Permit 74 CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
_ . COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00006
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/5/2009
PARCEL: 2S 102AC -00201
SITE ADDRESS: 09270 SW MAPLEWOOD DR T 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 & HIGHLANDS NORTH SKY COMMUNICATIONS INC
421 SW 6TH AVE STE #905 11818 SE MILL PLAIN BLVD
PORTLAND, OR 97204 SUITE 410
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: AaakiaLailb Permittee Signature: Q €. a4 (Oh
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 - Fox OFFICE USE ONLY :
City of Tigard JAN 0 5 2009 Rccel,el; .. _..
Date /11 ': • 5 OQ ' ♦ /y}
Fill 's 13125 Phone: SW Hall Olvtl„ Tigard, OR� OF TIGARD • w '
flan Revic,v
• Phouc: 503.639.4171 Fax: 503. Datc/0: Permit Na.: Other
TI GARU Int Line: � - or. ov .639. 4 1759UILDIWG D' , 1 18'0 Na to f ®Sec Page 2 for
Internet: www,tin F� V V Notified /Method: M Supplemental Information
. ' TYPE OF WORK . .. `PLAN REVIEW •' .
❑ New construction O! Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /itcros checked below):
❑ Service or rceder400 amps or more ❑ (iuilding over Mice stories.
❑ Demolition ❑ Other: whe c the available fault euinent ❑ Marinas and boatyards.
- — CATEGORY OF CONSTRUCTION . exceeds 10.000 amps al 150 volts or ❑ Floating buildings. •
less to ground. or exceeds 14.000 ❑ Coumnerci:d•use :Qs iculmrd
❑
I. and 2- family dwelling ❑ Commercial /industrlal ❑ Accessory building amps for all other installations. buildings.
El Multi- family ❑ Master builder ❑ Other: 0 Fire pump. ❑ Installation ol')5 KVA Cr • JOB SITE INFORMATION AND LOCATION C7Emergency system. larger separately derived system.
.. ❑ Addition or new mtanr load or ❑ - A" "E", "1 -2" "1.3 ",
Job no.: I Job site address: 9270 SW MAPLEWOOD DR. IiOHPormom occupancy.
❑ mink Six or more rcslial units. ❑ Recitations' vehicle parks.
City /Slate /ZIP: TIGARD, OR 97223 ❑ llenhh•carc'acuities. ❑ Supply voltage for more titan
0 Haaardons locations. (450 anbs nominal.
Suite/bldg./apt. no.: T 206 -213 Project name: MAIN STREET VILLAGE ❑Scryiec reed :, 000 amps VI mote.
FEE SCHEDULE '
Cross street/directions to job site:
J orstupIl,m 1 Qty. I 14c. I Polar I •
New residential single- or multi - family dwelling mil.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. or less 145.15
4
Tax map /parcel no,:
Et. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.04 2
DESCRIPTION OF WORK • (with :dnwc sq. It.)
INSTALL FIBER OPTICS FOR VERIZON
Limited residential (with tit multi-family 7500 -, .
Icsidcmial (wish alaxv; so. 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: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) • Fax: ( ) 200 amiss or less 66.85
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 2
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, per panel
Owner signature: - _ — Date: - A. Fce for branch circuits with
• ❑ APPLICANT • •1 0 CONTACT PERSON above Set vita; or feeder fee, 6.65 2
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. B. Fee for brunch circuits
tvirhoro service or feeder fee,
liras brunch circuit
Contact name: RYAN ROBERTS 46.85 2
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/Slate/ZIP: VANCOUVER, WA 98684 Each manufactured or modular
90.90 2
dwelling, setwice and /or feeder
Phone: (503 ) 519 -5264 I Fax: : ( )1 -866- 905 -4907 Reconnect only 66.85 2
E-mail: mduor northskvcomm,com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited-
Business name: NORTH SKY COMMUNICATIONS, INC. energy panel. aheralian, 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
Per inspectiou 62.50
Phone: (860) 254 -6920 Fax: ( ) 1- 866- 530 -4325 Investigation per hour (1 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
Plait review (25% ol' pernsit fee):
Print name: JACK CAGLE Dote: 1 -5 -09
s � _ � � 5tstc surcharge (12% of permit Tea): $9.00
Authorized signature: Ole a" '�// TOTAL PERM FEE: $84,00
Tub pet'ntit application expires if n permit is not obtained within 180
Print name: ETHON A. DOLPH Date: 1 -5 -09
clays after ll has becn accepted aacomplete.
Number of inspections allowed per permit.
1., ani hlin04uni,s \l3I•C•PmnB.\pp.dn< ov_vnc .I4w+nlsr(1 vavCoalnw ;n
CITY OF TIGARD
BUILDING DIVISION PERMIT #: FLR200f.3.00006
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: •1 /50009
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 « .ZAP
INSPECTION WORKSHEET FOR DATE: 1/12/2009 TIME: 7:00AM PAGE: 21
SITE ADDRESS: 09270 SW MAPLEWOOD DR T 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 & HIGHLANDS, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360 -254 -6920
Inspection Request Scheduled For: Date: P our Time:
Ins l
p q
1/1212009
Code # Inspection Description Confirm # Contact # Mes :age
199 Electrical final 079579.01 6034319. 2025 Y O ' . 00
Corrections /Comments / Instructions:
cJ n
vU •
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: " J 1\1661. Date: k 1 1 Phone #: (503) 718 - _IVA_