Permit `� n CITY O F TIGARD I GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00057
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/19/2009
PARCEL: 2S 101 AB - 01000
SITE ADDRESS: 12442 SW 72ND AVE 611 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: 1� Permittee Signature: Q o
Q �� S Woman
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 J OR OFkiCL USE ONLY
City of Tigard FEB 18 2009 Received i
, Dale /0': • V . • ` - Permit Nu.. a. ` �.� • � ' O�
131 5 SW Ball Blvd., Tigard, OR 9� OF TIGARD Plan Review Permit t: Phone: 503.639.4171 Pax: 503.5 DtuclOy: U+hcr Permit:
TIGARD Inspection Line: 503.639,4175 BUILDING DIVISION IJa1e Rc xIyIBy: hair la See Page 2 for
Internet: www.tigat'd or. Notified /Method; jI l n Supplcmcn(ol ;Dion
' - TYPE( OF WORK PLAN REVIEW
❑ New construction 0I Addition /alteration /replacement Please cheek an That apply (submit 2 sets of plats wljIcnts el iccked below):
, ❑ Scrvicc or rccdct 400 amps or mono ❑ Building over (limo stories.
❑ Demolition ❑ Other: where the available li current ❑ marinas and boatyards.
CATEGORY OF CONSTRUCTION • cancels 10,000 amps at ISO volt. or 0 Bloating builJiuss. •
Less to ground. or exceeds 14.000 ❑ Cummercix) -use agricultural
❑ I - and 2- family dwelling 0 Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
al Multi - family ❑ Master builder ❑ Other: Q fire pump. 0 Installation of 75 KVA m
JOB SITE INFORMATION AND LOCATION Q Emergency system. tarter separately derived system.
• 0 Addition of new muntnr load of ❑' • • .• I• ? ,•.• 3'
Job no.: Job site address: 12442 SW 72ND AVE. I (10HPormom occupancy.
Q Six or molt residential units. ❑ Rccroatiunal ,rohicic parks.
City /State /ZIP: TIGARD, OR 97223 ❑ Hcallh•care facilities. ❑ Supply voltage for more than
❑ Hazardous lucatiuns. (i00 MIS unusual.
Suite /bldg./apt. no.: BLDG 6 1 Project name: HAMPTON PARK ❑ Service or feeder fi00 amps or more.
FEE SCHEDULE
Cross sweet /directions to job Site: »oacn rno„
l 1 orv. 1 r•.r. I Tmal
-- New residential single- or multi - fancily dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
1 Ea. add•I 500 sq. ft. or portion 33.40 1
Tax map /parcel 110.'
Limited energy, residential - -
DESCRIPTION OF WORK (with above ill. it.)
75.00 2
INSTALL FIBER OPTICS FOR VERIZON Lintedc multi-family 7500 2
residential (wilt alxwe so. Ili
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.10 2
❑ PROPERTY OWNER • I . _ _ ❑ TENANT 201 amps to 400 amps 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 voles 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /er
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I
Owner installation: This installation is being made on property that I own which is not 201 amps l0 400 romps (00.3(1 2
intended for sale, 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 eslension, per panel
Owner signature:-_ - -_ -- -- . ,Date: _ --
A. Fce for branch circuits tvW1
❑ APPLICANT _ 1 0 CONTACT PERSON above service or feeder fee, fi 65 7
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. 13. Fee for branch circuits
R YAN ROBERTS u'i(hnar service or feeder ice, i 2
Contact name: first branch circuit l 46.85
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each add'I branch circuit 1 6.65 2
Miscellaneous (service or feeder not included)
City /Stale/ZIP: VANCOUVER, WA 98684 Each manufactured or modular
t : (503) 519 -5264 Fax:: dwelling, service and /or feeder
Phone: 90.90 2
( )1- 866 - 905 -4907 Reconnect only 66.85 1 2
E -mail: mduor(c�northskvcomm.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 •
tilisiness name: NORTH SKY COMMUNICATIONS INC, energy cireel alter timilcd
energy peset alteration, or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Paget $75.001 l 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 (I hr min) 62.50
CCB Lic.: 14117 Electrical Lic.17 154CL Suprv. Lic.: 173LEB Industrial plant per hour 73.75
CLECI'RICA1. PERMIT FEES -_ ,• -
Suprv. Electrician signature, required: .. Subtotal: $75.00
(' n review (25% of permit fee):
D ate:
Print name: JACK CAGLE 2 -18 -09
/�� - State surcharge (12% of permit fee): $9.00
•
,. / �/
Authorized signature: � f/J TOTAL PERMIT FEE: 84.00
��• This permit npplicnlion expires if a permit is not ohlaiucd u ithin 180
Print name: ETHON A. DOLPH Date: 2 -18 -09 (lays after 11 has been accepted so complete.
Number of inspections allwved per Knott.
huh,iIdins1'runit.0il.C.- Prate Appaloc 092.1410 440•af I,5 0(15/( :OMAVIin