Permit " a CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00015
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/5/2009
PARCEL: 2S 102AC - 00201
SITE ADDRESS: 09356 SW MAPLEWOOD DR J 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: aOki �Q j J 5 Permittee Signature: 11‘0Q1'( a t1 /�
�x•7�� 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 F orriCC USE : ONL Y : '
I 0 5 2009 -
City of Tigard Received - permit N,,.: •
..
't 13125 SW Ball Blvd„ Tigard, OR 91 ®C TIGARD Dace/0 : '� J r �: .0:0015 1 OF v� as+
Plan Review
IM Phone: 503.639.4171 Fax: 503 6 Other Permit: U atNBy:
TIGARD hlspeetiun Line: 503.639.4175 3UI DIV18I0 i pat Ready /By: r tr'r: B1 See Page 2 for
interne(: www.tigard- or.gov Notified /Method: , --' Supplemental information
TYPE OF WORK : :. • . PLAN REVIEW .. .
0 New construction 17I Addition/alteration/replacement Please check all that apply (submit 2 sus °rpladu w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over tine° stories.
Q Demolition ❑ Other: wharc the available Fault current ❑ Mormas and boatyards.
. • CATEGORY OF CONSTRUCTION . • • . exceeds 10.000 amps ;u 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commerci :d -ose agricultural
❑ I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for n11 other insiallalions. buildings.
O Multi - family ❑ Master builder ❑ Other: Price pump. ❑ insudlalion an KVA or
JOB SITE. INFORMATION AND LOCATION . ❑ Emergency system. larger separately derived system.
•--- • • ❑ Addition anew motor load of ❑ "A' .. f "1 "+„ "I r'
Job no.: Job site address: 9356 SW MAPLEWOOD DR. 100HP Rc 1ey
❑ Six nr more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: TIGARD, OR 97223 ❑ Hcalth•carcfacilities. ❑ Simply voltage ' slow thn
❑ H: a dmis locations. (11)0 volts nominal.
Suite /bldg. /apt.no.: J 103 -117 Project name: MAIN STREET VILLAGE ❑ SCrviceor feeder 600 amps ormost.
Cross sucet /directions to ub site: FEE SCHEDULE y. I
1 Drscrtpuau l Qty. per. I 'total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. 0.o less 145.15 4
Es. add' 1 500 sq. ft. or portion 33.40 1
_ Tax map/parcel no.:
limited energy, residential
D OF WORK 7s.00 2
(with above so. Il.)
Limiter) energy, multi - family 75.00 2
INSTALL FIBER OPTICS FOR VERIZON residential (with above. so, Al _
Services or feeders installation, alteration, and/or relocation
200 amps 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: Over 1,000 snips 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 I own which is not 201 amps to 400 amps 100.30 2
intended for sate, 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. Fee for bunch circuits with
❑ APPLICANT 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
without service or feeder fe 46.85 2
lust branch c ircuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each ildd'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/Stale/ZIP: VANCOUVER, WA 98684 Each tnanulacturedorn,odular
+ 90.90 I.
dwelling, service and/or feeder
Phone: (503 ) 519 -5264 Fax:: ( )1 866 - 905 - 4907 Reconnect only 66.85 2
E-mail: mduor a_northskvcomm.com Pump or irrigation circle I 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
N ORTH SKY COMMUNICATIONS, INC. energy circa), alteration, or
Business name: : Cncrsy ptn wl, aheratinn, ur
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
Per inspection 62.50
Phone: (360) 254 -6920 Fax: ( ) 1 -866- 530 -4325 investigation per hour (1 hr min) 62.50
CCD Lic.: 14117 Electrical Lic.17 -154CL suprv. Lic.: 173LEB industrial plant per hour _ 73.75
' ELECTRICAL PERMIT FEES ..
Suprv. Electrician signature, required: Subtotal: $75.00
Phut review (25% of permit fee):
Print name: JACK CAGLE Dote: 1 -5 -09 Slate surcharge (12% of permit fee):
$9.00
Authorized signature: pie TOTAL PERMIT PEE: $84.00
This permit application nvpires if a permit is not ohtninrd „ilhin 180
Print name: ETHON A. DOLPH Date: 1 -5 -09 da after it has been accepted as complete.
a Number of inspeclioas allowed tsar permit.
I ulloiilingWelat itdlil,GPontliMorooe 092.1106 441.461 S'(( 1 tattcoSI/wlin
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR 2009-
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/5/2009
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175 ; 11 I
INSPECTION WORKSHEET FOR DATE: 1/15/2008 TIME: 1:02AM PAGE: 14
SITE ADDRESS: 09365 SW MAPI E OOD D .1 CLASS OF WORK:
SUBDIVISION: MAIN STREET VILLAGE. APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: MAIN STREET VILLAGE
DESCRIPTION: Install fiber optics for Vorizon.
OWNER: CASA LA VETA ASSOCIATES +, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360 - 21-4 -6920
Inspection Request Scheduled For: Date: 1/15/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 07572403 503 - 849.2025 N
Corrections /Comments/ Instructions:
n PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: N6 6 v Date: - 1,-A■r" q l Phone #: (503) 718- 7 - �