Permit III CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2009 -00056
T I G A R iD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/19/2009
PARCEL: 2S 101 AB -01000
SITE ADDRESS: 12414 SW 72ND AVE 511 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: q"tra ,.. k i llt . QA,L Permittee Signature: C i Qic'
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 Applicati "E D
FOR OFFICE USE ONLY
City of Ti Ilyd i 8 Received [� /�[� r
Y F; l - r B 1 (7 200Q I)atNliy. pl' tR ' 0-1 Pc unit fd.� 1 2 ao5 . oCc
9 13125 SW Hall Blvd., Tigard, OR 972 v Phut Review
Ld \.�JL J
IFY
' Phone.' 503 639 4 171 Fax: 503 5 060 Datc/Oy: 010cr Permit
TIGARD Inspection Line: 503.639.4175 i "TY OFTIGARD Dale Really /By: mri:: El Sec Page 2 for
(n cornet: www.tigard -orgov BUILDING DIVISION Notified /Method: - r1_ c � Supplementol Information
• TYPE OF WORK PLAN REVIEW '
❑ New construction 01 Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w/item checked below):
Demolition ❑ Service or feeder 400 amps or newt CI Building over duct stories.
❑ Del nO
❑ other': where the :,vada fault cuncnl ❑ Marinas and boatyards.
• CATEGORY OF CONSTRUCTION - exceeds (0,000 mops at 150 volts or ❑ Floating buildings.
fen to ground. Of cxcccds 14,000 ❑ Commercial agsicuhntr l
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other insinuations. buildings.
El Multi - family ❑ Master builder ❑ Other: ❑ Fite. pomp. ❑ lostallation of 75 KVA ur
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger scparuely derived system.
❑ Addition nr new moor load ni ❑..�.. "( "'In •'L }
Job no.: I Job site address: 12414 SW 72ND AVE. 1001+P nr'nom occupancy.
❑ Six or num rcaiticnti :d Idia. ❑ Itcocut ion nI vehicle parks.
City /State /ZIP: TIGARD, OR 97223 ❑ Heahh.carc facililics. ❑ Supply voltage for more than
❑ I4xnnaluue locn6on,. 600 rolls non»inal.
Suite /bldg./apt. no.: BLDG 5 I Project name: HAMPTON PARK ❑ Service er feeder 600 amps or non0.
FEE SCHEDULE '
Cross street /directions to job site: Description I Qty. 1 her. 1 'total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. ur leas 145.15 4 '
Ea. ;WWI 500 sq. ft. or portion 33.40 1
Tax m;tp /pareol no.' Limited energy, residential - - --
DESCRIPTION OF WORK 75,00 -
(svilb alnn•e sap. Ii.)
INSTALL FIBER OPTICS FOR VERIZON Lin,ite<lenergy, lnu)li- b';hmi'y
75.00 2
residential (with above sn. ,i.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I . ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: I ' l '
601 amps to 1,000 amps 240.60 2
Address: Over (.000 amps or voles 454.65 2
City /Sate /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 t own which is not 201 mops to 400 amps (00.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.71 2
[hunch circuits - new, alteration. or extension, per panel
Owner signature; Date: A. Fee for branch circuits with
❑ APPLICANT I O CONTACT PARSON above service. or feeder Ice, 6.65 2
each hranch circu
Business name: NORTH SKY COMMUNICATIONS, INC. 1). Fee for branch circuits '
without service or (ceder lee,
lust branch c ircuit
Contact name: RYAN ROBERTS 46.85 2
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each :tdd'I branch chcuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: VANCOUVER, WA 98684 Each manofaelnred or modular
90,90 2
dwelling, service and /or feeder
Phone: (503 ) 519 -5264 Fax: : ( )1 -866- 905 -4907 Reconnect only 66.85 J 2
E -mail: mduor( northskvcomm.com Pump or irrigation circle 53.40 ' 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: NORTH SKY COMMUNICATIONS, INC. energy circuit(s) or 61 limited-
h cnor;y Panel, ahcralion. or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Paget $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 — invest igatiou per hour (1 hr min) - 62.50
CCB Lic.: 14117 Electrical Lic.17_154CL Suprv. Lie.: 173LEB industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: cie.
Subtotal:
Print name: JACK CAGLE Date: 2 -18 -09 Plan review (25% of permit fee):
_ —_ Slate surcharge T (12%
L. of fee): 0
� _.
Authorized signature: , � �� - - -_ - . - -. TOTAL. '1' FEE: $84,84.00
Date: 2 -18 -09 This permit application expires if u permit is not obtained within 180
Print name: ETHON A. DOLPH D
days after it has been accepted ;IN complete.
. Number or inspections allowed her permit.
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