Permit r . �
1, CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
3. COMMUNITY DEVELOPMENT PERMIT #: ELR2009 -00022
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/5/2009
PARCEL: 2S 102AC -00201
SITE ADDRESS: 09426 SW MAPLEWOOD DR G 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: i, ( j► Q p J\ Permittee Signature: e A 0tW'
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.
i
RECEIVED
Electrical Permit Application FOROFFICE
JAN 0 5 2009 It�eel,
City of Tigard .opt r Permit Nu (1224X C002,7.._ Dale ':
Er
1 hone S W Hall 503.639.4171 Tigard. Ord OF TIG Plan Itcv 5
Phone: 503.639.4171 Fax: 50. It OdterPerntil:
Uatc/By:
TIGARD Inspection Line: 503.639.417521II flING DIVISION U ;ucacady/ay e h�eti - : 62 SeePage2for
Internet: www.ttgard Urgov Noti /Method: \ 1 Supplemental Information
: TYPE OF WORK PLAN REVIEW
❑ New construction of Addition /alteration /replacement Please cheek an that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over Into stories.
❑ Demolition ❑ Other: where the :mailable lash euaeni ❑ Mnrinas nred Miaryards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps to 150 volts or ❑ I'+toatin buildings.
less In guxlu xi. or exceeds 14.000 0 Commercial -use alit 'cultural
❑ I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory buildi amps for all other installations. buildings.
el Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE, INFORMATION AND LOCATION ❑ Emergency system. larger separately dctived system. • Addition of new nom load of '
Job no.: Job site address; 9426 SW MAPLEWOOD DR. IOOHP ormolt. occupancy.
❑ Six or more residential units. ❑ keen:Anna' vehicle pauks.
City /Slate/ZIP: TIGARD, OR 97223 0 Hcattli.e rc facilities. ❑ suppl voha for itiore than
❑ Haze d' is locations. 600 volt nominal.
Suite /bldg. /apt. no.4 67 -78 Project name: MAIN STREET VILLAGE ❑ service Or (ceder 000 imps or nttuc.
FEE SCHEDULE
Cross street /directions to job site: Oexedpuua I QIr. I Per. 1 "'a ;i — T
New residential single- or multi- family dwelling unit.
Includes OttOChed garage.
Subdivision: Lot no.: 1,000 sq_ ft or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: _ i Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with aline sq. lid
INSTALL FIBER OPTICS FOR VERIZON Lltltttc <ICnct'gy.mulli•t ;unify 7$00
residential (with ,dove sq. n.)
Services or feeders installation, alteration, and/or relocation
200 amps or Less 80.30 2
❑ PROPERTY OWNER ' I . . ❑ TENANT • 201 amps to 400 stops 106.85 2
401 amps to 600 amts 160.60 2
Name: I I
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 turps or volts 454.65 1 2
City/Suite/ZIP: 'Fornporaty services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200aitlp-sorless 66.85 I
Owner installation: This installation is being made on property that I 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
Brunch circuits— new, alteration, or extension, per panel
Owner signature:____ _ _.___ A. Fee for branch circuits with
❑ APPLICANT • $ O CONTACT PERSON above service or feeder Ice, 6.65 2
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. B. Fee (or branch circuits
Contact name: RYAN ROBERTS wir/t brascrvice or nch circuit kaki nets,
l 46.85 2
first bra
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each udd'I branch circuit 6.65 _ 2
Miscellaneous (service or feeder not included)
city / Slate/ZIP: VANCOUVER, WA 98684 Oath manufactured or modular
90.90 2
dwelling, service and /or (ceder
Phone: (503 ) 519 -5264 Fax: : ( )1- 866 - 905 -4907 Reconnect only 66.85 2
E -mail: mduorc northskvcomm.com Pump or irrigation circle — ____.._ 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or li mited -
Business name: NORTH SKY COMMUNICATIONS, INC. cncrgY 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 1 62.50
Phone: ( 360) 254 -6920 Fax: ( ) 1 -866- 530 -4325 investigation per hour (i It min) 62.50
CCO Lie.: 14117 Electrical Lic.i 7- 154CLE Ss;prv. Lie.: 173LEB industrial plain per hour 73.75
ELECTRICAL. PERMIT FEES •
Suprv. Electrician signature, required: Subtotal: $75.00
Plat review (25% of permit fee):
Print name: JACK CAGLE Dale: 1 -5 -09
State surcharge (12% of permit fee): $9.00
Authorized signature: 4e ;::;) TOTAL PERMI FEE: $84.00
A. DOLPH 1 - 5 - 09
This permit application expires if petmtit is not obtained within IMO E THON A Date:
Print name: days after it has been accepted as complete.
Number or inspections allowed per permit.
lA lluihiingti 'cu 0.5/23/06 .IJIbJci 13T( 1 I/IWCOM/wf,l)
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: ELR2009-0t1022
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 16:12009
Phone: (503) 639-4171 .cti411
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 1/29/2009 TIME: . 7 : 01Am PAGE: 3
SITE ADDRESS: 09426 SW MAPLEWOOD DR G CLASS OF WORK:
SUBDIVISION: MAIN STREET VILLAGE APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: MAIN STUFF VILLAGE
DESCRIPTION: Install fiber optics for Verizon.
OWNER: CASA LA vErA ASSOCIATES +, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 36(12CA-6920
Inspection Request Scheduled For: Date: 1/29/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message •
199 Electrical final 080129-04 603-349-202a
Corrections/Comments/Instructions:
A/PASS 0 PARTIAL APPROVAL El CANCEL 0 NO ACCESS
0 FAIL CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: -..*</ Date: / - 0 Phone #: (503) 718-