Permit 71 " CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00339
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/10/2008
PARCEL: 25101 DB - 00801
SITE ADDRESS: 13397 SW 72ND AVE A ZONING: R -
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 /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: 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 at 503.246.6699 or 1.800.332.2344.
Issued By TIIIIIIII ermittee Signature: i��" r ✓ ") r/`/
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.
. .
. ..
. RECEIVED
Electrical Permit Applicatio Ivy 0 9 2008 Fo>i `oF. iCE USE ONLY :`.
nr con W 163 Tigard . G QFTIGARD F � A i��
13125 S W (dull B Tigard.
• Phone: 503.639.417 f Fa V��G DIVISION Other Pcrmie
T I GARD In spcct i om L ine: 503.639.4 U:ne Ready /Oy: ®Sec I'uge l for
Internet: www.tigard- or.gov Notified /t4clhod: O Supplcmenlnt Information
TYPE OF WORK 'PLAN REVIEW • •
❑ Ncw construction 121 Addition /alteration /replacement Ple:.ec check :11 than apply 60h0111 2 sots or plan, w/itcniv checked below):
❑ Service or reeler 400 amps or more ❑ Building over dove storie.
❑ Demolition 0 Other: where tlte:rvailablc fault current ❑Monnes and boatyards.
• CATEGORY OF CONSTRUCTION • exceeds I0.000 :umps:l 150 oiisor ❑ Floating buildings.
less to ground. or c Wccds 14.000 ❑ Conuncrcial.use aericulluml
❑ I - and 2- family dwelling ❑ Commercial/industrial 0 Accessory building amps for all outer installations. buildings.
12 Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA e,
7. JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
. • ❑ Addition of new motor load or ❑ "A ", - E . , "1.2", ''1.3".
l
Job no.: Job site address: 13397 SW 72ND AVE. ❑ Sixx or or more. occupancy.
more residential unit,;. ❑ ttCCIL'allltnal vehicle !talks.
City /State/ZIP: TIGARD, OR 97223 ❑ Health -care Facilities. ❑ Supply voltage Ow mere than
0 Hazardous locations. (M)0 volts nominal.
Suite/bldg. /apt. no.: A -J Project name: HAMPTON RIDGE ❑Sc, vicc orfccdeh GOO amps ur tunic.
FEE SCHEDULE .
Cross street /directions to job site: ueselpnon 1 Qty. 1 Fce. 1 Total 1 •
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. or less 145.15 4
- -- Ea. add 1 500 sq. 0. or portion 33.40 I
Tax atop /parcel n0.: i Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
INSTALL FIBER OPTICS FOR VERIZON Li es energy, multi-family 7500
I 'Ctiid idCtlllnl (with;dlovCs a.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER • ' . ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 :a j 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 matte on property that I own which is not 201 : 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
( branch circuits - new, alteration, or extension, per panel
Owner signature: ______,_ - - -- ._._ _ A. Fce for branch circuits with
❑ APPLICANT . I p CONTACT PERSON above service or feeder Ice, 6.65 9 •
each branch circuit
BnSir1CSS name: NORTH SKY COMMUNICATIONS, INC. B. Fee for brittlehcircuits
RY AN ROBERTS fi rst brunch service or fc«Icr Ice
lirsl
Contact name: 46.85 2
brunch h circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each add'IbranCh 6.65 2
Miscellaneous (service or feeder not it
City /Slate/ZIP: VANCOUVER, WA 98684 Erich manufactured or modular -
_.__ - ._.. _.... ...--- dwelline, service and /or feeder
90.90 3
Phone: (503 ) 519 -5264 Fax: : ( )1- 866 - 905 -4907 Reconnect only 66.85 2
E -mail: mduor(a)northskvcomm.com Pump or irrigation cirrae 53.40 2
CON'T'RACTOR Sign orolIlinc lighting 53.40 2
Business name: NORTH SKY COMMUNICATIONS, INC. energy alter•tiluilcd-
I
: cuur�y p:ncl, alteration. or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Paget $75.001 2
City /State/ZIP: VANCOUVER, WA 98684 Each additional inspection over allownbte in any of the above
Per inspection 62.50
Phone: ( 360) 254 -6920 Fax: ( ) 1- 866 - 530 -4325 (nvostigatiou per hour (1 hr mitt) 62.50
CCB Lic.: 14117 Electrical Lic.17 -154CL Suprv, Lic.: 173LEB • Industrial plant per hour 73.75
ELECTRICAL. PERMIT FEES
Suprv. Electrician signature, required: Subtotal: $75
Print ❑home: JACK CAGLE Dale: Plan review (2.5% of permit fee):
12 -9 -08 State surcharge (12r/' of permit fee):
�`� " $84.00
Authorized signature: // ] TOTAL PERMIT FEE: �B/�,OO
7•hi.s permit application ,spires if a permit is not obtained within 180
Print name: ETHON A. DOLPH Date: 12 -9 -08 days after it has been accepted ns complete.
" Number of inspections allowed per permit.
I: v) nihI Ing\I'cm mil MI,C- I e.V2.VfG .140.4613r(11 /03 /CoslAvl111
CITY OF TIGARD
BUILDING DIVISION
A PERMIT #: FLR2008-00339
D ATE 13125 SW Hall Blvd., Tigard, OR 97223 E ISSUED: •2/10/2008
Phone: (503) 639-4171 ,_.Artlit
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 1/14/2009 TIME: 7:01AIVI PAGE: 21
SITE ADDRESS: 13397 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 APARTMENTS LLC, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-2546920
Inspection Request Scheduled For: Date: 1/14/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 0796B6-04 971-563-4082 N
Corrections/Comments/ Instructions:
_ \ \
\ \IA \
PASS 0 PARTIAL APPROVAL 1 CANCEL 0 NO ACCESS
1 1 FAIL fl CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: G i'• 6e LE Date: I ' 1 4 ---1 Phone #: (503) 718- 4141174