Permit n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00014
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/5/2009
PARCEL: 2S 102AC -00201
SITE ADDRESS: 09339 SW MAPLEWOOD DR P 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: ( Permittee Signature: 9 k (i C 7V;� h�
��j �l OWNER INSTALLATION ONLY T r "�v v �/
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.
e
RECEIVED
Electrical Permit Application 1\-1 FOR OFFICE USE: ONLY
�•. Tigard 0 5 2009 :: . :..
City of �rigar(1 r. PermitNo.: 0001
'1 13125 SW Hall Blvd„ Tigurd, OR QM/ , OF TIGARD Phan Review
s' • Phone: 503.639.4171 Fax: 503‘5H1910 Date/fly: Other Noun:
TIGARD � I Date Re Y /0
Ins Line: 503.639:1175 ! ��� .nING DIVMS10 u Y� Auk: ® Set:fnp;c2for
• Internet: www.ligard- or.gov NotirledrMCINti: t ( C? Supplemental Information
' .: TYPE OF WORK ' . . .. . . . . . . . . . . . . . . .P L A N REVIEW - ..
❑ New construction Ell Addition /alteration /replacement Pletne check all alai apply (tuhntit 2 sets of plass w /item, checked below):
❑ Service or feeder 400 amps or more ❑ Buildin over thane stories.
❑ Demolition ❑ Other: where the available fault current ❑ NI villas and hnatyards•
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ flouting buiWhrge.
•
less to ground. or exceeds 14.0(10 ❑ Commercial-use agricultural
❑ I - and 2-family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all Other instnlbdions. buildings.
I:I Multi- family ❑ Master builder ❑ Other: ❑ fire pump. ❑ Inslauutiurr of KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency xystmn. larger separately derived system.
• - • Addition of new motor load of '
Job no.: Job site address: 9339 SW MAPLEWOOD DR, It1oHP nccrrpa icy.
C I units. ❑ Recreational vehicle parks.
City/State /ZIP: TIGARD, OR 97223 ❑ Heslth•care raciritics. ❑ Supply voltage for more than
❑ Hazautuns locations• 6130 volts mnminal.
Suite /bldg. /apt. P 174 -180 Project name: MAIN STREET VILLAGE ❑ Scrviccor (ceder 000 amps ormore.
Cross street/directions to ob site: FEE SCHEDULE
Description I Qty. I l ce. I And 1•
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 L
Ea. add 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: . Limited energy, residential
DESCRIPTION OP WORK 75.00 2
INSTALL FIBER OPTICS FOR VERIZON
Limited residential (with ti x w emily 7500 2 •
t>sidcntial (wihnddxm li.)
Services or feeders installation, alteration, and/or relocation
-- � 200 amps or less 80.30 I 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 amps 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
2
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30
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, Eer panel
Owner signature: -- _..___._.___ ___,__ A. Fce for blanch circuits with
❑ APPLICANT I O CONTACT PERSON above. service or feeder fee, 6.65 2
ettch blanch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. 13. Fee for brunch circuits
u'irho service or feeder fe
46.85 2
Contact name: RYAN ROBERTS
lust branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each :tdd'l branch circuit 6.65 2
Miscellaneous (service of feeder not included)
City /StaterZIP: VANCOUVER, WA 98684 Each manufactured or modular
90.90 2
dwelllne, service and/or feeder
Phone: (503 ) 519 -5264 Fax: : ( )1 866 - 905 -4907 Reconnect onl 66.85 2
E-mail: mduornorthskvcomm,com Plump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 7.
N ORTH SKY COMMUNICATIONS nerg lerrcul , alterlrnt"cd-
, INC. .
Business name: energy panel, :dtcr:diun, or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Page 2 $75.00 2
City /State/ZIP: VANCOUVER, WA 98684 Each additional inspection over allowable in any of the above
Fax: ( ) 1 -8 66- 530 -43 Per inspectiorn 62.50
Phone. (360) 254 -6920 Investigation per hour 0 hr rain) 62.50
CCB Lie.: 14117 Electrical Lic.17 -154CL Suprv. Lie.: 173LEB Industrial Elam per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
$75,00
Print Holm: JACK EAGLE Da1e; Plan review(25% fee):
1 -5 -09 State surcharge (12% of permit fee): $9.00
Authoricodsignature: j TOTAL PERMIt' FEE: $84.00
This permit application expires if n permit is not olrlaincd within ISO
Print name: ETHON A. . DOLPH Date: 1 -5 -09
days after it has been accepted as complete.
Number of inspections allowed per permit.
I : Ulu: 6lin5UNumr:nU'r.C•rcnni.yrp.dnc t5/33/06 440.4(151( r 1 /05/( :QmuiAVri11
]EkWical Permit Application FO 11 o
Q T
City of Tigard Received DateB : 17 to Permit No. ttlt~0 ~1~ v'Wf/
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
G Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction %Addition/alteration/replacement Please check all that apply (submit 2. sets of plans w/items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
❑ I- and 2-family dwelling N~Commercial/industrial ❑ Accessory building amps for all other installations, buildings.
❑ Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A", "E", "1-2", "1-3",
Job no.: Job site address: 0 !I ^ J 100HP or more. occupancy.
o ( / ~M ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: -r L C,_Ap ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: (Q { Project name: /2~ e t h NU G~ 2 S El Service or feeder 600 amps or more.
l/ FEE SCHEDULE
Cross street/directions to job site: l s ! -en 12-d Description Fee. Total
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map/parcel no.: Ea. add] 500 sq. ft. or portion 33.92 1
Limited energy, residential
DESCRIPTION OF WORK with above sq. 1167.84 2
t Limited energy, multi-family 67.84 2
Ak S fV SG CU V S S -e residential (with above sq. ft.
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 56.18 2
first branch circuit
Address: Each add'1 branch circuit 7.42 2
Miscellaneous service or feeder not included
City/State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: Signal circuit(s) or limited-VVN S L Q Q w r T vn C energy panel, alteration, or
2 Z (Q extension. Describe: Page 2 2
Address: y S 3 W , C ko 4 -e rr d' QH
City/State/ZIP: 7q r(A12 (9 l~ ZZ'/ Each additional inspection over allowable in an of the above
Phone: (5 o Per inspection 66.25
5 Z 5 Fax: ( )
~ ' Z / Investigation per hour (1 hr min) 66.25
CCB Lic.: l ~'Z 62 I Electrical Lic.: cL, 6: Suprv. Lic.: -41 q LF,¢ Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
t Plan review (25% of permit fee):
Print name: ~R Date: 2 2,00 ~ State surcharge (12% of permit fee): , t'
~A Al Authorized signature: TOTAL PERMIT FEE: . 9
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
' Number of inspections allowed per permit.
1:\Building\Permits\ELC-PermitApp.doe 10/01/09 4404615T(I 1/05/COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: EL R2009-00014
0U014
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/6/2009
Phone: (503) 639 -4171 'II?
Inspection Requests (24 Hrs.): (503) 639 -4175 ...�_.. -_.
INSPECTION WORKSHEET FOR DATE: 1/16/2009 TIME: 7 :02AM PAGE: 13
SITE ADDRESS: 09339 SW MAPLE WOOD DR P 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 - 254 -6920
Inspection Request Scheduled For: Date: 1/16/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 079724 -04 603 - 849 -2026 N
I
Corrections /Comments /Instructions:
I
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A ,
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❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL 1 1 NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
G o 718- V
Inspector: 'v Date: 4 '" 16 1 Phone #: (503) 718 � i
1