Permit C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I. COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00019
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/5/2009
PARCEL: 2S102AC -00201
SITE ADDRESS: 09398 SW MAPLEWOOD DR I 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 que tions to OUNC at 503.246.6699 or 1.800.332.2344.
c i n ,, ` Issued By: Permittee Signature: �� QVM
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.
' 4it P - - Ir. - 0
EIectrical Permit Application ,. D . FOR OFFICEUSE:ONLY
City of Tigard r TIGAR cccircd
' a 13125 SW Hall Blvd., Tigard, OR 9 7�f(,itI TY OF )ate /8 •: 'S 'OR ► 1� rr
/ Review
PP • • • Phone: 503.639.4 171 Fax: 503.5 % NQ D%V %S, 1 r i / o r
Other Permit:
TIGARD Inspection Line: 503.639.x One Ready/By: /laic[ RI See Page 2 for
Internet: www.ligard- or-gov Notified /Method: T I Supplemental Information
TYPE OF WORK . . PLAN REVIEW
El New Construction 01 Addition /alteration /replacement Plcuse check all than apply (whads 2 seta of plans wlitents checked below):
❑ Service or lcedct 400 amps or more ❑ Duildin over duce stories.
�-y
I_t Demoli1101! ❑ Other: who. re theavailable fault current ❑ Marinas and boatyards.
• CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or Q Floating buildings.
lets In ground. or exceeds I4.8(10 ❑ Commerei: l.mc snritohural
Q I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
o Multi - family ❑ Master builder ❑ Other: afire pump. ❑ Iuslall:aim; 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger ==Nancy rtetived system.
- --....- .- .._ --- ❑ Addition of new motor load of ❑ ••�.• "F' "I -�" ,• I.3"
Job no.: Job site address: 9398 SW MAPLEWOOD DR. IixHPormore. occupancy.
❑ Six or mete residential unite. ❑ Renwtional vehicle parks.
City/State /ZIP: TIGARD, OR 97223 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ H;rzardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: 191 -102 Project name: MAIN STREET VILLAGE ❑ Service or feeder 600 amps armore.
• FEE SCHEDULE '
Cross street/directions to job site: Owerlpueo I Qty. I Fee. I road I •
- New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. fl. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map /parcel n0.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with ;time sq. fr.)
lan,iled energy, multi•fami ly
INSTALL FIBER OPTICS FOR VERIZON residential (with above std. la.) 75.00 2
Services or feeders installation, alteration. and/or relocation
200 amps or less 80.30 2
❑ PROPER'T'Y OWNER _ I .. . ❑ TENANT • 201 amps to 400 amps 106.85 2
401am sto600am,s 160.60 2
Name: 1 amps
601 amps to 1,000 a mps 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 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
Branch circuits - new, alteration, or extension, pet
Owner signature:___________ _____. --- ____
A. Fcc for brooch circuits n•irlr
❑ APPLICANT •I . 151'CONTACf PERSON above service or feeder lee,
6.65 2
each branch circuit
Business noose: NORTH SKY COMMUNICATIONS, INC. 13. Fee for branch circuits
R YAN ROBERTS pilll0(r( service of feeder fee,
Contact name: thst brunch circuit 46'85 2
Address: 11818 SE MILL PLAIN BLVD STE. 410 Eachaddbtanchcircuit I 6.65
'l 2
Miscellaneous (service or feeder not included)
city /Stale/ZIP: 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: mduorc northskvcomm.com Pump or itrigaliott circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: NORTH SKY COMMUNICATIONS INC. Slgn.tltnnel,a)erItn,,tt.d
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 any of the above
Per inspection 62.50
Phone: ( 360) 254 -6920 Fax: ( ) 1- 866 - 530 -4325 Investigation per hoar (l hr min) 62.50
CCB Lie.: 14117 Electrical Lic.17 -154CL Suprv. Lie.: 173LEB , Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES •
Suprv. Electrician signature, required: - Subtotal: $75,00
Print name: JACK CAGLE Date: Plan review (25% of permit fee):
1 -5 -09 State surcharge (12% g ( permit fee): $9.00
Authorized signature: A 0, TOTAL PERM FEE: $84.00
� This permit applientinn expires it m•m
a pil is not obtained ,sirhin ISO
Print name: ETHON A. DOLPH Date: 1 -5 -09 days after It has been accepted as complete.
4 Number or inspections allowed per permit.
, annadingi 'ennit,Uil,C- lkoiOApp.dne 092346 .1.0.461SI'(I Int.VComisv3I
CITY OF TIGARD
BUILDING DIVISION PERMIT #: Ei
13125 SW Hall Blvd., Tigard, OR 97223 • DATE ISSUED: 1/5/2009
Phone: (503) 639-4171 A
tlit
Inspection Requests (24 Hrs.): (503) 639-4175 .&W ....
INSPECTION WORKSHEET FOR DATE: 1/29/2009 TIME: 7 PAGE: 6
SITE ADDRESS: 09398 SW MAPLEWOOD DR I CLASS OF WORK:
SUBDIVISION: MAIN STREET VILLAGE APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: MAIN STREET VILLAGE
DESCRIPTION: Install fiber optics for Verizon.
• OWNER: CASA LA VETA ASSOCIATES +, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 3602M-6920
Inspection Request Scheduled For: Date: 1/29/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 080129.01 50M49 '1
Corrections/Comments/Instructions:
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s D PARTIAL APPROVAL El CANCEL 0 NO ACCESS
FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: .)...",.4. Date: / -2-q-- 7 Phone #: (503) 718-