Permit !pi CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2008 -00335
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/10/2008
PARCEL: 25101 DB -00800
SITE ADDRESS: 13359 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/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: Permittee Signature:
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 Application DEC 0 9 2008
FOR OFFICE USE ONLY `:
City •
elf of Tigard itcceind
0.00 ,, Permit fro.: �' •
1 3125 SW Il ;dl Blvd., Tigard, OR 97 1 ��/ OF TI GA �'
�(�Y � 1j- �t.
'
IMP' • Phone: 503.639.4171 Fax: 503.598. i OF �j Other Permit:
TIGARD Inspection Lino: 503.639.4175 BUILDING DIVISI Ia t I ED See Page 2 for
Internet; www,tigard- or.Sov Supplemontnt Information
• TYPE OF WORK 'PLAN REVIEW
❑ New construction 01 Addition /alteration /replacement Please check edt that apply (submit 2 NCO; or oho. writv,n. checked hatow):
❑ Service or feeder 400 amps or more ❑ Building over trine stories.
El Demolition ❑ Other: where the available mull current ❑ tvinrinas and boatyards.
• . CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
• Less to ground. or exceeds 14.000 ❑ Cuunncrci:d -use agricultural
El 1 - and 2- I'<amily dwelling ❑ Commercial /industrial ❑ Accessory building amps for all outer insullhuions. buildings.
19 Multi - family ❑ Master builder ❑ Other: ° Fire pomp, J Installation of 75 KVA or
❑ Emergency system. larger separately delived system.
JOB SITE INFORMATION AND LOCATION ❑ Audition of new motor load of 2 ", " •3
Job no.: Job site address: 13359 SW 72ND AVE. 100HP or mote. occupancy.
❑ Six or more residential units. ❑ Recruniunal vehicle parks.
City /State /ZIP: TIGARD, OR 97223 ❑ Health-care facilities. C1 Supply vmuige for inure than
❑ Ha/antuus locations. 000 volts nominal.
Suite /bldg. /apt.no.: -J Project name: HAMPTON RIDGE ❑ Service or feeder d00 amps ormore.
job site:
FEE SCHEDULE
Cross street /directions to
J nrstrlptlun 1 Qty, ( Um 1 'I'ulal ] •
-`- New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lol no.: 1.000 sq. h. or less 145.15 4
En. midi 500 sq. fl. or portion 33.40 I
Tax map /parcel no.:
Limited energy, Icsidential 75.00
DESCRIPTION OF WORK (with chow sq. rl.) --
Limited energy, multi - family 00 2
INSTALL FIBER OPTICS FOR VERIZON residential (with ahovesg. a.) 75. •
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER • ❑ TENANT 201 amps to 400 ansps 106.85 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 I own which is not 201 amp l0 400 :unps 100.30 2
intended for salt, least, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps 10 599 amps 133.75 2
Branch circuits - new, alteration, or extension. per panel
Owner signature: —. -- - - -- —_
A. Fee for branch circuits with
0 APPLICANT 1 Di CONTACT PERSON above service or tccdcr Ice, 6.65 2
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. n. Fee for branch chianti;
wilhaur service or feeder fee, 46.85 2
Contact name: RYAN ROBERTS
lust brunch circuit
1 Address: 11818 SE MILL PLAIN BLVD STE. 410 Each add'I brand) circuit 6.65 2
Miscellaneous (service or feeder not included)
City /Stale/ZIP: VANCOUVER, WA 98684 Each manufactured or modular 9090T
dwelling, service and/or (ceder
Phone: (503 ) 519 -5264 Fax:: ( )1- 866 - 905 -4907 Reconnect only 66.85 I 2
E -mail: mduor((:r�.north$kvcomm.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
- Business name: NORTH SKY COMMUNICATIONS INC. energy panel, alter timiled-
, ahcrgy Panel, ;dtcraiiou. or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Page 2 $75.00 2
City /Stale /ZIP: VANCOUVER, WA 98684 Each additional inspection over allowable in any of the above
360) 2 -6920 ( ) 1- 866 - 530 -4325 I n v stig 62.50
Phone: ( Fax: - '
Investigation per hour (1 Or min) 62.50
CCs Lie.: 14117 Electrical Lic.17 -154CL Supra. Lic.: 173LEB lndustriai plant per hour 73,75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required:
Subtotal:
$75.OQ_
Print name: JACK CAGLE Dale- 12 -9 -08 Plan review (25% of permit fee):
S tate surcharge (12% of permit fee): $9.00
Autlhorizedsignutulc: ,... ,. ale TOTAL PERMIT FEE: $84.00
This permit application expires ir a permit is not obtained within 180
Print name: ETHON A. DOLPH Date: 12 -9 -08 days after h has been accepted as complete.
" Number of inspections allowed I er permit.
I: n )uilain4V'a,nh,CLC- NtmdAult•tcx 0133106 4 ni.loi1'1 I /Its /COMrvIin
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: El.10008-00335
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/10/2008
Phone: (503) 639-4171 :0210004/1
Inspection Requests (24 Hrs.): (503) 639-4175 LL
INSPECTION WORKSHEET FOR DATE: in 2j2009 TIME: 7 00At PAGE: 13
SITE ADDRESS: 13:359 SW 72ND AVE A CLASS OF WORK:
SUBDIVISION: HAMPTON RIDGE APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: HAMPTON RIDGE
DESCRIPTION: Units: A Installing fiber optics for Verizon.
OWNER: HAMPTON RIDGE APARTMENTS L.E.C, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-254-6920
Inspection Request Scheduled For: Date: 1/12/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 079590-02 971-563-4082
Corrections /Comments/ Instructions:
PASS 0 PARTIAL APPROVAL 0 CANCEL ri NO ACCESS
FAIL 0 CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED
Inspector: Cr • NO Date: 11 5 1 Phone #: (503) 718- 1116