Permit . . .
71 �� CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00352
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/18/2008
PARCEL: 1 S135CD -00900
SITE ADDRESS: 11547 SW 98TH AVE ZONING: R -
SUBDIVISION: GLACIER LILY APARTMENTS LOT: JURISDICTION: TIG
PROJECT: GLACIER LILLY APARTMENTS
Project Description: Install fiber optics for Verizon. This is for units: 11547 & 11549.
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:
SHARON DEVELOPMENT CO, LLC NORTH SKY COMMUNICATIONS INC
5795 SW CRANBERRY CT 11818 SE MILL PLAIN BLVD
BEAVERTON, OR 97007 SUITE 410
VANCOUVER, WA 98687
Phone: Contact #: PRI 360 - 254 -6920
FAX 1- 866 -530 -4325
Reg #: ELE 17- 154CLE
FEES LIC 14117
Description Date Amount
[ELPRMT] ELR Permit 12/18/200€ $75.00
[TAX] 12% State Surch 12118/200€ $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: I . Q * Q Ca
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.
. . 4 •
os Electrical Permit Applicat' G. FOR OFFICE VSE ONLY
�'��� Rece
City of'Ti Tigard /fly: /Q /! 0Q' /t/ ���5�
Y g r Permit N n.:
Er 13125 S W Hall Blvd., Tigard, OR 97223 Gi;,v , .view
Phone: 503.639.4171 Fax: 503 - 598,1960 ' ( , �� i 1 Other Permit: TIGARD
Inspection Line: 503.639.4175 � O ' Ready /ny: airs' RI Sec Page2
Internet: www.tigard- or.gov �`�IN* `V Notified /MCnro1: /� Supplemental Information
'TYPE OF WOIt 'PLAN REVIEW -
❑ New construction GI Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /ileins checked below):
0 Service or feeder 400 amps or I mre ❑ Building over (Mee stories,
❑ Demolition ❑ Other: where the available fault surreal 0 Minion and boatyards,
- CATEGORY OF CONSTRUCTION • exceeds 10,000 amps of 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,0(10 ❑ Commercial-use aolhelitm!
❑ I - and 2-family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other Metall:ainns. buildings.
NI Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. p Installation of 75 KVA of
JOB Sl "1'E INFORMATION AND LOCATION ID Emergency . .sysrem- larger separately derived system.
,- ,_,- __,._, -. 0 Addison nl ncry mom load of ❑ ..q" ,. Ii „ .. Y
Job no.: Job site address: 11511 SW 98TH AVE. I 110110orImre. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle italics.
City /Stare/ZIP: TIGARD, OR 97223 D Henuh -care facilities, ❑ Supply vnhago for more than
0 Hazardous locations. GOO volts nominal.
Suite/bidg./apt. no.: 11547,11549 Project name: GLACIER LILY 0 Servicoor feeder 400 amps or more.
- FEE SCHEDULE
Cross street /directions to job site: nexrdpnau 1 Qty. 1 inn, j Yxod 1 •
New residential single- or multi- family dwelling unit.
1/ 3 / j ' q Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft, orfess 145.15 4
Ca. adrl'I 500 sq. R. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK <w ill allow nl. ft.) 75.00 2
Limited idnnli rgy,muld family 7500 2
INSTALL FIBER OPTICS FOR VERIZON
residential (with above sit. 111
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER 0 TENANT ' 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2 I
Address: 601 amps to 1,000 antes 240.60 2
Over 1,000 amps or volts 454.65 2
City / Stare/ZIP: Temporary services 01' feeders installation, alteration, and /or
relocation
Phone: ( ) pax: ( ) 200 amps or less 66.85 1
2
Owner installation: This installation is being made on property that I own which is not 201 snips b0400amps 100'30
intended for sate, 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:_ -Dale: -- --
-- - -- A. Fee for branch circuits with
APPLICANT 1 Q CONTACT PERSON above service or feeder fee,
6.65 2
each branch circuit
Business name: NORTH SKY COMMUNICATIONS B. Fee for branch circuits
without service or feeder fee,
Contact name: RYAN ROBERTS first branch circuit 46.85 2
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each add't branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: VANCOUVER, WA 98684 Each manufactured or modular
90.90 2
Phone: (503 ) 519 -5264 Fax: : ( )1 - 866 - 05 - 4907 Reconnect
dwelling, t a onl ye and/or feeder
9
Reconnect onl 66.85 2
E -mail: mduor c(r� northskycomm.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: NORTH SKY COMMUNICATIONS e
INC.
signal
cilcuti(a)tar(lmited-
nergy 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 nhrmho 62.50
CCB Lie.: 14117 Electrical Lic.17 -154CL Supt-v. Lic.: 173LEB Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES `
Suprv. Electrician signature, required:
Subtotal:
$75.00
Print name; JACK CAGLE Date: Plait review (25% of permit fee):
12 -16 -08 Stine surcharge (12 %of permit fee): $9
Authorized signature: � - /�� TOTAL PERMIT I rr: $84.00
This permit application aspires if a permit is not obtained within ISO
Print name: ETHON A. DOLPH Date: 12 -16 -08 days rifler it has been aro:pied tin complete.
' • Number of inspections ■dlowcil per permit.
h5l lsihding \I'ern,ii, \l1C- PenndApp.dne 05123/56 JandSii'I'(I I /1157COMAVLII
, t : • ■ . •, .
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2008-00362
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/18/2008
Phone: (503) 639-4171 Ovild A
, , ir
Inspection Requests (24 Hrs.): (503) 639-4175 ......., ' ,- eb
—
INSPECTION WORKSHEET FOR DATE: 1/612009 TIME: 7:00AM PAGE: 16
SITE ADDRESS: 11547 SW 98TH AVE CLASS OF WORK:
SUBDIVISION: GLACIER LILY APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: GLACIER LILLY APARTMENTS A
DESCRIPTION: Install fiber optics for Vorizon. This is for units: .'it ..!:.-1-1-S487----'n •
OWNER: SHARON DEVELOPMENT CO, LLC, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-2546920
Inspection Request Scheduled For: Date: •/6/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 079401-13 503-663-4082 N
Corrections/Comments/Instructions:
C ..,
yLPASS 0 PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS
fl FAIL . fl CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: G ' Were - Date: 1 - i c) ' 1 Phone #: (503) 718- 11,140