Permit ' U q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 -00333
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/10/2008
PARCEL: 25101 DB - 00800
SITE ADDRESS: 13333 SW 72ND AVE A ZONING: R -25
SUBDIVISION: HAMPTON RIDGE APARTMENTS LOT: JURISDICTION: TIG
PROJECT: HAMPTON RIDGE
Project Description: Units: A -J. Installing fiber optics for Verizon.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /1RRIGAT:
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: 1
Owner: Contractor:
HAMPTON RIDGE APARTMENTS LLC NORTH SKY COMMUNICATIONS INC
15952 SW PARRISH LN 11818 SE MILL PLAIN BLVD
SHERWOOD, OR 97140 SUITE 410
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 12/10/200E $75.00
[TAX] 12% State Surch 12/10/200E $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 a 1 46.6699 or 1.800.332.2344.
Issued By: Imo ; ' Permittee Signature: . c% Zj'& -
— Aral
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.
1
Electrical Permit A IEIVED
AA FOR OFFICE USE ONLY :
City of Tigard DEC 0 9 2008 '
Er
13125 hone S50 lull 17., Tigard, OR 97223 � if
Plan Review
Phone: 503.639.4.4171 Fax: ff � (/t F TIQARD DatcI ` OtherPerinic
TIGARD inspection Line: 503.639.4 i D.,. Rea7 /ny: HI See rage 2 for
Internet: www.tignrd- or.g(>el 111 niNG DIVISION Notified /Method: Supplcmen(aI Information
. TYPE OF WORK '' • PLAN REVIEW
❑ New construction 0I Addition/alteration/replacement Heave check all that apply (tubnrit 2 sets or pinni wlileutc checked below):
❑ Service or tecder 400 amps or more ❑ Building over flute stories.
❑ Demolition ❑ Other: where the available fault eulTCnl ❑ Morinns and Nulty:lots.
• • CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, er exceeds 14,000 ❑ Cnlllhnchvlal•nb agricllllnra1
❑ 1- and 2-faintly dwelling ❑ Commercial/industrial ❑ Accessory building mops (or all usher installations. buildings.
o Muhi- family ❑ Master builder ❑ Other: ❑ Fire pomp. ❑ Installation of 75 KVA et
• JOB SITE, INFORMATION AND LOCATION ❑ Emergency system. huger separately &lived system.
• ❑ Addition of new mom toad of ❑ "A" •'(i" "1 -''" .. I.3
Job no.: I Job site address: 13333 SVV 72ND AVE. 100HP or inure. occupancy.
❑ Six or MOM residential halite. ❑ Rcctcational vehicle parka.
City / State/ZIP: TIGARD, OR 97223 ❑ HCahxh•care facilities. ❑ Supply voltage fur more Man
❑ Hazardous locations. 6(10 volts nominal.
Suite /bldg. /apt. no.: A -J Project name: HAMPTON RIDGE ❑ Scrvicc ur feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
1 DCSCrlptum 1 q,v. 1 Far. 1 fatal j •
New residential single. or multi - family dwelling unit.
Includes attached ga
Subdivision: I Lot no.: 1.000 sq. ft. or less 145.15 4
I Eat. utld'1 500 sq. R. or portion 33.40 1
Tax snap /parcel no.: Limited energy, residenial
75.00 2
DESCRIPTION OF WORK (with alovc .ay.If.)
INSTALL FIBER OPTICS FOR VERIZON Iill,ited eocl't;y,Inulti -f :,oily 7500
residential (wall ii.)
Services or feeders installalion and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ' 1 . ❑ TENANT 201 amps to 400 amps (06.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1.000 amps 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 t own which is not 201 amps (0 400 amps (00.30 2
intended for salt, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 lumps 133.75 2
-_- llranch circuits - new, alteration, or extension, per panel
Owner signature:__ Date: •
—_ A. Fce for branch circuits with
❑ APPLICANT ! O CONTACT PERSON above Scrvicc or feeder fee, 6.65 2
each branch circuit
Businessnnine: NORTH SKY COMMUNICATIONS, INC. B. Fee fur branch chianti,
i;'
R Y AN ROBERTS ,i/ service or ocean Ice,
Contact name:
rural branch circuit 46.85 2
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each taw! br :tnchciratt 6.65 _ 2
Mlsccllalleous (service or feeder not included)
City/State/ZIP: VANCOUVER, WA 98684 Each manuCtcmredormodular 91)90
dwelling, service and /or feeder
Phone: (503 ) 519 -5264 Fax: : ( )1- 866 -905 -4907 Reconnect only I 66.85 I 2
E -mail: mduoranorthskvcomm.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or supine lighting 53.40 2
Business name: NORTH SKY COMMUNICATIONS INC, ignal circuit(s)ortinlited-
r encrgY p:mcl, 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 hour (i in- nun) 62.50
CCB Lic.: 14117 Electrical Lic.17 -154CL LI Suprv. Lic.: 173LEB lntntxtriat plant per hour 73.75 -
ELECTRICAL PERMIT FELS_
Suprv. Electrician signature, required: �. +. Subtotal: $75,00
Plan review (251 of permit fee):
Prim name: JACK EAGLE Date:
,••
12 -9 -08 Stale surcharge (129c of permit fee): $9,00
Authorized signature: Ga 0 14f TOTAL PERM rim: $84.00
This permit application espires if n permit is not obtained within 180
Print name: ETHON A. DOLPH Date: 12 -9 -08 days after it has been accepted as complete.
• i Iun4 n of' inspections allowed per permit.
IOOAtiktl asoteiInih.til.C•IkrnluApp.nloc 05/0.1106 44II.40l SI( I I113VCO0/wli13
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: FLR2008-00333
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/1012008
Phone: (503) 639-4171 . 11
Inspection Requests (24 Hrs.): (503) 639-4175 ..,..— ----
INSPECTION WORKSHEET FOR DATE: 119/2009 TIME: 7:01AM PAGE: 19
SITE ADDRESS: 13333 SW 72ND AVE A CLASS OF WORK:
SUBDIVISION: HAMPTON RIDGE APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: HAMPTON RIDGE
DESCRIPTION: Units: A-J. Installing fiber optics.: for Verizon.
OWNER: HAMPTON RIDGE APAR1MENTS LLC, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-254-6920
Inspection Request Scheduled For: Date: 1/90009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 079546-04 971-563•4092 N
Corrections/Comments/Instructions:
\\,
\ \ -\\\
\ \\\
A or\
IA PASS 0 PARTIAL APPROVAL El CANCEL 0 NO ACCESS
0 FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: G- t Lk _....
Date: 1 ' C I ' ' C l Phone #: (503) 718- je_a_