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Permit v CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT PERMIT #: ELR2009 -00013 • TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/5/2009 PARCEL: 2S 102AC - 00201 SITE ADDRESS: 09338 SW MAPLEWOOD DR U 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 Reg #: ELE 17- 154CLE FEES 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. c Issued By: P jJ QJ J \9 J ��� ' Permittee Signature: aQ Q,„ A t i Vigi`b y1 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. • _._,..... RECEIVES Electrical Permit Application FOROFFICh USE :ONLY of Tigard ►!!,�`� 0 5 2009 City ` Y d r _ Permit No .:C.- • �� 4 13125 SW Hall Blvd., Tigard, OR r Phut }levies lb M • Phone: 503.639.4171 Fax: 503589 TICARD pa1clO : Other Permit: TIGARD Ins [.m e: 503.639 ^ NG DIVISION l i ea rly /ny ® See t'ugcbfor Internet: www.tigard- or.gov �� 1 , l Nutificd / Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction 17I Addition/alteration/replacement Pteaa check oil that apply (submit 7 sets or pisns w /iteno checked below): ❑ Demolition _ ❑ Ulcer: where Service or feeder 400 amps or more ❑ Building over three stories. ._ ._ .._ _ - _ where the available fault current Marinas and boatyards. - • CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating building,. less to ground. or exceeds 14.000 ❑ Commercial-use agricultural ❑ 1- and 2- fancily dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings. o Multi - family 0 Master bulkier El Other: ❑ Pile pump. ❑ Installation of75KVA JOB SLTF. INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of nevi motor load or ❑ "A" °(y" "I - ?" " 1.3" Job no.: I Job site address: 9338 SW MAPLEWOOD DR. 1(tkiPorinure. occupancy. ❑Six or more residential unite. ❑ Recreational vehicle larks. City /State /ZIP; TI GARD, OR 97223 ❑ Henmh -care facilities. ❑ Supply voltage for more than ❑ Nonillion locations. MO volts nominal. Suite/bldg./apt. no.: U 214 -221 Project name: MAIN STREET VILLAGE ❑ser viccor fceder GOO amps ormore. FEE SCHEDULE Cross street/directions to job site: nexcrnptivn I Qtv, I 0ev. I 'Fowl I • New residential single- or multi - fancily dwelling unit. Includes attached garage. Subdivision: Lot no.: 1.000 sq. ft. or less 145.15 4 fax map /panel no.: Ea. :WWI 500 sq. 6. or portion 33.40 1 Limited energy, residential 7504 DESCRIPTION OF WORK ' (critic above sq. B.) INSTALL FIBER OPTICS FOR VERIZON Limitctlenergy, mu]ti- 1 ;uuily 7500 2 . residential (with above sq, 0.) Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 0 PROPERTY OWNER ' ' I • . ❑ TENAN'r 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: I I 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 Ices 66.85 I Owner installation; This installation is being made oil property that I 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 Owner signature: UatC: Branch circuits - new, alteration, or extension, Per panel - -- A. Fee for branch circuits with ❑ APPLICANT I n CONTACT PERSON above so vice or feeder fee, each branch circuit 6.65 2 Business name: NORTH SKY COMMUNICATIONS, INC. B. Fee for Wand) circuits wirhuul service or realer Ice, Contact name: RYAN ROBERTS first brunch circuit 46.8S 2 Address: 11818 SE MILL PLAIN BLVD STE, 410 r:ttcli branch circuit 6.65 2 Miscellaneous (service of feeder not included) City /Slate/ZIP: VANCOUVER, WA 98684 Each manufactured or modular 90.90 '2 dwelllne, service and /or feeder Phone: (503 ) 519 -5264 Fax: : ( )1 Reconnect only 66.85 2 E-mail: mduornorthskvcomm.com Pomp or irrigation circle 53.40 I 2 - CONTRACTOR Sign or outline lighting 53.40 2 N ORTH SKY COMMUNICATIONS, INC, energy t:irtul, alteration, or Business name: energy Panel, ;dim :uiun, ur Address: 11818 SE MILL PLAIN BLVD, STE 410 extension. Describe: 1 Page $75.00 2 City/State/ZIP: VANCOUVER, WA 98684 Each additional inspection over allowable in any of tie 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.1 -154CL Supty. Lic.: 173LEB Industrial plant per hour 73.75 _ ELECTRICAL PERMIT FEES .. Suprv. Electrician signature, required: Subtotal: $75 _ Print name: JACK CAGLE ate; Plan review (25% of permit fee): 1 -5 -09 State surcharge (12% or g ( permit fee): $9.00 Authorized signature: / TOTAL PERMIT FEE; $84.00 This pet•nit application expires if a permit ix not obtained within ISO Prmt"am": ETHON A. DOLPH D 1 -5 -09 days ancr it has been accepted as complete. ° Number of inductions allowed per permit. I. cn,,:iuinst'e,nni,crt.C-reenc App.Ane 092105 440.4(113T( r ina /COMnvrII RECEIVED 4 Zo 10.000►3 JAN 2 ~ A ELECTRICAL PERMIT APPLICA~CITXOFTIGARD City of Portland, Oregon - Bureau ofUeveiop IelhAi~ii~es 1900 SW 4th Avenue, Portland, Oregon 97201 • 503.823.7363 • FAX 503.823.3018 • TTY 503.823.6868 • www,porttandonline.comlbds 7U-Demolition onstructfon Addition1alteration/replacement Please check all that apply Fire pump Building over three stories 0 Other: ❑ Emergency system ❑ Service or feeder 600 amps Q Addition of new motor bad of or over ❑ 1 & 2 family dwelling In Commeruallnduslrial ❑ Accessory building 100 HP or more ❑ Commercial use agricultural C3 ❑ Patient area health care facility buildings Multifa Film, mily O Master builder Q Other: C, iaslallationof 150 KVAor larger . • R. . . . . . . 0 Hazardous locations separately derived system Job no.: Job address: 2. e. 0 -5_W aV-Zc- , R~ ❑Reueationalvehiclepaeks ❑'A','E','1-2,'1-3'occupandes City/State/ZIP: P~0.rLp Q~ 7 L Z 3 U Marinas and boatyards ❑ Service or feeder 400 amps ❑ Floating buildings or more where the available Suite/bldg./apt. no.. Project name: fault current exceeds 10,000 Q Six or more residential units amps al 150 volts or less Cross streeUdirections to job site: ❑ Supply over 600 volts nominal to ground, or exceeds 14,000 amps for all other Subdivision: I I Lot no. Tax map/parcel no. 0 voluntary plan review installations Submit 2 sets of plans with any of the above. = • - - The above are not applicable to temporary construction service. ' C► C~ Z ~ ' ' Description Cry. Fee 7-7 I'MM ❑ Reference RS ! Combination Permit no. 1,000 sq. A. or less $217 4 Each added 500 sq. 0. or portion $ 47 Name: l t a C e u. Limited energy, residential $ 47 2 Limited energy, multtfamity $ 47 2 Address-U O l~ o 2va, (a`jC1 CitylStale21P:7 t. ez. i,),A 200amps $111 2 201 l0 400 amps $159 2 Phone: p 3 S _ l Jt FAX. 401 l0 600 amps $208 2 Owner installation: This installation is being made on property that I own, which is not intended for sale, lease, rent, 601 amps to 1,000 amps $315 2 or exchange. Over 1,000 amps or volts $578 2 Owner si nature: Date: 2 -Fe 200 amps or less $99 Business name: 3e S f- L L C_ 201 amps to 400 amps $150 2 Address: 6o KN kxrs , C 401 amps to 600 amps $190 2 City/State/ZIP: iLs b p tw%.) 750 A.Fee for branch circuits with service or feeder fee, each $10 2 Phone: ~j yl - 8 YL -1 60 a FAX: branch circuit 5 1' B.Fee for branch circuits ttifhout Elec. lie. no. 56-7 L E Z CCB Ile. no. I g service or feeder fee, first $92 2 branch circuit Metro or City Ilc no, s pa G Date: I • Z (o ' O Each additional branch circuit $10 Supervising electrician Qum= Signature, required: Each manufactured or modular $128 2 Print name: , IZ Q e dwel(in service and/or feeder J License no. a (6 7 L t; Reconnect only $101 1 Pump or irrigation circle S 8i 2 Authorized signature: Sign or outline lighting $ 61 2 Print name: $ u h Q Date: Signal circuit(s) or limited-energy $ 81 9I 2 panel, alteration, or extension. Describe: Business name: I Hourly rate: 5116 Contact name: ® .S L-P4j Per inspectJon $ 79 13 Address: O K,N.L),-r.S A Investigation fee Ci /StatelZlP: other ty ~m F~ Ors 7.~© Phone: S I !a Z A C) D-C> FAX: y/ " 8 ~f Z y3Z Subtotal Plan review (25% of permit fee) E-mail: State surcharge (12% of permit fee) Credit Card ❑ Trust ❑ RS Permit/No Fees Due ❑ TOTAL PERMIT FEE This permit application expires if a pornnit is not obtained within 180 days after it has ' Fee methodology set by Td-County f3upSng industry Service Board been accepted as complete Number of Inspections a(baYd per perms. insppenniapp_ekdricat 6322;09 CITY OF TIGARD BUILDING DIVISION Ao. PERMIT #: EtR2009 C.10013 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/5/2009 Phone: (503) 639-4171 1**• 1,,fil A Inspection Requests (24 Hrs.): (503) 639-4175 ...-44 'LL INSPECTION WORKSHEET FOR DATE: •/12/2009 TIME: 7 PAGE: 20 SITE ADDRESS: 09338 SW MAPLEWOOD DR U CLASS OF WORK: SUBDIVISION: MAIN STREET VILLAGE APARTMENTS LOT #: TYPE OF USE: PROJECT NAME: MAIN STREET VILLAGE DESCRIPTION: 1 11 stal I fiber optics for Verizon. OWNER: CASA LA VE:TA ASSOCIATES +, PHONE #: CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 36 Inspection Request Scheduled For: Date: 1/12/2009 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electri 1.: al final • 079579-02 503-849-2025 N Corrections/Comments/ Instructions: s., \ -..-- N \ ' \\\ PASS fl PARTIAL APPROVAL 0 CANCEL El NO ACCESS FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED Inspector: 6— • NOGi_ Date: 1 " i % ' 1 Phone #: (503) 718- ___________