date:
Brunch circuits - new, alteration, or extension, per panel
A. Fce for branch circuits with
❑ APPLICANT 1 O CONTACT PERSON above service or feeder fee,
6.6 5
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. 13, Fee for branch circuits
Contact name: RYAN ROBERTS without service or :ceder lee, 46.85 2
lust branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: VANCOUVER, WA 98684 Each manufactured or modular
90.90 2
dwelling, service and /or feeder
Phone: (503 ) 519 -5264 Fax :: ( )1- 866 - 905 -4907 Reconnect only 66.85 1 2
E- (nail: mduoranorthskvcomm.com Pump or irrigalion circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
N ORTH SKY COMMUNINC. energy p al or titniled
e usiaess name: CATIONS, , cncrgy p alteration, or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Page $75.00 2
City /State/ZIP: VANCOUVER, WA 98684 Each additional inspection over allowable in any of the above
(360) Fax: ( ) 1- 866 - 530 -4325 I n v s 62.50
Phone: (
36 254 -6920 lnvestigatinper hour (I6rmin) 62.50
CCB Lie.: 14117 I Electrical Lie.17 -154CL Suprv. Lie.: 173LEB Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required:
Subtotal: $75.00
Plan review (25% of permit fee):
Print name: JACK CAGLE Date: 2 -18 -09
State surcharge (12% of permit fee): $9.00
Authorized signature: A 0 TOTAL PERMIT FEE: $84.00
lltia permit application expires if a permit is not obtained within 160
Print name: ETHONA.DOLPH Date: 2 -18 -09 days after lt has been accepted ascomplete.
Number of inspections allowed per permit.
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: EI, R2009.0O0f2
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/19/2009
Phone: (503) 639 - 4171 pup lf�l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/2/2009 TIME: 7 :Q0AM PAGE: 1
SITE ADDRESS: 12332 SW 72ND AVE. 111 CLASS OF WORK:
SUBDIVISION: HAMPTON PARK APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: HAMPTON PARK APARTMENTS
S
DESCRIPTION: Install fiber optics for verizon.
OWNER: HAMPTON PARK LLC, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 361 - 254-6920
Inspection Request Scheduled For: Date: 3/2/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Elect ical final 08 967 -01 503 - 932.668 Y
Corrections /Comments /Instructions:
i t ! )
•
r4 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION E ADDITIONAL FEES ASSESSED
Inspector: . u� �t Date: 3 • Z' 0 Phone #: (503) 718- Sti 1