Permit CIT OF T I G A R D ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00053
T I G A R rD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/19/2009
PARCEL: 2S 101 AB - 00801
SITE ADDRESS: 12366 SW 72ND AVE 211 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: -cc U Permittee Signature: Q, ppii 0._Qa�ijn
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.
Electrical Permit A tic' CEDED FOROF1YCE USE ONLY ,.
City of Tigard
13125 S W Hall Blvd., Tigard, OR;-9722,1 M V • �r �� ��
17
8 2009 Plan Review
Phonc: 503.639.4171 Fax 503.598.1960 Date/0 ; Ober Perini!:
T IGARD Inspection Line: 503.639.4175 D:uo Ready/By: la Sec Page 2 for
Internet: www.tigard•or.govv CITY i O * FTIGARD Notified /Me hud: Supplemental Information
TY>yNi91l4P DIVISION PLAN REVIEW .
❑ New construction 1511 Addition /alteration /replacement Please check alt that apply (submit 2 sets of plats w /items checked below):
❑ Service or recdcr 400 amps or more ❑ Dnikting over 'Mee stories.
❑ D CIn01i[i0n
❑ Ousel•: whet: to available (atilt Current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000:unps at 150 volts or ❑ Floating buildings.
loss to ground. or cxeccds 14.000 ❑ Colmcrci: l•usc aericulwra
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building map, for all other installations. buildings.
o Multi - family ❑ Master builder ❑ Other: 0 hire pump. ❑ Installation nt 75 KVA us
❑ Emergency system. larger separately derived system.
JOB SITE, INFORMATION AND LOCATION ❑ Addition of new motor b oa t of ,. "1.3".
Job no.: Job site address: 12366 SW 72ND AVE. IflOHPor rrttrl:. Occupancy.
❑ 513 Or pone reSidenlial units. ❑ Recleutionnt vehteic park,
City /State /ZIP: TIGARD, OR 97223 ❑ HeaI1h•carc facilities. ❑ Supply voltage for more than
❑ Hamrdnus locations. 600 volts nominal.
Suite /bldg. /apt. no.: BLDG 1 Project name: HAMPTON PARK ❑ Service or feeder 600 imps ormom.
FEE SCIIEDULE '
Cross street /directions to job site: Description I Qty. 1 Fee. 1 row 1 •
New residential single- or multi-fondly dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. or less 145.15 4
Ea. ad<I'I 500 sq. 0. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK 75.00 2
(with atwvc sq. (i.)
INSTALL FIBER OPTICS FOR VERIZON L iini`e`Ieltersy'I "dlli•I'Irmily 7500 .
residential (with above so. 6.)
Services or feeders installation, alteration, and/or relocatio
200 atnps or less 80.30 2
❑ PROPERTY OWNER ' ... ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Ovcr 1,000 amps or volts 454.65 2
City / State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps l0400amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature:. - -_ .............. — __--__ _-_Dale: ---- - - - --+ A. Fee for branch circuits with
❑ APPLICANT 1 a CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business /same: NORTH SKY COMMUNICATIONS, INC. 13. Fee for branch citcuits
RYA ROBERTS o' t branch service or feeder f ee.
Contact name: 46.85 2
lust branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each :tdd'lbranch circuit 6.65 2
Miscellaneous (.service or feeder not included)_
' City /State/ZIP: VANCOUVER, WA 98684 Each manufactured or nodular 90.90 ?
dwelling, service and /or feeder
Phone: (503) 519 -5264 Fax: : ( )1 -866- 905 -4907 Reconncet only 66.85 2 -
E -mail: mduor eCr�' northskvcomm.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: NORTH SKY COMMUNICATIONS, INC, energ y Pan p a n el a l t rhmitcd-
energel, , aheration. or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Page 2 $75.00 2
City /State /ZIP: VANCOUVER, WA 98684 Each additional inspection over allowable in any of the above
Per inspection -__ 62.50
Phone: ( 360) 254 -6920 Fax: ( ) 1- 866 - 530 -4325 Investigation per hour (I in min) - -- 62.50
CCB Lie.: 14117 Electrical Lic.17 -154CL Sup". Lic.: 173LEB Industrial pant per hour 73.75
ELECTRICAL PERMIT FEES • .
Suprv. Electrician signature, required: Subtend:
$ 75.00 _ .
Print nne: JACK EAGLE Date: Plan review (25 /o of permit fee):
2 -18 -09 u slate so rchat e
lll g ( 12 of permit fee): $9.00
Authorized signature: ` ' O TOTAL PERMIT PEE: $84.00
This permit application expires if a permit is not obtained within 180
Prinlname: ETHON A. DOLPH Date: 2 -18 -09 (lays sifter itbas !seen aecepledascomplete.
• Nuudxr 01 allowed per penult
l ll1oikliu 5'cu ubplil,C•Penn,tuApp•doo 0925106 4054615111 l /(l3/COM/WIEI)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR'2009 000 3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 21.9/2009
Phone: (503) 639 - 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 s' 67 IL.
INSPECTION WORKSHEET FOR DATE: 3/2/2009 TIME: 7:00AM PAGE: 2
SITE ADDRESS: 12366 SW 72ND AVE 211 CLASS OF WORK:
SUBDIVISION: HAMPTON PARK APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: HAMPTON PARK APARTMENTS
DESCRIPTION: Install fiber optics for verizon.
OWNER: HAMPTON PARK LLC, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 36 254-6920
Inspection Request Scheduled For: Date: 3 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 ectrical final 080966M1 503-9316684 Y
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: N 66 Date: 1 - 2-' -1 Phone #: (503) 718- ,-11`41