Permit a C I TY OF T I GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
• .
� a COMMUNITY DEVELOPMENT PERMIT #: ELR2009 -00051
T I c A R D 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/19/2009
PARCEL: 2S 101 AB -00801
SITE ADDRESS: 12320 SW 72ND AVE CLUBHOUSE ZONING: MUE
SUBDIVISION: HAMPTON PARK APARTMENTS LOT: JURISDICTION: TIG
PROJECT: HAMPTON PARK APARTMENTS
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: 1
Owner: Contractor:
HAMPTON PARK LLC NORTH SKY COMMUNICATIONS INC
BY WEST COAST MORTGAGE 11818 SE MILL PLAIN BLVD
4000 KRUSE WAY PL, BLD 1 STE 2 SUITE 410
LAKE OSWEGO, OR 97035 VANCOUVER, WA 98687
Phone: Contact #: PRI 360 - 254 -6920
FAX 1- 866- 905 -4907
FEES Reg #: ELE 17- 154CLE
LIC 14117
Description Date Amount
[ELPRMT] ELR Permit 2/19/2009 $75.00
[TAX] 12% State Surch 2/19/2009 $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 Taws. 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: � izsAgikk. � `-' Q u Dn_(� Permittee Signature: �.�A App 1 \(1GA tOY1
v "' • ' 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.
ai ,.
Electrical Permit ApplicatiorlRECEIVED ., L o)it,OFF1Ck USEONLY ' ,;. :.
City of Tigard Et Q.20�f , 4,4L
'' 13125 SW Hall Blvd., Tigard, OR FEB 18 2009 pawn Review
97221 Pcr,nit No.:
I • Phone: 503.639.4171 Fax: 503.598.196
: � D :tic /A Other Perini':
TIGARD Inspection Line: 503.639.4175 Date Ready/By: ® Sex Page 2 for
It deniaC www.tioafd-orgov CITY OF TIGARD Notified/Method: Supplemental Information
• TYPE OF BINEDINUDIVISMN PLAN REVIEW
❑ New construction 01 Addition /alteration /replacement Please cheek tilt that apply (submit 2 sets anions w /items chceked t c(ow):
❑ Service nr (ceder 400 amps or more ❑ Attikling over I stories.
❑ Demolition ❑ Other: where the available limb currcnl U Marinas and boatyards.
. , . CATEGORY OF CONSTRUCTION , exceeds 10,000 amps to I50 volts or ❑ Floating buildings.
•
hiss 10 ground. or exceeds 14.000 ❑ Connnerchd -use agricultural
❑ 1 - and 2-family dwelling ❑Commercial /industrial ❑ Accessory building amps for all other in stallations. buildings.
r4 Multi- family 0 Master builder 0 Other: ❑ Fi,c pomp. ❑ I of 75 KVA Or
JOB SITE INFORMATION AND LOCATION
0 Emergency system. larger separately derived system.
0 Addition or new motor load of 0
Job no.: 1 Job site address.
12320 SW 72ND AVE. 1001* ormote. occupancy.
❑ Six or more rrsiticnuial units. ❑ Recondition! vehicle, pa,kc.
City/State /ZIP: TIGARD, OR 97223 ❑ Hcnhh -carp ticiattics. 0 Suppl voiIi 0 (or more than
❑ Hazardous locations. 6110 volts nominal.
Suite /bldg. /apt. no.: OFFICE Project name: HAMPTON PARK ❑ Sctvicc or feeder600 aunts or Imre.
FEE SCHEDULE
Cross street /directions t0 job site: nem -halm 1 Ow. I Fee. I Twat 1 •
New residential single- or milli - fancily dwelling 'nil.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. R. or lees 145.15 —T 4
Ea. ad dl 500 sq. fl. or pot (ion 33.40 1
Tax map /parcel no.: Limited energy, residential y
DESCRIPTION OF WORK (with above 'q. ft.) 75.00 2
INSTALL FIBER OPTICS FOR VERIZON Limitc(tencrgy, multi- rtmtlly
75.00 2
residential (with glove.% h.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROP):RTY OWNER _ - 0 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 ; or volts 454.65 2
City /State /71P: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent. or exchange, according to ORS 447, 449, 670, and 701. 401 amps !0 599 amps 133.75 , _ 2
Owner signature: _ Branch circuits - new, alteration, or extension, per panel
_._ ._.._.._._ — .Date: _•_. -__ — A. Fee for branch circuits wig, l
❑ APPLICANT I O CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. B. Fee for branch circuits
Contact nano:
first RYAN ROBERTS
without banch circuit or feeder ice. 46.85 2
fi branch
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each add'I branch circuit 6.65 1 2
Miscellaneous (service or feeder not included)
City /Slate /ZiP: VANCOUVER, WA 98684 Each manufactured or modular
dwelling, service and /or fcccler 9U.y0T 2
Phone: (503 ) 519 -5264 Fax: : ( )1 -866- 905 -4907 Reconnect only 66.85 I 2
E-mail: mduar aC�.northskvcomm.com Pump or irrigation circle ! 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: NORTH SKY COMMUNICATIONS, INC. energy panel, alteration, or
Address: 11818 SE MiLL PLAIN BLVD. STE 410 extension. Describe: 1 Page2 $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 Fay: ( ) 1 -866- 530 -4325
investigationperhour(thrmin) 62.50
CCB Lic.: 14117 Electrical Lic.17- 154CL: Suprv. Lic.: 173LEB IndusIiad plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, require(!: '�.. .. Subtotal: $75.00_
Print name: JACK CAGLE Date: 2-18-09 review (25% of permit fee):
2 -18 -09 State surcharge (12% of permit fee): $9.00
Authorized signature: /�1 TOTAL PfRMI'I' 11l: $84,00
this permit application expires if a permit is not Outlined within (80
print name: ETHON A. DOLPH Date: 2 -18 -09 days after 11115 been accepted as complete.
Number of inspeelioaa allowed per permit.
IAltoildingV'cnuin \I)l,C•I'enna App.dnc OV23ros 44IN613•l'( I In15 /COMAVIa)