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Permit a „.. , i . v CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00008 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/5/2009 PARCEL: 2S 102AC -00201 SITE ADDRESS: 09304 SW MAPLEWOOD DR W 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: 4a10/ A9 Permittee Signature: SKOQ _ ?n , ` 1 + �`,1�n OWNER INSTALLATION ONLY t' 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 .In 05 2009 Electrical Permit Applicatioit OF TI GAR FOR Or+F cE USE City of Tigard ©IVI81 '' anal _ 40 • 0111111: to /B • QG Permit No„ Q " 13125 SW Hall Blvd.. Tigard, OR 07223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Data Olber Permit: TIGARD Inspection Line: 503.639.4175 Dale Ready /By: rut.: El See Page 2 for Internet: www.tigm'd or.gov Notified /Method: Supplemental information ' .. ' • TYPE OF WORK .. PLAN REVIEW ` ' • • ❑ New construction 511 Addition /alteration /replaCemcnt Please check all that apply (submit 2 acts of plans whims checked below): ❑ Service or feeder 400 amps or more [I Building over three stories. ❑ Demolition CI Other: where the available Rath currant ❑ Morinac :md l uatyords. • CATEGORY OF CONSTRUCTION - • .. 10,0 exceeds 00 wimps al ISO volts or El Floating buildings. lens m groun& or exceeds 14.000 ❑ Commercial-use agricultural ❑ I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building tulips for all other installations. buildings. 0 Multi - family ❑ Master builder ❑ Other: ❑ Piro pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger scparu ^ly 'let vcd system. ❑ Addition of new moor load of ❑ "A ", "G', "I I l , Job no,: 1 Job site address: 9304 SW MAPLEWOOD DR. 1(IDHPor occupancy. __ -- ❑ Six or MUM residential units. ❑ o cctca ncy. vehicle links. City /State /ZIP: TIGARD, OR 97223 ❑ Henhh•carc facilities. ❑ Supply voltage for more than ❑ Haeattlnus locations. 600 voles nominal. Suite /bldg. /apt. no.: W 230 -237 Project name: MAIN STREET VILLAGE ❑ Service di' feeder 600 amps or MOM. FEE SCHEDULE ' Cross street /directions to job site: nrserlptlm, I Qty. 1 Fee. I Total I • New residential single or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1.000 sq. ft. or less 145.15 4 Et. add 500 sq. ft. or portion 33.40 I Tax map /parcol no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK ' (with above sq. 0.) INSTALL FIBER OPTICS FOR VERIZON Lil„itetlettetgy , lnalli fah „iiy 75.00 2 residential (with above sq. nJ Services or feeders Installation, alteration. anti/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 Name: 401 amps to 600amps 160.60 2 601 amps to 1,000 ;unps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City /Stale/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, firer panel Owner signature: _ • Dais: ___ A. Fcc for branch circuits with 0 APPLICANT • • I GI - CONTACT PERSON above service or feeder Ice, 6.65 2 • each branch circuit Business name; NORTH SKY COMMUNICATIONS, INC. B. Fee for branch circuits Contact llama: RYAN ROBERTS ou t rr/ service or feeder Iced, 46 85 2 tarsi branch circuit Address: 11818 SE MILL PLAIN BLVD STE. 410 Each 80'1 branch circuit 6.65 ? 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 I Fax: : ( )1- 866 -905 -4907 Reeonttecd only 66.85 2 E •mail: mduorenorthskvcomrn.com Pump or irrigation circle 53.40 2 CONTRACTOR • Sign or outline light ing 53.40 2 Business name: NORTH SKY COMMUNICATIONS, energy Signal y poach circuit, alteration, energutiun, 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 Per inspection 62.50 Phone: (360) 254 -6920 Fax: ( ) 1- 866 -530 -4325 Investigation per hour (I hr min) 62.50 CCB Lie.: 14117 Electrical Lic.17 -154CL Suprv. Lic.: 173LEB Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: _ Subtotal: $75,00 - Print name: JACK CAGLE Date: Plan review (25% of permit fee): 1 -5 -09 State surcharge (12% of permit fee): $9.00 Authorized signature: 0.,�d� TOTAL PERM IT FEE: $84,00 i �� This permit imp 1Ni:olio. expires if n permit is not oldainrd within 180 Print name: ETHON A. DOLPH Date: 1 -5 -09 days rifler tl has been ncccpled as complete. ” Number of inspections allowed per permit. IAlnikliuewconikUil ,C4tnnitApp.dnc 05 /23106 .1a0.4(I31'(I vosicOM,Wt0 CITY OF ��n o m n�'m� n mn�U�m�m�� BUILDING PER�1T�#� ~°~~"°~~~""~~= DIVISION � ELR2O09'DDJU8 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 1/12/20U9 TIME: 7:00Ak4 PAGE: 18 SITE ADDRESS: CLASS � O9�WSW k4APLBA�)0DDRVV � SUBDIVISION: MAIN STREET VILLAGE APARTMENTS LOT #: TYPE OF USE: PROJECT NAME: MAI STREET VILLAGE DESCRIPTION: ltall fiber optic for Verizon. OWNER: CASA LA VETA ASSOCIATES +, PHONE #: CONTRACTOR: NORTH SKY COMMUNICATIONS S INC PHONE #: 360 254 Inspection Request Scheduled For: Date: 1N2/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 079579 503 [4 Corrections/Comments/Instructions: `\ PASS 7 PARTIAL APPROVAL E CANCEL | | NO ACCESS 7 FAIL E CALL FOR INSPECTION ADDITIONAL FEES ASSESSED �� ~ � � ��/ Inspector: N��J�' Date: �^� � Phone #: (503) 718- Ti � � ^/