Permit 11 v CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2009 -00020
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/5/2009
PARCEL: 2 S 102AC -00201
SITE ADDRESS: 09399 SW MAPLEWOOD DR N 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.
Issued By: �11�p Y A O)J Permittee Signature: � (�() \
-ao u✓ 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 Application - I
E t ApplicationFOROFFICE USE ONLY
City of Tigard JAN 0 5 2009 Received S' ..., ,
E
13125 $W Hall Blvd., Tigard, OR 97223 pram Revic
•. • Phone: 503.639.4171 Fax: 503.59QI y O F OatcrOy;
TICARD Odrer Permit:
TIGARn Inspection Line: 503.639.4175 ate Ready/Br hurl.. ® Sec Page 2for
Internet: www.tigard•or.gov Z1 JI[nING owls* ruffed /M dual: Ti e Supplemental Information
• TYPE OF WORK v PLAN REVIEW '.
❑ New Construction m Addition/alteration/replacement Please check; all that apply (submit 2 sets Cl plans whims checked below):
0 Service or reeler 400 slops or mote ❑0uihling over (love stories.
❑ Demolition 0 Other:
u4rcre the available faith current ❑ Murinas and boatyards.
•
CATEGORY CONSTRUCTION exceeds 10,0x0 mops at 150 volts or ❑ Hooting buildings.
Icss to ground, or exceeds 14,010 ❑ Co nullen:iMI - use ayhicuhural
❑ I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building r ,,, qs for all other hndanallm,s. buildings.
O Multi- family ❑ Master builder ❑ Other: ❑ fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION Cl Emergency system. larger separately dal ived system. • ❑ Addition of new motor load of ❑ "A" °(;" "1.2" "l •]",
Job no.: ____-1 Job site address: 9399 SW MAPLEWOOD DR. IIIOHP ormuro. occupancy.
❑ Sid or more residemial units. ❑ Recreational vehicle parks.
City /Stale /ZIP: TIGARD, OR 97223 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg, /apt. no.: N 150 -161 Project name: MAIN STREET VILLAGE ❑service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: memcrinnalt I ow. I Fre. L Taw:d I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lol no.: 1.000 sq. Ii. or less 1- 145.15 4
Et. add'1 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited cncrgy, residential
DESCRIPTION OF WORK (with above sq. (t.) 75.00 2
INSTALL FIBER OPTICS FOR VERIZON
Limited energy, multi-family 7500
1'es (dent int (w ith ulimv sq. n.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑PROPERTY OWNER • L_ ❑ TENANT ___ 201 amps to 400 amps 106.85 _ 2
Name: 401 amps to 600 amps 160.60 2
Address: 601 amps to 1.000 amps 2x0.60 2
Over 1,000 amps or volts 454.65 2
City/Stale/ZIP: Temporary services or feeders installation, alteration, antd /ar
relocation _
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property ilia( I own which is not 201 amps to 400 amps 100.3(1 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 399 snips 133.75
Owner signature: .Date: __ ___
— Branch circuits - new, alteration, or extension, Qer panel
A. Fce for branch circuits with
❑ APPLICANT ' f O CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. B. Fee for branch circuits
Contact name:
RYAN ROBERTS toil /tart ncrv;ec of rater lee' 46.85 2
lust branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each add'l branch ehwit 6.65 2
Miscellaneous (service or feeder not included)
City/Slate/ZIP: VANCOUVER, WA 98684 Each manufactured or modular
dwel(ine. advice and /or feeder 90.90 2
Phone: (503 ) 519 -5264 Fax:: ( ) 1-866-905-4907 Reconnect only 66.85 2
E-mail: mduorenorthskvcomm.com Pump or irrigation circle 53.40 2
CONTRACTOR • Sign or outline lighting 53.40 2
Business name: NORTH SKY COMMUNICATIONS INC. energy circuit(s) alte limited-
cncrgy p ;rea alteration. or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Page 2 $75.00 2
City/State/ZIP: VANCOUVER, WA 98684 Each addhloatat inspection over allowable in any of the above
Pct. inspection 62.50
Phone: (360) 254 -6920 Fax: ( ) 1- 866 - 530 -4325 Investigation per hour (I hr min) 62.50
ccI3 Lic.: 14117 Electrical Lic..17 -154CL sttprv. tic': 173LEB Industrial plan 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: 1 -5 -09
State surcharge (12% of permit fee): $9,00
Authorized signat ��, _ TOTAL PERMIT I I;G: $84,00
This permit applicatiun expires if a permit is not oblaiucd within 180
Print name: ETHON A. DOLPH Date: 1 -5 -09 -" days after it hos been accepted rmmpaete.
• Number of impecttous allowed per permit.
lam,gdingu'c,mi 111,c•Pern,c,xpp.doe o5/2.1a6 4411.4613 ulSJCOi,IAViin
o ° o 0
Electrical Permit A12piication Fl%
MMMIM City of Tigard Rcceivctl c
b Daturiy: Permit No.: (2 ZO J '
13125 SW 1-hl) Blvd., Tigard, OR 97223 JAN 2 9 2010 flan Revicw
Phone: 503.639.4171 Fax: 503.598.1960 JAN Other Penmt:
s Inspection Line: 503.639.4175 Datc Rcadyllty: }u c: SeePage 2 for
Internet: Nvnmv.tigard-or.gov CITY OF TIGARD tr1ilir i \inthnd Supplemental Information
I=I A1v xi vtc~v s
s Y PE or « X
MOON
Please check all that apply (submit 2 sets of plans w/items checked below):
Mlidec-biwftction Addition/alteration/rep,acement
' ❑ Service or feeder 400 amps or more ❑ Building over three stones.
❑ Demolition ❑ Other: I{{{ ,ahcrc the available fault current ❑ Marinas and boatyards.
r" (dIL~(,ORY _Oh`CONlR1TC1107\ ) (cccds I O.nnO amps at 150 volts or ❑ Floating buildings.
i leers to around, or cycee ds 1.1,000 El Commercial-use agricultural
❑ 1- and 2-family dwelling ❑ CommerciaVindustrial ❑ Accessory building f amp, for .,u )[her installations. buildings.
❑ Multi-family ❑ Master builder ❑ Other: I El hire coon. El Installation of is tcvA or
El Emergency system. larger separately derived system
L51~ • ' r~.. "1_3.,.
UN FO RMA1I! 4NL r dpr e~ tnrv: ❑ c
d
r . uun of new motor road of
OK O_-06;
-E-, "1-2", Job no.: Job site addresS~~ / L ^ / 1 "i.xnr nrtoes occupancy.
~ c; nn,re nsi dzntiat units. Recreational vehicle parks.
City/Statc/z ~A_10e f El health-rare facilities. ❑ Supply voltage for more than
VV (_I Ha>.a,dous lucatioos. 600 volts nominal-
Suitelbldg./apt. no.: Project name: ~ft ~(f S ❑ Servtc or feeder 601 amps or more.
I .II)uDULE r
Cross street/directions to job site: urscri tion Q . Fcc. Total
C 1 New residential single- or multi-family dwelling unit.
1tn-1nd15altachialgarage.
Subdivision: Lot no : 1.000 sq. ft. or less 168.54 4
i
F,a. add'I 500 sq. fl. or portion 33.92 1
Tax map/parcel no limited energy, residential 67.84 2
DESCRIPTION OT WORIt (with above sq. ft
Linrted energy, multi-lamely
residential (with alWwc sq. li. 67.84 2
I services or feeders installation, alteration, and/or relocation
200 amps or less 100-70 2
s ❑PROPi?RTl',~OWl\LR J p ❑ :fti 4 tirT 201 :naps to 4(}0 amps 133.56 2
_z ..w. >z k_
Name: 401 amps to 600 antPs 200.34 2
601 amps to 1,000 amps 301.04 2
Address: t Over 1,00(} amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alleralion, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps U. less 59.36 1
21.1
0 1 1 amps to Goo amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 4
intended for sale, lease, rent, or exchange, according to ORS 447; 449, 670; and 701. 40 amps to 599 amps 168.54 2
Branco circuits -blew, :alteration, of extension, el' panel
Owner signature Date: f I A. Fee for branch circuits with
APPZ3AN f Li?I`7 FA` F P11:1:~f2P7. above service or seeder tee,
each branch circuit 7.42 2
Busitams name: j 13. Pee fur branch circuits
uilhoul service or Iceder 1ec,
Contact name: 56.18 2
lust branch circuit
Address: Each add'i branch circuit 7.42 2
Miscellaneous service or feeder not included
City/State/GIP: Each rnanul ictured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax:: ( ) Reconnect oniv 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRA( TOR 2.<... Sign or oulhne lighting 67.84 2
Business name: Signal circuit(s) or limited-
Cner,y panel, alteration, or
Address: /C) . i xtcatsion. Describe: Page 2 2
City/State/ZIP: Each additional inspection over allowable in an ofthe above
_ Q Pcr inspection 66.25
Phone') (p~ 2 Fax: 3) /'y~ - / Investigation per hour (I hr min) 66.25
66 ndustrial plant per hoar 78 18
CCB Lic.: Gj 3 Electrical Lic;,?-tL 41- uprv. Lie.: 9PYd [ t h
l<,LE,t, d'it1CA~ `PLr12R111 `NI~1J.5
I _ -
Suprv. Electrician signature, required: Subtotal: 46& C 11'09 Print name: 4 Date: Plan review (25% of permit fee):
Roar LA S Gl StaleSurcharge (12%ofpermitfec):
Authorized sigriahuc: rl TOTAL. PERMIT FEE:
This permit application expires if a permit is not obtained r:ithin 180
Print name: ti h s ~e + 7 f/`L Date: / ' days after it has been accepted as complete.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELP2009-00020
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/5/2009
Phone: (503) 639 -4171 A
Inspection Requests (24 Hrs.): (503) 639 -4175 .. Vi
INSPECTION WORKSHEET FOR DATE: 1/1512003 TIME: 7:O2AM PAGE: •i8
SITE ADDRESS: 09399 SW MAPLEWOOD.()R N CLASS OF WORK:
SUBDIVISION: MAIN STREET VILLAGE APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: MAIN STREET VILLAGE 1
DESCRIPTION: Install fiber optics for Vorizon.
OWNER: CASA LA VETA ASSOCIATES +, PHONE #:
CONTRACTOR: NORTH H SKY COMMUNICATIONS INC PHONE #: 360-254-61:120
I
Inspection Request Scheduled For: Date: 1i1512009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 E=lectrical final 079724 -01 503-849-2025 N
Corrections /Comments/ Instructions:
•
.
I I
❑ PASS ❑ PARTIAL APPROVAL n CANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ` f" o e 4 Date: I . 1 c' C 1 Phone #: (503) 718- A
I