Permit i y CITY OF TI GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
e COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00021
T I G AR D 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/5/2009
PARCEL: 2S102AC -00201
SITE ADDRESS: 09407 SW MAPLEWOOD DR M ZONING: CBD
SUBDIVISION: MAIN STREET VILLAGE APARTMENTS LOT: JURISDICTION: TIG
PROJECT: MAIN STREET VILLAGE
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:
Owner: Contractor:
CASA LA VETA ASSOCIATES + NORTH SKY COMMUNICATIONS INC
HIGHLANDS ASSOCIATES ET AL 11818 SE MILL PLAIN BLVD
BY GUARDIAN MGMT ATTN: BARRY B SUITE 410
PORTLAND, OR 97228 VANCOUVER, WA 98687
Phone: Contact #: PRI 360 254 - 6920
FAX 1- 866 -530 -4325
Reg #: ELE 17- 154CLE
FEES LIC 14117
Description Date Amount
[ELPRMT] ELR Permit 1/5/2009 $75.00
[TAX] 12% State Surch 1/5/2009 $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 r\ l J \X 611 Permittee Signature: S_Q 0 :31\--KA os py)
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.
RECEIVED
Electrical Permit Application
FOROFiFtcEUS ONLY
JAN 0 5 2009 -
City of 'Tigard Reeeted
Date/ 11 •: 5 - a
PP
• 1h 1ne SW Hall 1. 11bat � TIGARD Recei Review 1
Plan
""-------
Phone: 503.639.4.417171 I ; 9 I Date/13y: No.: 1 . Q V.7 J y: Oilier Pcnnil:
TIGARD D Inspection Lino: 503.639. ILDING DIVISION Dutc Rcad /my: m n:1 ta See Pnge 2 for
-- - _ _ Internet; www.tigard- or.gov Notified/Medium -t l(7 Supplemental tnformatpun
TYPE OF WORK PLAN REVIEW
❑ New co1011 uetlon 171 Addition/ alteration /replacement Please check all that apply (submit 2 sots of plies w /items checked ()clue):
❑ Service or feeder , I00 amps or more ❑ flullding over Mice stories.
❑ Demolition ❑ Other: w the Available fault current ❑ M n nnm and heal yards.
CATEGORY OF CONSTRUCTION excctds 10,000 coups at ISO volts or ❑ Floating buildings.
•
less to ground, or exceeds 14.000 ❑ Conmtarcial -use agricultural
❑ I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building anyts for all other installations. buildings.
Multi- family ❑ Master bulkier ❑Other: ❑ Fire pomp. 0 Insiallationof75KVAor
JOB SITE INFORMATION AND LOCATION ❑ Emergency sysent. larger separately dewed system.
❑ Addition oI new molor load ol ❑ "P" "I "I -' "I.3
Job no.: I Job site address: 9407 SW MAPLEWOOD DR. Imp or ;nom occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: TIGARD, OR 97223 ❑ Heahh -cave facilities. ❑ Supply voltage for more hit
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: M 138 -149 Project name: MAIN STREET VILLAGE ❑ Se rvice or (ceder 600 amps or tore.
FEE SCHEDULE '
Cross street /directions to job sac: msrnpumr t Ow, I Pee. I 'rend I '
New residential single- or multi - family dwelling unit.
Includes attached garage.
-
Subdivision: Lot no.: 1.000 sq. ft. or less 145.15 4
Es. add'I 500 sq. 0. or portion 33.40 I
Tax map /parcel n0.: Limited energy, residenlial
75.00 2
DESCRIPTION OF WORK - � _ (with above sq. 0.)
INSTALL FIBER OPTICS FOR VERIZON Iilllitetlenergy, multi- I;Ilttiiy
75.00
residential (with;moves+ t.)
Services or feeders installation, alteration, anti /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ' ' I . _ . ❑ TENANT 201 ansps to 400 amps 106.85 2
Name: 40l amps to 600 amps 160.60 2
601 ;steps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /Stitt /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 I own which is not 201 stops to 400 amps 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: Date: __ - -�
A. Fcc for branch circuits wish
❑ APPLICANT • ' • I • d CONTACT PERSON above service or (ceder fee,
•
each Minch circuit 6.65 2
Business name: NORTH SKY COMMUNICATIONS, INC. O. Foe for branch circuits
RY ROBERTS without service or feeder fee
Contact name: RYAN 2
Cast branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each :ldd'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City / State/ZIP: VANCOUVER, WA 98684 Each manufactured or nodular 00.90 2
dwelling, service and /or feeder
Phone: (503 ) 519 -5264 I Fax: : ( )1- 866 - 905 -4907 Reconnect only 66.85 2
E-mail: mduorc northskvcomm.com Pump or irrigation circle 53.40 _ 2
• • CONTRACTOR • Sign or outline lighting 53.40 2
Signal circuit(s) or limited-
Business name: NORTH SKY COMMUNICATIONS, INC. energy 'notch alteration, or
Addi'esti: 11818 SE MILL PLAIN BLVD. _ S _ TE 410 extension. Describe: 1 Paget $75.00 2
City /State/ZIP: VANCOUVER, WA 98684 Each additional inspection over allowable in any of the above
Per i 62.50
Phone: ( 360) 254 -6920 Fax: ( ) 1 -866- 530 -4325 investi per hour (I hr min) 62.50
CCB Lie.: 14117 Electrical Lic.17 -154CL Suprv. Lie.: 173LEB Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES '
Suprv. Electrician signature, required: Subtotal: $75.00
Print name: JACK CAGLE Date: Plan review (25 %01' permit fee):
1 -5 -09 State of (12% surcharge permit fee): 0
Authorized ssignature: � / s , ' �' g ( TOTAL PERMIT FEE: $8484 ,00
This 'toroth upplicaliou °spirts if a permit is not obtained within 180
Print name: ETHON A. DOLPH Date: 1 -5 -09 days oiler 11 has been accepted as complete.
° Number of inspections allowed per pernin.
I: tlwtdingileuniositt .C•PennitAnp.nne ei/aalb 4.10.460 I uQVCOSIAVIiI)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: k:l.l' 200B 00021
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11:.x 2009
Phone: (503) 639 -4171 1(11
Inspection Requests (24 Hrs.): (503) 639 -4175 --
INSPECTION WORKSHEET FOR DATE: 1/20/2009 TIME: 7:00AM PAGE: 48
SITE ADDRESS: 09407 SW MAPLEWOOD DR M CLASS OF WORK:
SUBDIVISION: MAIN STREET VILLAGE APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: MAIN STREET VILLAGE
DESCRIPTION: Install fiber optics t'or Verizon.
OWNER: CASA LA VET A ASSOCIATES +, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-254-6920
Inspection Request Scheduled For: Date: .1m0009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
136 Low voltage 0798013.02 50-849-2025 Y
Corrections /Comments /Instructions:
1
�'t
XPASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: i 0 vB L Date: 1 — 2,0 - 1 Phone #: (503) 718- __ {