Permit 1111 V . CITY O F T I GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00025
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/5/2009
PARCEL: 2S 102AC - 00201
SITE ADDRESS: 09479 SW MAPLEWOOD DR B 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 qu stions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: c (] t �b Permittee Signature: A�� tOjn
�►•'� 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 : FOR OFFICEu
JAN 0 b 20C� .. .: • : -
City of Tigard Received
• Permit No.:
Dale /0 : •� a 2 �It .�
13125 sal Hall Dlvd., Tigard. OR. r' � �'Y OF TIGAR
I I Pl Review Other Pennii:
l
Phone: 503.639 .4n1 Cstx: So3.59 crlty
TIGARD Inspection Line; ; 03 x175 BUILDING DIVISI � 1 p ° Rcody/Oy: Iota:: 6� ice Page 2 for
Internet: www.tigard- or wined /Method: 1- Su ilemenlalInformation
. TYPE OF WORK ' . .. . 'PLAN REVIEW ... ..
❑ New Construction 01 Addition /alteration /replaccmunt Please check all that apply (submit z sets or plains wlItens checked below):
❑ Service or feeder 400 amps or more ❑ Ouilding over tame stories.
❑ Demolition ❑ Other: when the available rash calico' ❑ bh,rinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floatin buildings.
less to ground. or exceeds 14.0110 ❑ Commercial-use acricut»tral
❑ I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other instal lntions. buildings.
n Multi- family ❑ Master builder ❑ Other: 0 P pump. ❑ Installation of75 KVA or
❑ Emergency system. larger separately de, ivcd system.
• ' JOB 'SITE INFORMATION AND LOCATION p Addition or new tot nor Intl of
Job no.: Job site address: 9479 SW MAPLEWOOD DR. 1it0HPormore. rec rea t ion
❑ Six or nitre residential units. ❑ Recreational "chick {auks.
City /State /ZIP: TIGARD, OR 97223 ❑ Health - care lacililies. ❑ Sltl,l,ly vultagc for mere than
❑ Hazardous locations. too volts nnrninal.
Suite /bldg. /apt. no.: B 9 -23 Project name: MAIN STREET VILLAGE ❑ Serv,co feeder600 maps or more.
FEE SCHEDULE .•
Cross sweet /directions to job site: Description I ow. r Fa'. I 'total I •
New residential single- or multi- fantily dwelling unit.
includes attached glunsge.
Subdivision: Lot no,: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. tdd'l 500 sq. ft. or portion 33.40 1
limited energy, residential 75.00 2
DESCRIPTION OF WORK • (with:Move sq. ii.)
INSTALL FIBER OPTICS FOR VERIZON Lil,,ited energy, roulti- f „m'ily 7500 2 •
residential (with :{oven!. U.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER - 1 • _ 0 TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,0(0 amps 240.60 2
-
Address: Over 1,000 turps or volts 454.65 I 2
City /State/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 1003(1 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 soups 133.75 2
Brandt circuits - sow, alteration, or extension. per pallet
Owner signature: .Date:
A. Fee for branch circuits with
❑ APPLICANT • • •! O CONTACT PERSON above set vicc or feeder fee, 6.65 2
each hnutch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. B. Fcc for braise), citcuils
Contact l b ,ch circuit
r service or fccdcr lace,
ontact name: RYAN ROBERTS 46.85 2
first b,m
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /StaleIZlP: VANCOUVER, WA 98684 Each manufactured or modular --
dwelling, service and /or feeder 90.90 2
Phone: (503 ) 519 -5264 Fax:: ( )1- 866 - 905 -4907 Reconnect only 66.85 2
E-mail: mduorcnorthskvcomm,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, alteration. or
Address: 11818 SE MILL PLAIN BLVD. STE 410 exlonsion. 1 Page2 $75.00 2
City /State /ZiP: VANCOUVER, WA 98684 Each additional inspection over allowltlrle in any of the above
( ) 1 866 - 530 -4325
Per inspection 62.50
Phone: (360) 254 -6920
Fax: invcsli per hour tJ hr win) 62.50
CC13 Lie.: 14117 Electrical Lic.1 7 -154CL Suprv. Lic.: 173LEB tttdtlsltittl plant per hour 73.75
ELECTRICAL PERMIT FEES ^.. ..
Suprv. Electrician signature, required: Subtotal:
$75.00
Plan review (25% of permit fee):
Print narrle: JACK CAGLE Date: 1 -5 -09
Slane surcharge (12% of permit fee): $9.00
Authorized signature: _ ,. ' / TOTAL PER FEE: :_ -__ - / _. $84.00
This permit application expires if n permit IA 1101 obtained within 180
Print name: ETHON A. DOLPH Date: 1 -5 -09
days after It has been accepted as complete.
Number of inspections allowed per permit.
l:WulhlingV'crml„V:t,C- Penn's\pp.doc OV231e6 4.10.46i Silt some :ONIAVIDi
CITY OF TIGARD
BUILDING DIVISION
41111 PERMIT #: ELR2009-00026
D ATE 13125 SW Hall Blvd., Tigard, OR 97223 ISSUED: 1/612009
Phone: (503) 639-4171 Ittlt
Inspection Requests (24 Hrs.): (503) 639-4175 —
INSPECTION WORKSHEET FOR DATE: •/26/2009 TIME: 7 PAGE:
SITE ADDRESS: 09479 SW MAPLEWOOD DR 3 CLASS OF WORK:
SUBDIVISION: MAIN STREET VILLAGE APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: MAIN STREET VILLAGE
DESCRIPTION: Iristafl fiber optics for Verizon.
OWNER: CASA LA WI ASSOCIATES +, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-264-6920
Inspection Request Scheduled For: Date: 1/2612009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Elecifical final 000014-03 503-049-2026
Corrections/Comments/ Instructions:
.7‘
PASS El PARTIAL APPROVAL II] CANCEL NO ACCESS
FAIL CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: NU:11..gd Date: 11,6 Phone #: (503) 718- IA__41)._