Permit •
h . 4 CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00024
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/5/2009
PARCEL: 2S 102AC -00201
SITE ADDRESS: 09452 SW MAPLEWOOD DR F 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
FEES Reg #: ELE 17- 154CLE
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. �-1 a Issued By: Permittee Signature: '\ _ ) ` O�
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 FOR OFFICE USE ONLY
- JAN 0 5 2009
City of Tigard . Permit No.: O `.•
r 1 125 SW Hall Blvd., Tigard, OR ( -
• �"
' i OF TIGARD Pont Ito
= r 3 ' Phone: 503.639.4171 fax: 503. I DStc /By: Other Permit:
TIGARD Inspection Line 503.639 Oahe Ready /Dy Joni:: Ea Sec Mtge 2 for
Internet: www.tigard- or.gov lUILDING DIVISIO N T I Supplcmcntut Information
. TYPE OF WORK PLAN REVIEW
❑ New construction 171 Addition /alteration /replacement Please rheck all that apply (subunit 7 sett or plans w /itcros chocked helow):
❑Servi or (coder 400 amps nr Store ❑ Building overihtec stories.
❑ Demolition ❑ Other: where the available hu current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at ISO rolls Sr ❑ Floating buildings.
lets to ground. or exceeds 1 1,000 ❑ Couunereial•uso agricultural
❑ I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building stops for all other insndtnlions. buildings.
El Multi - family ❑ Master builder ❑ Other: ['Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately del Trod system.
❑ Addition of new motor load of ❑ "A" "f:" "I • ?" "I •]",
Job no.: I Job site address: 9452 SW MAPLEWOOD DR. 100HPor occupancy. ❑Six or more fesideutinl units. ❑ Rewoutionnl vehicle 'mks.
City /State /ZIP: TIGARD, OR 97223 ❑Health•carefacilities. ❑ Supply voltage for more titan
0 Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: F 55 -66 I Projcet siuste: MAIN STREET VILLAGE ❑ Service or feeder 600 amps ur store.
Cross street /directions to job site: FEE SCHEDULE
J urxnpuun ) Qty. I fee. I 'royal )
New residential single- or multi- family dwelling writ.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. or less 145.15 4
Et. udd'I 500 sq. ft. or portion 33.40 1
Tax map /parcel so.: I Limited energy, residential
DESCRIPTION OF WORK (with alcove sq. ft.) 75.00 2
INSTALL FIBER OPTICS FOR VERIZON Limited energy, multi-family 75.00 2
residential (with :More su. 0.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ' ❑ TENANT 201 amps 10 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 I 2 '
City /State /ZIP: Temporary cervices 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 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599/1111/)3 133.75 _ 2
tirawcli circuits - new, alteration, or extension. Qer panel
Owner signature: — _ ._.___. Date: - --- -_ -. —_
A. Fee for branch circuits with
0 APPLICANT 'I ❑r CONTACT PERSON above service or feeder I'ee, 6.65 9
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. B. Fee for brunch circuits
Contact name: RYAN ROBERTS
without service or feeder fee, 46.85 2
last brunch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Emit add' 1 branch circuit 6,65 2
Miscellaneous (service or feeder not included)
City /State/ZIP: VANCOUVER, WA 98684 Each twillacutred or modular
dwelling, service and/or feeder 90.90 2
Phone: (503 ) 519 -5264 Fax: : ( )1 -866- 905 -4907 Reconnect only 66.85 2
E-mail: mduor ..northskvcomm.com Pomp or irrigation circle I 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or li mitcd-
Business NORTH SKY COMMUNICATIONS, INC, energy panel, alteration. or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Paget $75.00 2
City/State/ZIP: VANCOUVER, WA 98684 Each additional inspection over allowable in any of the above
Phone: (360) 254 -6920 Fax: ( ) 1- 866 - 530 -4325 investigation inspection 62.50
o nn ,vcsiau perhour(Ilwrmin) 62,50
CCs Lie.: 14117 Electrical Lic.17 -154CL Suprv. Lie.: 173LEB lodnslti plant per hotly 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
$75.0L
Plan review (25% of permit fee):
Print u JACK CAGLE Dale: 1 -5 -09 Sluts surcharge (12% $9.00
g permit fee):
ALIT horiZed signature: 0 TOTAL PERM FEE: $84.00
Print nan,uc ETHON A. DOLPH Date. 1 -5 -09 This permit application expires il'u permit is not obraincd within 180
days after it has been accepted as complete.
Number of inspections allowed per permit.
1.\Suildiusuw ninsull- c.rvrnbA1,p.,tne os?.ves •tatNat51'(11/I15 /COStr\\'ria
CITY OF TIGARD
BUILDING DIVISION PERMIT #: Ei R2009
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1t t {1119
Phone: (503) 639 -4171 " ^ ;�il�l t
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1 /2Or2Q09 TIME: 7 :0QAI`; PAGE: 7
SITE ADDRESS: 0945 ' SW MAPLEWOOD DR F CLASS OF WORK:
SUBDIVISION: MAIN STREET VILLAGE APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: MAIN STREET VILLAGE
DESCRIPTION: !Wail fiber optics for Veri on.
OWNER: CASA LA VETA ASSOCIATES +, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360 -754 -6920
Inspection Request' Scheduled For: Date: 1/21112009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 electrical final 079849-01 50:3 -849 -2026 N
Corrections /Comments/ Instructions:
/
C
I
I
PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector:. Cry I K& ) Date: V -.1 °' - '1 Phone #: (503) 718- IA
1