Permit N CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
7 ' COMMUNITY DEVELOPMENT Permit #: ELR2009 -00239
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/05/2009
Parcel: 2S110AA00200
Jurisdiction: Tigard
Site address: 14130 SW 105TH AVE 25
Subdivision: CANTERBURY TERRACE APARTMENTS Lot: 0
Project: Canterbury Terrace
Project Description: Install fiber optics for Verizon.
Owner: FEES
VOIEN, BETH TRUST Description Date Amount
BY BETH VOIEN TR, 24 VILLA POINT DR Restricted Energy Permit 07/31/2009 $75.00
NEWPORT BEACH, CA 92660 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:
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 B u` li )1111 1 . • L Permittee Signature: r N� 34 1
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.
: RECEIVED
JUL 2 9 2009
CITY OF TIGARD
Electrical Permit Application; BUILDING DI!'
r
< Fo t7ma; USEONLY • :'..: - :,
• City of Ti nd �1,,c1w <
�' a Permit Nu., L-
4 7 IMe /fly: {.� 1 '7 ) 1 ' L« �c ,1
131 - 5 SW Nail Blvd., Tiwird, OR 9722.1 plan Review C ` Y� G
' . ' Piwue: 503.639.4171 1:0E 503.590.1960 Darr/fly: Other permit:
it C, ARD inspection Line: $03.630.4175 0 4O Roadylu : tic . 21 See Page /for
Wanton www,dgnrd er.gov NuIII dlMahwl: , q _ Supplemerttol lnfornuuiat
. •■ ;' TYPE or WORK • :i.:. *. : . ' •: FLAN IIRV: MW. V.. *'!:. ' ..... "
0 NewconstRIction in Addition /alteration /replacement ' Please caeca all that Imply (submit ; sets or plans wfaemselre kccbefuw):
CI Demolition 0 Uli1Cr: 0 Service 61 feeder 'RIOantpa 00olbting over throe al let
lw,ero ale awilable 1a1111 curious 0 Morino* nml homyordr,
...h'.e;',; :.,., :, •:• CATEGORY •OF• CONS1'RUC VON. . muftis 10000 mops le ISO soft to Q Malibu buiWinna.
lad to would, or moods 14,000 0 Commercl :d•uso atalcalturnl
El l- and 2- 1'nmilydwelling ❑Comtnecial /industrial ❑ Accessory building mops for 611 olkc 1'144111km. Wdhtinga.
oMuhi.fami)y 0 Master builder L7 Other: O Pitepomp, Q (emanation o(75KVr1or
; ••.:, - ire QCnkr$Oia:y syamm. taw separately derived *yam,
- , , , •'- J OB SITE. INFORMATION AND LOCATION • ...• . .� : "• • QAlklitiaunf new ntnler toad nt [] . K . ,./i .. , "L:>" ••I •T"
Job no,: I Job site address: 14130 SW 105TH AVE 1104P or MOM. acC/il)anry. Re
City /Slate/ZIP: TIGARD, OR 97224 Cl Q Se WIC faSi lites, i 0 alMla. Q Su y v olit lC f f moro nd lis
i.l H facilities, Supply v nlui o o r nno than
❑ Hnaanhlna locution*. GOO Nth ne111h,at
$11111 /bldg,/apt, no. 25 - 26 Project name: CANTERBURY TERRACE Dservtvoot !odor 600 mho or 1114116.
—
FCE'tiCfTET1Ui.E
Cross street /directions to job site: nwMlntun 1 qtr, 1 t./ .1 sous p •
Now rustdontlal single- or uttdtl•famlty t unit.
lachtdos attached ga<srge,
Subdivision: I Lot no; 1.000 so. R. or less 145,15 - , 4
Ea. arkt'l 500 sq. ft. or potion 33,40 I
Tax nt11p /parecl no.:
- Limited enemy. residat{fnl
Dt*SCRIP'rION OF WORK (wilts above sq, a.) 75,00 2
INSTALL FIBER, OPTICS FOR VERIZON c
Lt e s t a e nlulli-ilonity 75.00
c (wits Menu W O.)
Services or feeders ins1atlotion, ulteratlnn, and/or relucn(lon
200 amps or less 80.30 2
'•'0 PROPER'PY•'OWNER •' ` :. .. 'El' TENANT - ' 201 amps 10 400 craps 106.85 2
Name: 401 amps to600amps 160.60 2
601 amps to 1000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: 'foutpurary services or feeders installation, alternllos, aullior
Phone: ( ) j Fax: relocation 00 mps
Fax: ( ) 200 amps or less 66.85 I
Owner installation: This installation is being made on propetty that I own which is not 201 "ntL I° 404 amps 100.30 2
intended for sale, /ease, rem, or exchange, according to ORS 447, 449, 670, and 701. 401 loops to 599 amps 133.7$ 3
Owner signature: Date: Branch circuits - new, Microdot!, orextension, per panel
A. tea for brooch cu'cumie IV(/l,
' ; - ' to APPLICANT • • - : '• :a. . ' - ®'- CONTACT PERSON above service or feeder fee 6.65 2
t3ueiiness nano: COMMUNICATIONS, each branch circuit
NORTH SKY COMMUNICATIONS INC, 0. Foe for branch circuits
t viU,onl service or feeder fee,
Contact name ERIK SCHENCK 46.85 2
fist brunch circuit
Address: 11818 SE MILL PLAIN BLVD STE, 410 Each :tdd'I branch circuit - 6.65 ---
Misrclloneous (service or foe(ferjwt ipcluded)
City /Slalc/ZiP: VANCOUVER, WA 98684 Each inonuftcluredormodular 00.90 2
Phones: (503 ) 969 - 7729 Pax:: ( 866 ) 452.4853 dwelling, service and /or feeds
Becalmed only - 66.85 2
E -mail: mduorenorthskycomm,com i or irrigation circle : 53A0 2
CONTRACTOR Sign or outline lighting 53,40 2
Bu incss 115,110: igaal cimuit(s) or limited.
NORTH SKY COMMUNICATIONS, INC. i energy panel, alteration, or
Address: 11818 SE MILL PLAIN BLVD, STE 410 extension. Describe: 1 Page 2 $75.00 2
City /Stace/ZIP: VANCOUVER, WA 98684 _ Csadi additional Inspecti over allowable In any of the above •
Phone: ( 360) 254 -6920 I Fax: ( ) 1 -868. 530 -4325 62 p °r impaction 62.50
htvestigation par hour0 br ado) St)
CCS Lie,: 14117 I Electrical Lic.17. S upt-v. Lic.: 1 73LEB hrduahial plant per hour 73.75
Stlprv. Eicetricinn signature, requited:
- • •• •• •Ef,P4TRICAt. PERMIT REM ..' ..."' •
Subtotal: $75.00
Print ummu: JACK CAGLE Date: 7/29/09 Phut review (254,ot•permit fee):
State surcharge (1255 of permit fee): $9,00
Authol'iycdsignature: ai - I i I), TOTAL PE:RMITPEE?: $84.00
Print name: ETHAN A, DO! P I Date: 7/29/09 •rtes poendl uirpiirntiun impious if a vomit h not claw Mona 180
e, days OW It Inns been aetcpteal Its uumplety,
timing ufiu spcctluns unmet! ticrpond.
191 ..auinolknnh41i1,C.tbrn■app.tnc O5M/06 110461r1Y1141,9C0SVAVIA1
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