Permit .--- :.
I N
a CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00060
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/19/2009
PARCEL: 2S 101 AB - 01000
SITE ADDRESS: 12490 SW 72ND AVE 911 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: DATAITELE 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: Permittee Signature: ,, I,, 40 UO_Dibl
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. ELECN: 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 Application Pcnni
oicori�'ICr. t.r oJVLY ` :
Y 8 2009 -• '.. :.,
City Received
of Tigard
S 1)atcia • -1 p • O l ♦ Pcnn,t No. :....l�O9 .00406%
' 13125
hone S50 all Blvd., Tigard, OR 9 if OFIIGARD
J u 6(Qj � TJ Plan Review
M
Phone SW
503.639.4171 fax: 503.59 1r I , ec /B :
Other Permit TI GARD Inspection Line: 503.639.4175 U J DNI _• D pae Re ally /By: 6J See I :age 2 for
Internet: www.liganl or.gov Notified /Method: SupplementalInfornuriva,
• TYPE OF WORK . PLAN REVIEW ' •
❑ New construction 13 Addition /alteration/replacement Pic:sc check all That apply (submit 2 sets ol'plans w /item checked below):
❑ Sorelee or Cecile, 400 amps or a1P7e ❑ a uildiny over dove stories.
❑ Demolition ❑ Other: wheat Ibc available flub current ❑ Marinas and boatyards.
. • CATEGORY OF CONSTRUCTION exceeds ROM amps at 150 votes or ❑ Finning brilding:.
less to ground. or exceeds 14.000 ❑ Commercial -use agricultural
❑ I- and 2.familydwelling ❑Commercial /industrial ❑ Accessory building aims for all other install:lios. buildings.
o Multi - family ❑ Master builder ❑ Other: ['Fiat pimp. 0 Inst elation of 75 KV,1 or
JOB SITE INFORMATION AND LOCATION O Emergency system. larger scpvatcly delived system.
• ❑ A,Wition of new molar Toad of ••A" ..(,., "I �.• .•I.1"
lob no.: Job site address: 12490 SW 72ND AVE. 100HP or mom occupancy.
❑ Six or more residential unite. ❑ Recreational vehicle pinks.
City /Slate /ZIP: TIGARD, OR 97223 0 Health -care facilities. ❑ Supply Vthagc fur mere titan
❑ Haeanlous locations. 5)10 volts nominal.
Suite /bldg. /apt. no.: BLDG 9 Project name: HAMPTON PARK ❑ Service or feeder 600 mum emote.
FEE SCHEDULE •
Cross street /directions to job site: Description 1 Q. I co. I 1 'Irwin 1 •
NOV residential single - or multi - family dwelling unit,
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R. or less 145.1 4
- -- Ea. ndd'1 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION 01? WORK (with above nil.)
75.00 2
INSTALL FIBER OPTICS FOR VERIZON Limitcdenergy, muhi- family
75.00 .
residential (with above so. 0.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ' L ❑ 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 volts 454.65 2
City /Suuc/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 I own which is not 201 amps to 400 amps 100.30 2
intended for sale, least, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps _ 133.75 2
- __..- _ ^ - -�-Datc :.
Brunch circuits - new, alteration, or extension, per panel
Owner
A. Foe for branch circuits with
❑ APPLICANT 1 ri CONTACT PERSON above service or feeder fee,
each branch circuit 6A5 2
Business name: NORTH SKY COMMUNICATIONS, INC. B. Fee for branch circuits
wirhour service or feeder fee,
lust beach circuit
Contact name: RYAN ROBERTS 46.85 2
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each 044'1 branch circuit 6.65 2
Miscellaneous (.service or feeder not included)
City /State/ZIP: VANCOUVER, WA 98684 Each manu factured or modular 90.90
dwelling, service and /or feeder 2
Phone: (503 ) 519 -5264 Fax: : ( )1- 866 - 905 -4907 Reconnect onl 1 66.85 j 2
E mduor( northskvcomm.com Pomp of irrigation circle 53.40 I 2
CONTRACTOR Sign or outline lighting 53.40 1 2
Business name: NORTH SKY COMMUNICATIONS INC. e t t e rg pa alt limited-
or
cuergy puucl, alteration. or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Pa 2 $75.001 2
City /State /ZIP: VANCOUVER, WA 98684 Each additional inspection over allowable in any of the above
Fax: ( ) 1 -866- 530 -4325 Per inspection i(io 62.50
Phone: (360) 254 -6920 Investigation per tour(( urn,llu 62.50
CCB Lic.: 14117 Electrical Lic.17 -154CL S,tprv. Lie.: 173LEB Industrial plan per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required:
Subtotal: $75.00 ,
Plan review (25% of permit fee):
Print name: JACK CAGLE Oat': 2 -18 -09
Slate surcharge (12% of permit fee): $9.00
Authorized signature: TOTAL PERiv1 PEE: $84.00
This permit application expires if a permit is not obtained within 180
Prim name: ETHON A. DOLPH Date: 2-18-09 days after it has been accepted as rwiiplete•
Number of inspections allowed per pcn1ttl.
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