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Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00146 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/6/2008 PARCEL: 1S135CD-03900 SITE ADDRESS: 11909 SW 95TH AVE 15 ZONING: R-4.5 SUBDIVISION: DOVE COURT APARTMENTS LOT: 008 JURISDICTION: TIG PROJECT: DOVE COURT APARTMENTS Project Description: Units: 15 -17. Installing fiber optics for Verizon. A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPEIIRRIGAT: 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: HOUSING AUTHORITY OF NORTH SKY COMMUNICATIONS INC WASHINGTON COUNTY 11818 SE MILL PLAIN BLVD STE 4 111 NE LINCOLN ST #200 -L VANCOUVER, WA 98687 HILLSBORO, OR 97124 Phone: Contact #: PRI 360 - 254 -6920 FAX 1- 866 -530 -4325 FEES Reg #: ELE 17- 154CLE LIC 14117 Description Date Amount [ELPRMT] ELR Permit 6/6/2008 $75.00 [TAX] 12% State Surch 6/6/2008 $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: �` r �i Permittee Signature: c 7, 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. _JUN 05 2008 11:51 PM FR TO 5035981960 P.07 ECEIVt EIectrical Permit Application .i OR OFFICE LI ONLY City of Tigard JUN 0 5 201 .. : nnrl n,t c.->2 �— . r ' 13125 SW Null Blvd.. Tigard, OR 97223 Ono, Vcr ( Phone: 503.639.4171 Fax: 503.596,1960 ,' L� F i i +.,a;—: i _ Inspection Lille: 503. 639.41 75 't f^ 111 In ( ® Sec Page Z ror TIGARD A Supplemontaltnrormntiun .,,,,,11't: www.ti -or gew - TYPC a?F WORK PLAN REVIEW... - Please cheek alt that apply (suhnlit b f mans etb oans w /ttcm decked below): CI New construction of Ad dItion /alleralt021 /toplflcurlettt El 0 Service or reader 400 amps or trxiro ❑ Iiuildin; over three Stories. [0 Der710lition El Other: where the available Wit current ❑ Mnri =tats amt boatyards c:iee,xls 10,000 an, td ISO volts or ❑ Floating buildin� CAIN CURY`Of CONSTRUCTION loss lagrmmd or _. ` ❑ Cotumen_iai - nso agttcuhiu;ll ❑ 1- and 2-family dwelling © Commercial /industrial ❑ Accessory building amps torah othet' Inslttltalinos, bui ldings. p Multi- family a Master builder ❑ Other: Untie pomp. 0 Iimclt Lion or 75 KVr1 ur © Emergency system. hail: t separately derived swept. JOB SITE INFORMATION AND LOCATION a Addition m or new nax bald or 1:1 "A" "E', ' 13" " 1.3", - lump or mom. necopnncy• Job no.; Job Site address: 11909 SW 95TH AVE (3 Six or mace reSidc ccii nttitd. U Itcc,c'stilnat vcllielc trtrks. Cit /State/ZIP: TIGARD, OR, 97223 ❑ Health -cam roc {lilies. ❑ slrytt>ly voluigo or more than - ....__-. CI Haaaulous loetinni. WO volts nominal. Su ite /bktgJapt. no.: 15 -177 Project mane: DOVE COURT APTS Els-rvlce feeder (SOOampsor ..r. ._..... .: FEE SCHEDULE .., . Cross Sweet /dirrclions to job SItc; Ueacd inn Oty. so, 'Pint , , • -' New residential single or multi - family dwelling unit. Includes attached garage. _ - _ ._,.., ~. 1 Lot no. — 1,000 sq. ft, or less al 145.15 — Q . 33,41) Ttlx map /parcel no.: _.. � Ili 75.00 �...._ DESCRIPTION OF WORK INSTALL FIBER OPTICS FOR VERIZON 75.00 I : - ServiCeS Or feeders installation, alteration, and/or relocatMn 200 amps or lass 1111 a 2 • 1:1 PROPI'sR7 "Y;OWNER 1.. , -,[] TENANT r cr 106.85 401 amps to 600 am - is II_ 160.60 M Name: ell anips 240.60 Address Over MO ' TonvorAry geVviCCV Or feeders installation, alteration, andlor City /State/ZIP: relocation Phone; ( ) Fax: ( ) 200 amps or 201 amps to Owner installation: This installation is bring matte on property that 1 own which is alit it ►1 intended for sale, lease. rent, or exchange. according to ORS 447, 449, 670, and 701. 4di amps to 399 amps 133.75 2 Branch circuits - new. alteration. or exton,Rion. er and Owner signature: - „_... - ._... Date: . © APPLICANT 1 ,,0�, .CONTACT PERSON above service or feeder leo, 6.65 . each branch circuit Business name: NORTH SKY COMMUNICATIONS, INC. B, Fee tor branch circuits Connie; name: RYAN ROBERTS nest brunch circuit Address: 11818 SE MILL PLAIN BLVD STE. 410 ` Miscellaneous (service or feeder Ind IIICIUded. City /State/ZIP: VANCOUVER, WA 98684 al 90,94 — a • Phone: (503 ) 519 -5264 Fax: ' ( )1- 866 -905 -4907 Reconnect only 66.85 mon - E -mail: mduorOnrt o hskvc(�m(rl.om or irrigation circle 53.40 NM . CONTRACTOR _ 53.40 2 • Signal eitruit(s) or limited- Business name: NORTH SKY COMMUNICATIONS, INC- - energy panel, alteration. or Address: 11818 SE MILL PLAIN BLVD. STE 410 Paget $75.00 2 City/State/ZIP: VANCOUVER. WA 98684 Each additional ' 62.50 MUM Phone: ( 360) 254 -6920 Fax: ( ) 1- 866 -530 -4325 Investigation per hour (i ie moo (32.50 111 CCB Lie.: 14117 Electrical Lie.1 -154CL 1 Suprv. Lie.: 173LEB W 11949;9tvial plant per hour 71.75 Suprv. Electrician signature, required: - 1 • Print name: JACK CAGLE Date; 6 State surcharge (1296 or permit fee): . .9.00 Authorized signatu ( 1 - TOTAL PERMIT PEE: 84.00 Thla permit npplical;un expires if 19 permit ie not obtained within 130 Print name: ETH ON Aa., D 4 L P H paw; 6 -5 -08 days ner a ii hoe been accepted Au cony , fete. Number cf inspections :mowed ItcY non*. }pS5i,ii OWcnei, \t'I.C.P.im4,lip,dor, 5503105 4411 -001rI'tl 11051COMM'1313 ** TOTAL PAGE.07 ** CITY OF TIGARD BUILDING DIVISION PERMIT #: ELR2008- 00146 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/6/2008 Phone: (503) 639 -4171 pill Iafi Inspection Requests (24 Hrs.): (503) 639 -4175 .114,3W 1L INSPECTION WORKSHEET FOR DATE: 6/13/2008 TIME: 7:01AM PAGE: 36 SITE ADDRESS: 11909 SW 95TH AVE 15 CLASS OF WORK: SUBDIVISION: DOVE COURT APARTMENTS LOT #: 008 TYPE OF USE: PROJECT NAME: DOVE COURT APARTMENTS DESCRIPTION: Units: 15 -17. Installing fiber optics for Verizon. OWNER: HOUSING AUTHORITY OF, PHONE #: CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360 -254 -6920 Inspection Request Scheduled For: Date: 6/13/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 071340 -05 503.572 -3632 N Corrections /Comments /Instructions: X PASS ❑ PARTIAL APPROVAL (I CANCEL ❑ NO ACCESS n FAIL CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED Inspector: P� � Date: 6// ��O g Phone #: (503) 718 - `� •