Permit 1111 CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a
Permit ELR2009 -00243
COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/04/2009
Parcel: 1S135DD03300
Jurisdiction: Tigard
Site address: 11555 SW 88TH AVE 27
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
Landscape Lighting: N Medical: N
Required Items and Reports (Conditions)
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 5012466699 or 1.800.332.2344.
Issued By: `11 UN .. i/ ' Permittee Signature: t�1 )! 0 4(e .
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.
. . . Ck!.\\I ED
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V , 1 0 Electrical Permit A�licat L O f0, 0 -
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City of Tigard • •• i t>r.M• • _I 43
a 13(25 SW Hal) Olvd Tigard, OR 97223 -
1,1 li Phone: 503,639.4171 Fax: 503.598.194 Odrecponld+,
(1 GAR r) inspection Line: 503.639.4175 tine Rcadynly: Jarig !II Soo t•nxc 2fer
internet: www.dgnrd- or.gov Notified/Method: AA (+ Suppion.e,unt Information
. ' TYPE OP ' r. . . . . . . . . . . . . . . . .: ' ' . •- ,. -: PLAN RRVI6W.V•'''.:;;. ° , . •
0 NOW construction 12 Additionhtlteral ion/retflaccmcita Metre chock ail titan wy+ly airtime j co:s nl' p+anx %Rteins checked below):
[3 f3cIn011tipil _ [] Other:
C) Sc+vlco or aorta 400 mom or paw ❑ An dlning ov,a 1hl0O Sto tes,
. nls Oro Iota limbic Molt coma Q Mudnm nod booty, ,rds,
' : ".., : ;. •. . CATEGORY .OP CONSS'I «UC'17UN . .; '77 euxwis IOAW an+irs at 150,onxur ❑ ffhntirog wildiuys.
loss so ground. or moods wan 0 Cumin clal.m ogrleuaural
❑ I - and 2- famliy dwelling ❑ Commercial /industrial Q Accessory building amps tbrnll other i+rslalh+dutu. buildings.
(3+ Multi- fainil ft 0 Master builder 0 Other: Cain, p+ 0 lna +d4dionuOS KVA or
, .•' JOB SITE INFORMATION AND LOCATION [iamwrgei1 y larges separatelyderived%yitm.
� ':
••.5• QAddi uc or,17:,10rinadnf D ue, •t;•' "i.:gyi,y,
lob no.: i Job site win= 11555 SW 88TH AVE uaNP or mom. occupancy.
psis it mere rcsidcnUal units, ❑ Rsureutinl+ai vehicle Parks.
City /State/ZIP; TIGARD, OR 97223 ❑Hcanh•cic rockier. Cl Supply volwponu' own thou
C1 Hzxartlmis'motions. 600 v,dis nwnhwl.
Suite /bldg. /apt. no. 27 -36 I Project mope: PARK PLACE Osorutco M feeder 600 tun su H am m ..
• ^.•' -PEE 'SCHEDULE "r ' '
Cross street /directions to job site: _ 0taadnnn I der. 1 for. [ Tod [ •
Now resideadal single• or nntftl•fnntliy dwelling unit.
lucfudes altaebed garage,
Subdivision: , i Len no.: 1,000 sq. I. or loos 145.1$ 4
TIM prop /parch:! fie,: Vii. mdd'I $00 Sri. II. or portion 31,40 I
Limited coolly. Mil duntial
75.00 2
DCSSCRIPTION OP WORK (wide dhow s
INSTALL FIBER OPTICS FOR VERIZON Lin6leetcitorLy . ntald- 12tmily 7500 '
residential (with ob re xtt, a.)
Services or feeders inslnllation, Ultcrelton, ancUor ivtacmtio
(] PR <IPiiR'l'Y; OWNER 200 amp or less 80.30 2
,, • .. • El • TENANT • 201 amps to 400 stops 106.85 2
Nance: 401 amps to600amps 160.60 2
""— — -- 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 stops or volts 454.65 — 2
City /Staue/ZIP: Temporary services or feeders insfn8atlon, alteration, and(ot•
relocation
Phone: ( ) I Fax: ( ) 200 amps ol'less _ 66.85 I
Owner instmRatlon: This installation is being made on property that I own which is not 201 antes to 400 amps 100.30 2
intended for sale, letucc, roil, or exchange, according to ORS 447, 444, 670, and 701. 401 amps to 599 amps 133.75 1 2
Owner signature: — -__- p a1e: Drench circuits - new, utter:Won, or extension, per panel
A. f'cc for branch ctrcuil6 with
. ••';.:..- • ❑ APPLICANT . "•. r ' 1 . • ` CONTACT PERSON above service or feeder fee, 6.65 2
Ma branch circuit
Rosiness name:
NORTH SKY COMMUNICATIONS, INC. B. Fee for branch circuits
Contact name: ERIK SCHENCK widow sorvioo or feeder fee, 46,85 2
rim brunch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each adrt'lbranchoilcan I 6.615 - 2
Miscellaneous (service or feeder not included)
City /SIntc /ZIP: VANCOUVER, WA 98684 Each i anufochucd or modular 91)190 2
Phone: (603 ) 969 -7729 I Fax; ; ( 066 > 4524853 Reconnect only nndfor feeder
cco only 66.85 2
Entail: rndUOrenorib$icYCOMm: mom Pump or irrigation circle 5140 2
CON'1'RAL"f(1R Sign or outtlito lighting 53,40 2
Business panto: Sigmdcimuit(s)orli+uitcd-
NORTH SKY COMMUNICATIONS, INC, energy pawl, ahomGun,or
Address: 11818 SE MILL PLAIN BLVD. STE 410 ext.: atop, Describe: 1 2 $75.00 2
City /State/ZIP: VANCOUVER, WA 98684 t3ach additional las , celion over alinwabloinan Ofihe above •
Phone: ( 360) 254 -6920 I Fan; ( ) 1- 866 - 530 -4325 Poi 1tipentt00 62.50
htvestignon per hour Or Cam I♦ 62.50 II
CCB Lie,; 14117 I Elecaical LIc.17_154CL Suprvv. Lic.: 173LE6 htdttsuiaiplantperuour � �
•..,. .• PERMIT PEES '° •. - -
Suprv. Electrician signature, required: Subtotal: $75.00
Print name: JACK CAGLE Date: 7/29/09 Plan raview (25% of permit fee):
Slate surcharge (1258 of permit fee): $9,00
Authorized signature:
TOTAL PERklfrPSG: $84.00
Print 0Wf10: ETHAN A. IDOL PH DM: 7/29/09 % I l i t o porailt apptlm Wiwi Oxplivs ifs permit s not obu mod olibtn Imo
dogs oiler it fro brow no:1W or complete,
° Num of h+spealons nlleuad per moll.
intro kengwetn.b,ea.Cdimr0,ylp.dee 0.111x106 4to.1616110 Ia1.GCOaawtill