Permit C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00005
TIGARD . 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/5/2009
PARCEL: 2S 102AC -00201
SITE ADDRESS: 09500 SW MAPLEWOOD DR REC CENTER 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: Vfti (Ad � Q `z Permittee Signature: S\ n n AIM i 0 (31 C oy1
OWNER INSTALLATION ONLY r � '
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 JAN 0 5 ZOO' FO OFF U ONLY :
City of Tigard �+ .1 >r tin - I. 5 . 0 I , Permit Nt. : E iR2 0
Er
13125 S W (tall 131vd., Tigard. OR 9722 OF TIGA ! I ws 1
Ot her Permit:
au
Phone: 503.639.4171 Fax: 5 0 3 P e r m i t : I n s p e c t i o n Lino: 503.639.4175 8�11 DIVI •a te • cad /n
TIGARD Internee www.tigard•or.gov Notified/Method: S plemcunl Informat i on
TYPE OF WORK .. PLAN REVIEW ..
❑ New construction la Addition/alteration/replacement Plasm check all that apply ( submit 2 set, of plans whims chucked below):
❑ Service or feeder 400 amps or more ❑ Building over dime stories.
❑ Demolition ❑ Other: where d,e available fault current ❑ Marinas and boat yards.
' • CATEGORY OF CONSTRUCTION exceeds 10.000 amps at ISO volts or ❑ Floating htitdings.
less to ground. or exceeds 14.000 ❑ Comae ci :tl•use agricultural
❑ I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building wisps for all other installations. buildings.
o Multi - family ❑ Master builder ❑ Other: D Gila pump. ❑ Installation of 75 KvA or
JOB SITE. INFORMATION AND LOCATION O Emergency xyslcm. larger separately derived system.
M 4 t., 1u.- _ • ^ f ❑ Addition or new motor load of
Job no.: I Job site address: ❑ "A" °(' "I • ?" " 1.3
6 � � ' 10011P or inure. occupancy.
❑ Six or more residential toots. ❑ Recreational vehicle parks.
City /State/ZIP: TIGARD, OR 97223 ❑ Health-carc facilitics. ❑ Supply voltage for more than
❑ Hazardous locations. (1(10 volts nominal.
Suite /bldg. /apt. no.: OFFICE Project name: MAIN STREET VILLAGE 0 SC( ACC or feeder r,00 amps ormore.
Cross sheet /dircctiona to ob site: FEE SCHEDULE
J trsrd wm I •
P I Otv. I ter. I Total
New residential single- or multi- family dwelling im11.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. or less I 145.15 4
Et. add'I 500 sq. ft. or portion 33.40 I
TeX map/parcel ❑0.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
INSTALL FIBER OPTICS FOR VERIZON
Limited energy.niuhi fancily 7500 2
residential (with:love xq. fit
Services or feeders installation. alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 20) amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 stops 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 I
Owner installation: This installation is being made on property that 1 own which is not 201 tunes to 400 amps 100.3(1 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
firanch circuits - new, alteration, or extension, Per pane)
Owner signature: _._._ Date:
. _._,•_. — A. Fcc for branch circuits with
❑ APPLICANT I GI CON1A PERSON above service or feeder fee, (,,GS 2 •
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. B. Fee for branch circuits
Contact name: RYAN ROBERTS tvilholrl service or Icctler I'ec, I 46.85 2
Ii1 at branch oirt:uit 1
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each add'I branch circuit 6.65 2
Miscellaneous (service or fccdcr not included)
City /Stale /ZIP: VANCOUVER, WA 98684 Each manufactured or modular
dwelling, service and/or feeder 90.90T 2
Phone: (503 ) 519 -5264 Fax: : ( )1 - 866- 905 -4907 Reconnect only 66.85 I 2
E-mail: mduar a('�northskvcomm,corrl Pump or irrigation circle 53.40 2
'CONTRACTOR Sign nr outline lighting 51.40 2
N ORTH SKY COMMUNICATIONS, INC. energy cin: panel, a uil(s) er limited-
Business name: , cncrg hcraliwt, 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
Por inspection 62.50
Phone: ( 360) 254 -6920 I Fax: ( ) 1 -866- 530 -4325 Investigation per hour (I lir mire 62.50
CCR Lic.: 14117 Electrical Lic.17 -154CL suprv. Lic.: 173LEB Indusltial plant perhottr' 1 73,75
• ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
$75,00 __"
Phan review (25% of permit fee):
Print name: JACK CAGLE Dote: 1 -5 -0 9
State lurch: e gc (12% of permit fee): $9.00
Authorized signature: . ,� TOTAL PERMIT FEE: $84.00
11,4 permit application expires if n permit is not oblaincd within 184
Print name: ETHON A. DOLPH I Date: 1 -5 -09 days Asa. h has been accepted iscomplete.
v Number of inspections allowed per permit.
n: tO ,durnguei iliintm.C•r.vma, y lpdin 05r2304 44114515'111IV/COMAx9 :II
CITY OF TIGARD
BUILDING DIVISION
41Ik PERMIT #: ELR2009-0006
13125 SW Hall Blvd., Tigard, OR 97223 • DATE ISSUED: 1/60009
Phone: (503) 639-4171 41i;'\•\iiifi. 1
Inspection Requests (24 Hrs.): (503) 639-4175 1
INSPECTION WORKSHEET FOR DATE: 1/26/2009 TIME: 7 PAGE: 4
SITE ADDRESS: 09600 SW MAPLEWOOD DR REC CENTER - CLASS OF WORK:
SUBDIVISION: MAIN STREET VILLAGE APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: MAIN STREET VILLAGE
DESCRIPTION: Install fiber optics for Verizon. 1
i
OWNER: CASA LA VE:f A ASSOCIATES +, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-254-6920
Inspection Request Scheduled For: Date: 1/26/1009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electiical final 080014-01 503-849-2025 N
Corrections /Comments/ Instructions:
1(
) D PARTIAL APPROVAL El CANCEL III NO ACCESS
111 FAIL III CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: (1' IQ) (--- Date: 1 /2.4) 1 Phone #: (503) 718- 1/41440