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Permit a ., : , .. 7 CITY OF TI GA R D ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00027 T I G A R D 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/5/2009 PARCEL: 2S 102AC -00201 SITE ADDRESS: 09491 SW MAPLEWOOD DR A 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: Permittee Signature: , � Oat 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. ,CEIVED i Electrical Permit Appli a > a>ft oz♦> i<cE ue °oivLv RcccivcJ c Permit No.: City of Tigard J 2 2 i 0 5 20 `9 , ) • SOS .' ■ CI�ZO�t , O -] Other Permit; ' 13125 SW Hull Blvd., Tigard, OR 9722 v Date/By: PLtn Ncvicw Phone: 503.639.4171 Fax: I Dat Permit; hrspectiw7 Line: 503.639.41 i ( TIGARD Date Read lay: Jut Y El See Page 2 for TIGARD (ntcrnet www.ti� Notified/Method: Su 7lementat Information s ��u��rnN� DIVISION pl TYPE Ole WORK - PLAN it EVIEW .. ❑ New constntetion 1i Addition /alteration / rplacement Nonce cheek anw:n:q,ply(submit 2sets or plane twur checked 6eto v): ❑ Service or feeder 400 amps or more ❑ Building over dime stories. ❑ Demolition 0 Other: where (ho available fault current ❑ Marinas and boatyards. • CATEGORY -OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Flouting buildings. Less to ground. us exceeds 14,000 ❑ Cunuwcreial•use agticulmrtl ❑ I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building maps for all other instalbtions. buildings. GI Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. © Installation of75KVAus JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger r separately derived system. • ❑ Addition of new motor load of ❑ "A" "F•' '• 14" "1.3", Job no.: Job site address: 9491 SW MAPL EWOOD DR. I00HP or mom. occupancy. ❑ Sis or more residential unit,;. ❑ itecrealiun vehicle polo:. City /State /ZIP: TIGARD, OR 97223 ❑ Henllh.CUe facilities. ❑ Supply voltage fur mote than ❑ Hazardous locations. (00 volts nominal. Suite /bldg./apt. no.: A 1 -8 I Project name: MAIN STREET VILLAGE ❑ Servieeor feeder 600 amps ormost. -FEE SCHEDULE Cross street /directions to job site; Description 1 9w. I err. 1 Mal I • New residential single. or mlti- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1.000 sq. ft. or less 145.15 4 — Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 I Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. it.) INSTALL FIBER OPTICS FOR VERIZON Linlhed energy, nlulli•1'nmily 75,00 2 • residential (with above so. 0.) Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER L. 0 TENANT 201 amps to 400 amps 106.85 2 Name: 401 amps to 600 snips 160.60 2 601 Amps CO 1,000 amps 240. 2 Address: Over 1,000 amps or volts I 454.65 2 City/State/ZIP: 'temporary services or feeders installation, alteration, and /or relocation Phone: ( ) Fax: ( ) 200 amps or less 66.85 1 Olvrics' installation: This installations is being made on property that l own which is not 201 amps l0 400:1117))F 100.30 2 intended for sale, lease, rent, or exchange. according to ORS 447, 449, 670, and 701. 401 uulps to 599 amps _ 133.75 2 Branch circuits — new, alteration, or extension, per panel Owner signature: -- ,... -.. _Dale: ____. A. Fce for branch circuits with ❑ APPLICANT ..1 O "CONTACT PERSON . above service or feeder fee, 6.65 2 each brunch circuit Business name: NORTH SKY COMMUNICATIONS, INC. B. Fee for branch circuits Contact name: RYAN ROBERTS f i i stb r an crviccor fecdcr ice. 1 46.85 2 lint brunch circuit Address: 11818 SE MILL PLAIN BLVD STE, 410 Each add•i branch circuit I 6.65 2 _ Miscellaneous (service or feeder not included) City/State/ZIP: VANCOUVER, WA 98684 Each manufactured or modular 90.90 2 Phone: (503) 519 -5264 Fax:: ( )1- 866- 905 -4907 dwelling, or lye and/or feeder 66.85 _ 2 E -mail: rnduorenorthskvcomm.com Pomp or inigatiun circle 53.40 2 CONTRACTOR Sign or outline lighting 53A0 I 2 en l:tlt:al, alterltmltcd- Business name: NORTH SKY COMMUNICATIONS, INC, energy panel, alteration. 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 tiny 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 Electrical Lic.17 -154CL s nprv. Lie.: 173LEB Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: $75.00 Play review (25% of permit fee): Print name: JACK CAGLE Date: 1 -5 -09 s � - -_ State surcharge (12% of permit fee): $9.00 tu Authorized signature: ip d// TOTAL PERMIT FEE: $84.00 T his permit application espices if a permit is not obtained within 180 Print name: ETHON A. DOLPH I Date: 1 -5 -09 anys after it has been accepted as complete. a Number of inspections allowed per permit. t atluildingtre, tu 0.V23/116 4.10..16 t SI'(1 uui/COMAVIin CITY ��N�~�� OF mm��mwu�� BUILDING DIVISION PERMIT #: B82009-00027 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/6/2009 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503 ) 639-4175 ~Sjilt INSPECTION WORKSHEET FOR DATE: 1/26/2O09 TIME: 7:O0AM PAGE: 3 SITE ADDRESS: 09491SW k4ApLEVV000DRA CLASS OF WORK: SUBDIVISION: MAIN STREET VILLAGE APARTMENTS LOT #: TYPE OF USE: PROJECT NAME: MAIN STREET VILLAGE DESCRIPTION: lntall fiber optic for Veizon. OWNER: CASA LA VETA ASSOCIATES +, PHONE #: CONTRACTOR: NC)RTH SKY COMMUNICATIONS INC PHONE #: 360- 25.4- 6920 Inspection Request Scheduled For: Date: 1/2G/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Bechimdfinal 00014-02 603-849-2025 N Corrections/Comments/Instructions: . c, ci_, • !W ASS El PARTIAL APPROVAL 0 CANCEL Ilj NO ACCESS | | 1 FAIL � CALL FOR INSPECTION || ADDITIONAL FEES ASSESSED ��~^ � ` . ~�� = / �~ � Inspector: G- / 1~w 6140 1...- Date: ^ «~~�) ' Phone #: (503) 718' l Rk . / ` ` � '' �