Permit a jJ CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00016
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/5/2009
PARCEL: 2S102AC -00201
SITE ADDRESS: 09367 SW MAPLEWOOD DR K 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
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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. Ql12 Issued By: '� 4 (/kQ " V'- Permittee Signature: /, , 1i vi (), ��
"WWW OWNER INSTALLATION ONLY `u'
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.
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Electrical Permit Application • FoR OFFICE us oNLY ,`. •
Cr City of Tigard C TY ttte „ea ' 1: C ) G .. A pen „it N».: ��. /�
1 1125 S W Ball Blvd., Tigard, OR lNG D%VI�l� x 10 /B•: l p� Y • ti. • alai Ian , Be, . w ••............... . • .• ... ....
Phone: 503.639.4171 Fax: .503. 1 Dsic/By: Other Permit:
TIGARD Inspection Line: 503.619.4175 Date Really /ay: nun: 6f1 See Page 2 for
Internet: www.tigard- or.gov Notified /Method: 'r i r k Supplemental Information
TYPE OF WORK PLAN REVIEW .'. ' -
0 New construction Gl Addition /alteration /replacement Please check all that apply (submit 2 sore ol•plans w /iteme checked below):
❑ Service or feeder 401) amps or more 0 Building over !hive stories.
❑ Demolition ❑ Other: whore COO available ':Tull current Q Marinas and boatyards.
'
. CATEGORY OF CONSTRUCTION exceeds 10.000 amps id I50 volts or Qflo a ting buildings.
less to arot nd. or exceeds 1 4.000 ❑ Commercial-tee ant cultural
Q I - and 2- family dwelling CI Commercial /industrial ❑ Accessory building amps for all other in:ash:l ions. buildings.
El Multi- family ❑ Master builder ❑Other: 0 Fire pump. 0 Iustallationor75KVAin
JOB SITE, INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
____ • ❑ Addition of new motor load of D ..,�. ..>:., .
Job no.: Job site address:
9367 SW MAPLEWOOD DR. 1uoore<.»r„v. R c cni rrny.
❑ Six or mom residential units. ID Rccremional vehicle isarks.
City/State /ZIP: TIGARD, OR 97223 ❑ Health -care Facilities. ❑ Supply voltage for more than
❑ Harardtms locations. 600 volts nominal.
Suite /bldg' /apt. no.: K 118 -125 Project name: MAIN STREET VILLAGE ❑ Service or feeder GOO amps onmrc.
'FEE SCHEDULE '
Cross street /directions to job site: Dencrtpuon I Qrv. I Fee. I 'total I •
New residential single- or nudti•fantily dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. or less 145.15 4
Ea. ndd'I 500 sq. h. or portion 33.40 1
y TilX map /parcel no.: Limited cncryy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ii.)
INSTALL FIBER OPTICS FOR VERIZON Limited energy. n,ulli.nu "ity ro 75.00 2
sidcntinl (with al.: s n.)
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
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 2
City /State/ZIP: Tmnporary services or feeders installation, alteration, and /or
— __ relocation _
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I
Owner 'Chis installation is being made on property that I own which is not 201 snips l 0 400 im ps _ 100.3(1 2
intended for sale, lease, rent. or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 snips 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: _ - Date: ___
A. Fce for branch circuits with
❑ APPLICANT I ID CONTACT PERSON • above service or feeder lee, 6.65 2
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. a. Fee for branch circuits
Contact name: RYAN ROBERTS without service or feeder fee, 46.85 2
first branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 • Eachaddi branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP: VANCOUVER, WA 98684 Each manufactured 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: mduorc northskvcomm.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign 01.0104 1c lighting 53.40 2
Signal circuit(s) or limited-
Business yam: NORTH SKY COMMUNICATIONS, INC. energy panel, ultel;ttion,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
Pcr inspection 62.50
Phone: ( 360) 254 -6920 Fax: ( ) 1- 866- 530 -4325 fllvcsligalioll per hour (I Iu min) 62.50
CCB Lie.: 14117 Electrical Lic.17 -154CL Stlprv. Lie.: 173LEB Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: $75.00 .
Print mtmc: JACK CAGLE Date: Plan review (25% or permit fee):
1 -5 -09 State surcharge ( 12% of permit fee):
$9.00
Authorized signature: 4. ��1,Z___ TOTAL PERMff FEE: $84.00
1'hk pa'mil npplicaYO„ expires if a permit is not obtained within 1S0
Print name: ETHON A. DOLPH Date: 1 -5 -09 . toys Wrier it has been accepted as complete.
s Number or inspections allowed per permit.
Ial loildingu 'coninnil.C•Paro,aippAoc 05123105 .140.4 1ST( I ,a15/COMAY131l
• , •
CITY OF TIGARD
BUILDING DIVISION PERMIT #: aR2009„00016
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 16/2009
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 1/16/2009 TIME: 7 PAGE: 14
SITE ADDRESS: 09367 SW MAPLEWOOD DR K CLASS OF WORK:
SUBDIVISION: MAIN STREET VILLAGE APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: MAIN STREET VILLAGE
DESCRIPTION: install fiber optics for Verizon.
OWNER: CASA LA VETA ASSOCIATES +, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-2644i920
Inspection Request Scheduled For: Date: 1/16/2009 Pour Time:
Code # Inspection Description C irm # Contact # Message
199 Electrical final 079786-01 L03-849- Y
Correbtions/Comments/Instructions:
9
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' PASS El PARTIAL APPROVAL 111 CANCEL NO ACCESS
FAIL CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: Date: t .1 tP Phone #: (503) 718- .1,141i12