Permit C ITY OF T I GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00054
T I G A It D 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/19/2009
PARCEL: 2S 101 AB - 00800
SITE ADDRESS: 12388 SW 72ND AVE 311 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 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: L1 c a Permittee Signature: A Ocx (0y I
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.
Electrical Permit Applicat�oli CEIVED •` FOR'OF 'ICE USEONLY; '
City f'fi and Received
y ' Oaten) •: - - 0 r . Permit No.:
t 1 3125 SW Hall Blvd., Tigard, OR 97223'; 8 2009 -- 00:4 ��
Plan Review • Phone: 503.639.4171 Fax: 503.598. U60 Oate/0y: Oder Permit:
TIGARD Inspection line: 503.639.4175 r �. Date Ready/By: /vtt El See Page 2 for
Internet: www.tigard 'T'Y j O j F TIG Notified/Method: 1 C.' Supplemenlnl Information
. TYPrs"���tt i0 DIVISION V ISION PLAN REVIEW
❑ New construction RI Addition /alteration /replacement Please check all Mu apply (submit 2 sets or plans w /Bents checked below):
CI ❑ service. or order 400 amps or room Building over thmc nories.
U Demolition ❑ Other: where the availahle fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 1 50 volts or ❑ Floating buildings.
less to gt ound. or exceeds 14,000 ❑Commerci:d•useagticubural
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all outer installations. buildings.
17 Multi - family ❑ Master builder ❑ Other: ❑ Fite pump. ❑ installation or 75 KVA of
JOB SITE INFORMATION AND LOCATION 0 Emergency system. Inver separately derived system.
• __ ❑ Addition nI'new motor load of
❑ ..�. ..
Job no.: Job site address: 12388 SW 72ND AVE. 100HPormom. occupancy.
❑ Six or more residential mot,. ❑ Keeiveliunal vehicle pans.
City /State/ZIP: TIGARD, OR 97223 ❑ Health•carc facilities. ❑ Supply voltage for more than
❑ Hazardous locutions. WO volt, nominal.
Suite/bldg. /apt. no.: BLDG 3 Project name: HAMPTON PARK ❑Sc Mix or feeder 600 mops or more.
' • FEE SCHEDULE
Cross street /directions to job site: Description 1 Qty. 1 Per. 1 'rota t •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot tlo.: 1.000 sq. R. orHess 145.15 1 4
Ea. add'I 500 sq. It. or pot tion 33.40 1
Tax nr3lp:uccl no.: i Limited energy, residential
DESCRIPTION OF WORK 75.00 2
(with above sq. Ii.)
INSTALL FIBER OPTICS FOR VERIZON Limitedentil(withu1ti•fnnlily 7500
residcnlinl (with ,(slue up. 0.)
Services or feeders installation, alteration, andlnr relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER •
_ _ . ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 aanps 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, a(terafion, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps l0 400 amps 100.30 2
intended for sate, lease, rem, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - Dew, alteration, or extension. ter panel
Owner signature: ___- _._ ______,.__ __.__,__._____._ A. Fee for branch circuits tviil
❑ APPLICANT I O CONTACT PERSON above service or !deco lee,
6.65 2
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. 13. Fee for branch circuits
RYAN ROBERTS _ wirhuarr service or feeder roe. I 46.85 2
Contact name:
first branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each add'l branch circuit t 6.65 2
Miscellaneous (service or feeder not included)
City /Slate /ZIP: VANCOUVER, WA 98684 Each manul;tctured or modular 9090T
dwelling, service and /or feeder I!
Phone: (503 ) 519 -5264 Fax: : ( )1-866-905-4907 Reconnect only 66.85 2
E -mail: mduor northskvcomm.com pomp or irti circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
nosiness "Me: NORTH SKY COMMUNICATIONS energy ne y P p a n el , s) or limited -
alteration, or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Paget $75.00
City / State/ZIP: VANCOUVER, WA 98684 Each additional inspection over allowable in any of the :thrive
Per inspection 62.50
Phone: (360) 254 -6920 Fax: ( ) 1- 866 - 530 -4325 Investigation per hour (i In min) 62.50
CCB Lie.: 14117 Electrical Lic.17 -154CL Suprv. Lic.: 173LEB Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
s75
Print name: Plan review (25% of permit fee):
JACK CAGLE Date: 2 -18 -09
State sutch,ngc (1 Z% of perms( fee): $9.00
Authorized signature: �.„ 0,./ TOTAL PERMIT FEE: $84.00
This permit application expires if a permit is not obtained within 180
Print name: ETHON A. DOLPH _ Date: 2 -18 -09 drys after it has been accepted as complete.
Number of inspections allowed per permit.
I: U) uihfing (1ermil,VO.C.I'ertiitApp.rur 05)23/86 440.46131'(1 IRIS /COM/wI:13
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2009 -00014
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 2/19/2009
Phone: (503) 639 -4171 Ruyf��,+�
Inspection Requests (24 Hrs.): (503) 639 -4175 �
INSPECTION WORKSHEET FOR DATE: 2/27/2009 TIME: 7 :01AM PAGE: 7
SITE ADDRESS: 12308 SW 72ND AVE 311 CLASS OF WORK:
SUBDIVISION: HAMPTON PARK APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: HAMPTON PARK APARTMENTS
DESCRIPTION: Install fiber optics for verizon.
OWNER: HAMPTON PARK LLC, PHONE #:
CONTRACTOR: NOR`I SKY COMMUNICATIONS INC PHONE #: 360 - 261 -6920
Inspection Request Scheduled For: Date: 2127/ 2009 Pour Time:
Code # Inspection Description 6on#i # Contact # Message
199 Electrical final ( 080907 -0' 603 -93 "2 -6681 N.
( Y
Corrections /Comments /Instructions: --
- (2
•
\ \-/\/1 ;
y l PASS ❑ PARTIAL APPROVAL ❑ CANCEL 111 NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G N s5e W Date: 3.' 1 1 Phone #: (503) 718- IN)