Permit CI TY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 -00344
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/18/2008
PARCEL: 1S135CD-00900
SITE ADDRESS: 11483 SW 98TH AVE ZONING: R -12
SUBDIVISION: GLACIER LILY APARTMENTS LOT: JURISDICTION: TIG
PROJECT: GLACIER LILLY APARTMENTS
Project Description: Install fiber optics for Verizon. This is for units: 11481 & 11483.
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:
SHARON DEVELOPMENT CO, LLC NORTH SKY COMMUNICATIONS INC
5795 SW CRANBERRY CT 11818 SE MILL PLAIN BLVD
BEAVERTON, OR 97007 SUITE 410
VANCOUVER, WA 98687
Phone: Contact #: PRI 360 - 254 -6920
FAX 1- 866 -530 -4325
Reg #: ELE 17- 154CLE
FEES LIC 14117
Description Date Amount
[ELPRMT] ELR Permit 12/18/200€ $75.00
[TAX] 12% State Surch 12/18/200€ $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: 6 � AA Permittee Signature: S Q Q ' T T ) IA .
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.
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Electrical Permit Application `� FOR OFFICE USE ON LY ` . ..,
City of Tigard %f0C/ � /IAA Permit No.: E � -00.3 A
Z vi 13125 SW Hall Blvd., Tigard. OR 9 3 C 1 ���,,
' Ph one: 503.639.4171 Fax: 503.598.1960 OG� ` . » Qlhcr Permit:
TI GA RD Inspection Line: 503.639.4175 1 [ r . t> Sec t'age z for
Internet: wxvw.tigarel or (`tJ 0G` ` (�� ` T . CwdlMcthotl: SupplemontalInformation
TYPE OF WORK v ` ` ` ` O We" • : .. PLAN REVIEW
❑ New construction 171 Addition /al teration C tent Please check all thin apply (submit I sets of Plans w /ileme chocked below):
❑ Service or feeder 400 turps or more Q 8idlding over throe stories.
❑ Demolition ❑ Other: where the available Nail current t (J Marinas and boatyards.
. • CATEGORY OF CONS"I•RU(: LION exceeds 10,000 amps to 150 rolls or Cl Plowing buildings.
I -an< - tumid dwelling tees to ground, or exceeds 14,000 ❑C:ommeni0- uscagricultural
❑ 2-family g ❑ Commercial/industrial 0 Accessory building amps for all other installations. buildings.
r4 Multi- family ❑ Master builder 0 Other: Cl lane pump. D Installation nl • 75 KVA or
JOB SITE INFORMATION AND LOCATION CI Emtorganey aystom. larger sopamroly derived system. • ❑ Addition of new motor load of ❑ 'A" "ti" "1.2", I.3
Job no.: I Job site address: 11511 SW 98TH AVE. I0014Pormere oecmtutncy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: TIGARD, OR 97223 ❑ Hea racilitics, 0 Supply voltago for mom titan
❑ Hazardous locations. 600 volts nominal.
suite /bldg./apt. no,: 11481,114831 Project name: GLACIER LILY ❑ Servicetie feeder 600au g tsor more.
FEE SCHEDULE
Cross street /direction job site: noet+uaan I Om t Fee. I 'total I •
Lti_ 14 3 New residential o or multi-family dwelling unit.
.�___LL
includes deS attached garage.
Subdivision: I Lot no.: 1.000 sq. ft. or toss 145.15 4
Et. adri'I 500 sq, ft. or portion 33.40 t
Tax map/parcel no.: Limited energy, residential
DESCRIPTION OF WORK 75.00 2
(with ',bow sq. a.)
INSTALL FIBER OPTICS FOR VERIZON Umittdenergy, ncalti • fnn'ily 7500 " 2
residential (with Avow sq. 11.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
0 PROPERTY 'OWNER 0 - TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 temps or volts 454.65 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.83 t
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 snips 100.3(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 extension, per panel
Owner signature; __ -, Date: A. Fee For branch circuits with
El APPLICANT p CONTACT PERSON above service or feeder fee,
6.65 2
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. B. Fee for brunch circuits '
Contact name: RYAN ROBERTS without service or feeder fee, 46.85 2
first branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each mdd'Ibltucchcircuit - 6,65 J 2
Miscellaneous (service or feeder not included)
City /State/ZIP: VANCOUVER, WA 98684 Elleh manufactured or modular
dwelling, service andlor feeder 90.90 2
Phone: (503 ) 519 -5264 I Fax:: ( )1 -866 -905 -4907 Reconnect only 66.85 2
E-mail: rnduorenorthskycomm,com Pump or irrigation circle 53.40 2
CONTRACTOR Sign oroutline lighting 53.40 2
Business name: NORTH SKY COMMUNICATIONS, INC. S( crgy p a e l,( al erlt n o i, or
h ctncrgy panel, alteration, or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Page 2 $75.001 2
City /StatelzlP: VANCOUVER, WA 98684 Each additional inspection over allowable in tiny of the above
I Pax: ( ) 1- 866 -530 -432 I n v inspection 62.50
Phone: (360) 254 -6920 hcvcsliguti anper hour (I hrmin) 62.50 _
CCE t 14117 I Electrical Lic.17 -154CL Suprv. Lie.: 178LEB Industrial plant per hour 73.75 _
- ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal; $75.OQ
Print name: JACK CAGLE I Dale, 12 16 08 Plan review (25% of permit fee):
State surcharge (12% of permit fee): $9.00
Authorized signature: ec 01 TOTAL PERMIT ITS: $84.00
'rids
Prin! name: s permit application expires if a permit is not obtained within Igo
ETHON A. DOLPH Date, 12 -16 -08 days after It II•sc been accepted ns completo.
• Number of inspections allowed per permit.
1: lnuihlingWcimhse 0I.C•t'eratitApp.rinc 05/21/0& la0.461K1'(l tll$R:OMAVIia
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�U����U����U�U�U��� PERMIT ~�~~""~~~~"~~~ DIVISION � ELR2008-00314
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/18/2008
Phone: (503) 639-4171
Inspection Requests �4Hnn.):(5O3)G3Q~4175 .
INSPECTION WORKSHEET FOR DATE: TIME: PAGE: � 1/8 /��O� � �� D��kA : 24
SITE ADDRESS: 114838W 88TH AVE CLASS OF WORK:
SUBDIVISION: GLACIER LILY APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: GLACIER ULLYAPARTIvIENTS ---.5:.7.11";!:1;
DEGCR|pT|ON: Install fiber optics for Vnv�un. This is for units: "446,
OWNER: SHARON DEVELOPMENT CO, LLC, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 350
Inspection Request Scheduled For: Date: 1/6/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
13 Low voltage 073407-85 603-563-4002 N
Corrections/Comments/Instructions:
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.
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IN ��RARTALAPPR[��L F — � CANCEL �� NOACCESS
�� �_, PARTIAL u ��
ri FAIL 0 CALL FOR INSPECTION || ADDITIONAL FEES ASSESSED
���_ t�\�� t o�� � � �� � �� N
Inspector: ~�- �^ "`w���� ^—«� Date: �' a»' -� Phone #: (503) 718- ��'�°�K2
CITY\OF TIGARD
SULt NG DIVISION PERMIT #: ELR2008.00344
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/1812008
Phone: (503) 639- 4171�°u �� �', -
Inspection Requests (24 Hrs.): (503) 639 -4175 Jail"
INSPECTION WORKSHEET FOR DATE: 12/19/2008 TIME: 7 :00AMv1 PAGE: l,l
SITE ADDRESS: 11483 Sw 98TH AVE CLASS OF WORK:
SUBDIVISION: GLACIER LILY APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: GLACIER !ILLY APARTMENTS
DESCRIPTION: Install fiber optics for Verizon. This is for units: 11481 & 1
OWNER: SHARON DEVELOPMENT CO, LLC, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-2M-6920
Inspection Request Scheduled For: Date: 12/19/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
13 S Low voltage 079154 -05 503.209.7014 N
Corrections /Comments /Instructions:
rilor
❑ PASS ❑ PARTIAL APPROVAL ❑ ANCEL NO ACCESS
n FAIL 1 CALL FOR INSPECTION ❑ ADDIT ONAL EES ASSESSED
7
Inspector: Date: '7 &t Phone #: (503) 718-