Permit _ y CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2009 -00009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/5/2009
PARCEL: 2S 102AC -00201
SITE ADDRESS: 09305 SW MAPLEWOOD DR R 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: c� ('� /� Q XI it_ ,J�\fl i a t Permittee Signature: ,Q g 31/4701. � ` V)
�1dV� -� �"' 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.
IP r RECEIVED
Electrical Permit Application JAN 0 5 2009 ., . •. ,_.. ON •
-. ; . FOR OFFICE US `. .
_ .
City of 'Tigard Rt ccivcd r Permit Nn.:
y iTY O FTIGA R • D,./1).: • s•cQ _ C�'6� �• •rte `••
13125 sw Hall Blvd„ Tigard, OR 9 _ -
n Review
Er
Phanc: 503.639.4171 lax: 503. )DIG DIVI31 lotB Olhur Permil: •
TIGARD
Inspection Line: 503.639.4175 Date Really /ny: See Page Z for
Internet: www.tigard or. gov Notified /Mcduui: Supplemental Information
• TYPE ,Olt WORK .• • PLAN REVIEW
0 New construction MI Addition /alteration /replacement Plcase clock :dl that appty(submit 2 sots ol•plum: w /ilmns checked below):
❑ Service or feeder 400 snipe or more ❑ Building over throe stories.
❑ Demolition ❑ Other: setter. the available fault cereal ❑ Mnrinav and Mnatyaedi.
. - CATEGORY OF CONSTRUCTION . cxceeds IOA00 amps ei 150 volts or ❑ Floating buildings.
less to ground. or exceeds 14.000 ❑ Commercial - use agricultural
❑ I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
17 Multi - family ❑ Master builder 0 Other: ❑Pirc ❑ Installation of75KVAin
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
. ❑ Addition 01 new motor Mad Of ❑ "A" "F" "1 �„ .
Job no.: I Job site address: 9305 SW MAPLEWOOD DR. 100HPorman.t. occupancy.
❑ Six or more reside tidal unite. ❑ Recm:Monet vehicle lurks.
City /State /ZIP: TIGARD, OR 97223 ❑ Henilh•earc facilities. ❑ Supply voltage for more titan
❑ Hazardous locations. 610 volts nominal.
Suite/bldg./apt. no.: R 190 -197 Project name: MAIN STREET VILLAGE ❑Servicco, feeder 600 amps or more.
FEE SCHEDULE •
Cross street /directions to job site: »ncrlpnmt I Qtv. I Pee. I 'rued I • --
New residential single- or multi-family dwelling unit,
Includes attached garage,
Subdivision: Lot no.: 1.000 sq. ft. or less 145,15 _ 4
'I
Ea. add500sq. ft. or portion 33.40_ 1
Tax map /parcel no.: ' Limited energy, lcsitlenlial
75.00 2
DESCRIPTION OF WORK (with above sq. a.)
INSTALL FIBER OPTICS FOR VERIZON Limited cllcrgy,molti- family 7500 7
residential (with :mow: sq. n.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ' f . • ❑ TENANT ' 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 naps 160.60 2
601 amps to 1,000 :amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State/Z_iP: • 'temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.83 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 snips 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 imtps 133.75 2
Branch circuits - new, alteration, or extension, er panel
Owner signature:_____ ___ • Date: — A. Fee for branch circuits with
0 APPLICANT .'I 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
without service or feeder fe
Contact name: RYAN ROBERTS 46.85 2
tiro branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZiP: VAN UVER, WA 98684 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (503) 519 -5264 Fax: : ( )1 -866- 905 -4907 Reconnect only 66.85 2
E mduor aenorthskvcomm.com Pump or irrigation circle 5140 2
CONTRACTOR Sign or outline lighting 53.40 2
Business Hanle: NORTH SKY COMMUNICATIONS, energy
Signal
erg y panel, panel.(s)orlimited-
energ alteration. or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Pagc2 $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 I Electrical Lic.17- 154CLE Suprv. Lic.: 173LEB industrial plant per hour 73.75
Suprv. Electrician rician signature, required: ELECTRICAL PERMIT FETS ' Subtotal: $75
Print name: JACK CAGLE Date: Plan review (25% of permit fee):
1 -5 -09 Slate surcharge (12% of permit fee): $9,00
Authorized signature: reC /.7 TOTAL PERMIT FEE: $84.00
This permit application expires if a permit is not obtained within ISO
Print name: ETHON A. DOLPH Date: 1 -5 -09 da after II has been accepted as complete.
0 Number of inspections allowed per permit.
I :Uhniltlingsl'enn5 \lit.C•IRmluapp.rtne 0.5,2.1/06 •411.40151•(11 /uiS /COMAVIiI)
. '
CITY ��mm m ��w� mm�����m��
BUILDING DIVISION
PERMIT #: 20O9-00O()9
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/6/2005
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 1/13/2009 TIME: 7:00&N1 PAGE: 9
SITE ADDRESS: 093O5SWh4ApLE3^O{)DDRR CLASS OF WORK:
SUBDIVISION: MAU'I STREET VILLAGE APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: MAIN STREET VILLAGE
DESCRIPTION: lnstaU fiber optic for Verizon.
OWNER: CASA LA VETA ASSOCIATES +, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-254-6920
Inspection Request Scheduled For: Date: 1/13/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 E|mclriom|Una| 079639-02 603-849'2025 N
Corrections/Comments/Instructions:
Ix \ \ `
PASS pi PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS
0 FAIL 0 CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
/ *+� U
Inspector: ��~-� �~�������� Date: � ��~'� Phone #: (503) 718-