Permit -.- CITY OF TIGARD
1p;
ELECTRICAL RESTRICTED ENERGY PERMIT
I ° COMMUNITY DEVELOPMENT PERMIT #: ELR2009 -00026
TIGARD DATE ISSUED: 1 /5/2009
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S102AC - 00201
SITE ADDRESS: 09480 SW MAPLEWOOD DR E 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 Surcha: 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.
r
Issued By: Vpsly fL IV S12,2 e Permittee Signature: �(kUll
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.
Electrical Permit AppllcatiOR' .` FOR - OFFICE USE :ONLY.
City of Tigard JAN 0 b 1Gt Received 's 13125 SW Hall Blvd., Tigard. OR 97223 D its /0 S ,_ rte: 1 �r • tl
PIP
yOFT IGAR Pl. ltaltev i s r
Phone: 503.639.4171 Fax: 503 -59 f D : Other Permit:
Inspection Line: 503.639.1175 `' type Rcasl /0
TIGARD Internet www.ligard- or.gov BUILDING NISI f IiiibuficdnMerhud: S p See rage 2. fur
lemental Informntion
• • TYPE OF WORK 'PLAN REVIEW .•
Q New construction MI Addition / alteration /replacement Please check ;III that apply (submit 2 sets of plans wAtenig checked below):
❑ Service or feeder 400 amps or more ❑ Building over lines stories.
❑ Demolition _ ❑ Other: where the availahle until current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps al 150 rolls or ❑ Floating buildings.
less to ground. or exceeds 14,0(10 ❑ Commercial-use agricultural
I. and 2- fntnily dwelling 0 Commercial /industrial ❑ Accessory building amps for all inlet' installations. buildings.
o Multi -famil y ❑ Master builder ❑ Other: ❑ Fite pomp. ❑ Installation ol'75 KV A or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A" •`tti' "1-2", "1.3",
Job no.: Job site address: 9480 SW MAPLEWOOD DR. mOHPortome. occupancy.
❑ Six or mum rcsitlemial units. ❑ RCCIVUtin11111 vehicle pi
City/State/ZIP: TIGARD, OR 97223 ❑ Beaus• care facunies. ❑ Supply voltage for more than
❑ Hazardous locations. WO volts nominal.
Suite /bldg. /apt. no.: E 47 -54 Pwjeet name: MAIN STREET VILLAGE ❑Service or feeder GOO ;anpsurmme.
FEE SCHEDULE
Cross street/directions to job site; uMCnlmnn I sty. I tiro. I Total I •
New residential single- or multi- family dwelling trait.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. or less 145.15 4
Ea. add'1 500 sq. ft. or portion 33.40 _ I
Tax map/parcel no.: L imited energy. residential
DESCRIPTION OF WORK 75.00 2
(wits about sq. li.)
INSTALL FIBER OPTICS FOR VERIZON Lin,itddelaergy , inuiti- tatrlify 75.00
tesidemint (wens above a'a n.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPER'L'Y OWNER ❑ TENANT 201 stops to 400 a mps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to I .0)0 :Imps 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 1
Owner installation: This installation is being made on property that l own which is not 201 amps 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
Itrauclr circuits - new, alteration, or extension, per panel
Owner signature:._ —._ ---- Date: -- --- _- -_ - -__ A. Fee for branch circuits with l
❑ APPLICANT I • 0 CONTACT PERSON above savior or (ceder fee, I 6.65 2
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. D. Fcc for branch circuits
f
without service or feeder cc,
Contact name: RYAN ROBERTS 46.85 2
first branch circuit
Address: 11818 SE MILL PLAIN BLVD STE, 410 Each :dd'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: VANCOUVER, WA 98684 Each inanut;lcuu'ed or modular -
dwelling, service and/or feeder 90.90 •7
Phone: (503 ) 519 -5264 Fax: : ( )1 - 866 - 905 - 4907 Reconnect only .
66.85 I 2
E -mail: mduornnorthskvcomm.com Pump or irrigation circle 53.401 2
CONTRACTOR • Sign or outline lighting 53.40 2
N ORTH SKY COMMUNICATIONS, INC. enerl:r)cireuit(s)111•timitod-
Business name: , energy panel, alteration. or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Page 2 $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 hour (1 hr min) 62.50
CCB Lie.: 14117 Electrical Lic.17 -154CL Suprv. Lie.: 173LEB ,ndnsnts, plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
$75.00
Plan review (25% ol permit fee):
Print name: JACK CAGLE Dale: 1 -5 -09
s � _ ^ — State surcharge (12% of permit ter:): $9.00
Authorized signature: 0/ d% a" J TOTAL PERMIT brae: $84.00
� +v — T his permi uppliendon expires if a permit is not obtniucd within ISO
Print name: ETHON A. DOLPH Date: 1 -5 -09 days after it has been: accepted as complete.
+ Number of inspections allowed per permit.
r.Vt ii:IingU'euni+AGLC•Pennu App.4oe 092Vn6 •1411-10 I NO I r /WA:O AviSa
•
CITY OF TIGARD
BUILDING DIVISION
iho PERMIT #: FLR2009,00026
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: iiE
Phone: (503) 639-4171 W' J
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 1/2912009 TIME: 7•01Am PAGE: li
SITE ADDRESS: 09480 SW MAPLEWOOD DR E CLASS OF WORK:
SUBDIVISION: MAIN STREET VILLAGE APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: MAIN STRUT VILLAGE
DESCRIPTION: Install fiber optics for Veiizon.
OWNER: CASA LA VETA ASSOCIATES +, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 3(1.254-8920
Inspection Request Scheduled For: Date: ip9129 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 000129-03 503.849-202 N
Corrections/Comments/Instructions:
s
Eil PARTIAL APPROVAL El CANCEL fl NO ACCESS
n FAIL E CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: -3:41- Date: /- - 2 - - --- - 0-5 Phone #: (503) 718-