Permit M
I y w CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
II II COMMU DEVELOPMENT Permit #: ELR2009 -00245
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/04/2009
Parcel: 1 S 135DD03300
Jurisdiction: Tigard
Site address: 11555 SW 88TH AVE 50
Subdivision: PARK PLACE GARDEN APARTMENTS Lot: 0
Project: Park Place
Project Description: Install fiber optics for Verizon.
Owner: FEES
1616 SHORELINE LLC & Description Date Amount
LOMITA WEST LP, PO BOX 15516 Restricted Energy Permit 07/31/2009 $75.00
FREMONT, CA 94539 12% State Surcharge - Electrical 07/31/2009 $9.00
PHONE:
Contractor:
PHONE:
FAX:
Type of Use: MF
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: Y Fire Alarm: N
HVAC: N Instrumentation: N Total $84.00
Intercom /Paging: N Landscape /Irrigation: N Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through AR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: C��l :C .�, l f Permittee Signature: 2 , p
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' 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.
4 s
RECEIVED
JUL 2 9 2009
CITY OF TIGAR 1
Electrical Permit A 13licatio U ILDING DIVISIi isoR011!etr USE ONLY . '
r ii City of Tigard E' ` r L 4-E
't 13125 SW Hail 131v(1_, Ti8ord, OR 97223 r
, Plume: 503.639.4171 Rix: 503.598.1900 16651.1111111111111111111111111 00 Penn11.
TIGARD inspection Line: 502.630.4175 UatoReady/Ity: 1. El Soo t'nxcz
Fntentet: www.tigatrd- or.gov Nollrrcd /Mcdool; t! Sup lnfnrronnot
. TYPE 01■ WORK .. •.. ':' PLAN REVIEW
Q New oons(tuclion 12 Addition /alteration /repineclnent -- Ptc;ne chock 811 that ,h1ly6 611' 1'; ,onnfl>tuns ,rnlcowchrtlo4 :Oow),
El Demolition 0 Other: Q Sclvioc or feeder 403 mops to more 0 h u8diug two turn sto,fcs.
whets ti o nv,tiluhlc Cult current 0 Mnrilus nod boatyards.
.. .. •• CATEGORY of CONSI'1ouCTtoN , CM:Cells 10,000 amps ;It ISO vonr a rluanngiwlWings.
❑ I - anti 7.- fntnil dwelling tees to ground, or exceodr l 4.000 (3 Canunercld•usu as;,kaborn!
y 0 Q Commercial /indusirint [ ] Accessory building oyes for in other iustulimions. buildings,
0+ Multi - family ❑ Master builder ❑ Other: 0 Pi,n pomp 0 Instalhdiun of 7S KVA or
. - 7013 SITE INF.ORNIATlON AND LOCATION On hryerscporatelyndrwed
----• ❑AdditinnAl'nnvnt„lnrh,ul d "A" "!• ""I•t "•'1•J'•
Job no.: Job Mtn addre.ex: 11555 SW 88TH AVE loom or MON. sacv,11"nry'
EI Six or more revidentiol units, 0 itcercmtnnai vehicle parks•
City /Slate1ZIP: TIGARD, OR 97223 0 Heaieh•cu,orncuitics. 0Supplyvoltup for "tom Utao
0 Hut nahssu loc(1lions. 600 mix nominal.
Stile/bldg• /apt.nove50 Project mum: PARK PLACE 0 Servicootfeedorn00 how uf more.
Q FIT 'SCI1EDUt,E
Cross street/directions to job site: Je) _-, narrspuan 1 ply. i ph. .1 'NW I •
New residential single• or nullll- fandly dwells ug (sail,
Includes attached garage,
Subdivision: Lot no.: 1.000 nq. it. or loss i45.13 - _ 1 4
Ton neap /parcel no.: I tin, odd 500 sq. u, or portion 33.40 !
Limited eacrgy, resitIU Iiai 75.00 2
DESCRIPTION OF WORT( (wilt„ eq. II.)
INSTALL FIBER OPTICS FOR VERIZON Limitcticlrol I; 7500 2
residcntiad (slit,ow,; n II.)
Services or feeders inslidl tion, ulleralion, and/or rotlieniton
200 amps or icon 80.30 2
❑ PROPER'1'Y•OWNER - 1 .• '. TENANT 201 amps to 400 mops 106.85 2
Name: 401 amps to600Amps 16040 2
" 601 into to 1,000 amps 240.60 2
Address; Over 1,000 snips or nobs 454.65 2
City/Stine/ZIP: Temporary services or feeders Installation, :iteration, and/or
relocation
Phone: ( ) Fax: ( )_ 200 amps o' lass 66.85 1
Owner installation: This instellntion is being made on property that I own which is not 201 amps to 400 amps 100.:0 2
intended for suit, tense, rent, or exchange, according to ORS 447. 449, 670. and 701. 401 amps to 599 omits 133.75 2
Branch car cults - new. 0111rattou _er panel
Owner signature: ___ .._.__Dale: _ extension, p
A. Fee for bronco circuits frith
:. '-' • 0 APPLICANT . - . '. :. • • C. CONTACT PERSON • above service or feeder reo, 6.65 2 •
each lynch circuit
Rusincssonion: NORTH SKY COMMUNICATIONS, INC, O. Fee rnr brunch circuits - '
Contact name: ERIK SCHENCK without service or feeder feu,
_,___., - -_ 1)rsnbr:,nchcirceit 46.x5 2
Address: 11818 SE MILL PLAIN BLVD STE. 410 E:rcll add'Illr/anchcircuit I _ _ 6.65 • - - � ?
roisectianemss (service or feeder not included)
City /Stole /ZI VANCOUVER, WA 98684 Each indoor:temred or madulur
Phone: (503) 969 - 7729 I l=ax:: ( 066 ) 452 dwallinr, service and /or feeder 90.90 --
Reconnect only - GG.85 2
E-mail: duo a�7north- Pump orirri irrigation circle 53.40 2 '
- [ sisYOOmm �Qm p d'
CON'CRACTOR • • • Sign °mullion lighting 53.40 2 '
INC, energy circel alte rtimitcd -
Businoss name: NORTH SKY COMMUNICATIONS, encrgypanci, alteration, or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Pogo 2 $75.00 2
City /State/ZIP: VANCOUVER WA 98684 Eaclt additional luspeclion over allowable in of the abo
Ph000: ( 360) _ Per /1/114/C01011 62.50
n
254 -6920 Fax: ( ) 1- 866 -530 -4325 urvoslignlinn per hour u brmitt) 62s0
CCB Lit:,: 14117 Electrical Ltc.y 7 -164CL Sltply. Lie.: 173LEB Industrial plant per !tom. 73.75
. . ELECTRICAL PERMIT F E E S • ` -
Suprv. Electrician signature, required: Sublulnl: $75.00
Print none: JACK CAGLE Datc: 7 /29/09 Phut review (259h of permit fee):
Stare surcharge (I 2% of Krim ice): - $9.00
Authorized sigrtmuro: _
/�� TOTAL PERMIT tv.E: $84.00
Print nnmc ETHAN A, DOLPH Dale: 7/29/09 - This pormh upplicntiva oxphvs Ire porndl Is not ohtahtcd ettllin 1110
doy-x After It /tax boon neropted as cuurydMr.
Number of itlspeclluns ulluwrd pre pernd4
l: 1000dinb 'ormlMlil,C•r'erninApp.dnc elr)4a6 III 16151'(1IttleCOJInvlill