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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT 1111 COMMUNITY DEVELOPMENT Permit #: ELR2009-00237 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/05/2009 Parcel: 2S 110AA00200 Jurisdiction: Tigard Site address: 14130 SW 105TH AVE 9 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 0 R 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: , t 0). ( .1 ) jb / \� Perm ittee Signature: S Q , 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. .c RECEIVED JUL 2 9 2009 CITY OF TIGAR[' Electrical Permit Anpttcatton BUILDING DIVIS - ..,: ,.; .,. . : POTI p#FicE USE orii,Y:. City of isu h Tigard � 17C11:1111! ^ .. `` .. . .. J 17 II 13125 SW flail Bhri., Tigard, OR 97221 Hon Review I' ' Phone" 503.610.4171 Fix; 503.S9R.I %0 Other Poona: DarNOy: r inspection Line: 503.639,4175 13ateReatlY /ny: M� �rs�••, / m See I' 2for interact:lwvw.liglutlwtgov Nurlfted /Mahrsl: 11 Supplementalleroematiwn . - TYPE OF WORK "rt:; .., : .. • r . ...1' t ALAN ATiY.16W. V.' .. . . 0 New ionstluotion pAddiiion/alteration1 /replacement 1100enock dlIkIt apply (seismal sets orismis wfnansuiuxleedbelow): [� Demolition Other; O Service orttxder400ampsIlr 0 nnhdity; overdrmexro.kx. ;--, , Metre the available nedli eottenl ❑ Mnvnas curl M,xr»ndx. • ` ..''+::':'. ,r =,... : . CATEGORYor:CONS1I1UC'PION - ..'•:t'. exccm, IMO min al150+oexur ❑ Molloy buildingx. b ulnil dwelling lest to ground. orexvecds14,000 0Counnerchdaoroan /hollaal I- and 2- 13 y G ©Commercial /inelustrinl 0 ousts rornll oilier Installations. buildings. [] Multi - tinnily CI Muster builder El Other a F144 puny,. 0 tnaalhOion of 75 KVA or INF.OR �'': ``- • . i0B SITE tIATIUN 'AND LOCATION °: Q y xyxmm. larger repuuteiy derived xyslem, ....• .. . •,,, . • • 1.4Arklltl:,..7, awr,Wlnr d °A" IV. "I•:! ", "i .3". Job no.: I Job site address: 14130 SW 105TH AVE HARP it see of mom `cems:Iney. ❑ Six to rx more residential nails, C) Rcerualianel vehicle parks, City /Stnte/ZiP: TIGARD, OR 97224 (J HcMth•caxofncititlee. 0 Supply vintage for owe Man CI Hezanbnux Iw:utionxn, 60D void ruuninul. Suita/btdg. /apt. 00. 9 - 20 I Project name: CANTERBURY TERRACE 0 Servisuor feeder 400 unlit% Or tome. :14,.:••• ::; :.' • ...FEE'SCIiEDUI2 Cross strecUdirections to job site: oe linrur 1 Olv. I ere. I Tod ) Now residontiat single- or muill- fondly dwelling nuts. isieltidve attached garage. Sub di vision: I Lot no.: 1.000 sq. 0. or ieee 145.IS 4 Tax pulp /parcel no.: f ls:t. add'f 500 ny. R. of p01(10l 3340 I l energy. residential 7300 2 DESCRIPTION OP WOiltK ' . (with :uxwe sq. it.) INSTALL FIBER OPTICS FOR VERIZON Linatcdenrorgy,ma)t!- 131t 75,0 2 • rcvidcntial (with Anson sy, 0.) Services or fecilcrss inetallgtlon , olteradon, andF r t'locittion 200 amps or Ices 80.10 a • '''0 PRt)P):RTY,'OWNER .' "'I ,, . : • ••. • -0 •TR,NANT 201 amps lo 400 imps 106.85 2 Name; 401 amps to 600 amps 160.60 2 601 maps 10 1.000 aunts 240.60 2 Address: Over 1,000 mops or volts 454.65 2 City /Stale/ZIP: Temporary services or feeders Installation, alteration, aad/ov relocation Phone: ( ) Fox: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being in on property that i own which is not 201 amps to 400 amps 100.30 2 intended for sale, !case, rent. or exchange, according to ORS 447, 449, 670, and 701. 401 mops to 590 snips I I 133.15 1 2 Owner signature: Date: Branch circntts - new. ullcratlou, or extension, per pan A. Fee for broach circuits meta ` 1 ` -'• • ' (7 APPLICANT • ' .. • .. : ` '.4 . ' - © •CONTACT PERSON above service or feeder (co. 665 2 Business nuns: NORTH branch circuit NORTH SKY COMMUNICATIONS, INC. D. Its Contact name: ERIK SCHENCK without scrviccortocderrec. 46.85 2 lust branch circuit Address: 11818 SE MILL PLAIN BLVD STE. 410 Kieft add'i branch circuit 6.6S ] — Miscellaneous (Service or f44Jer)lat ipcluded) CltylSlatc/ZIP: VANCOUVER, WA 98684 riacli Ieunufachrred or modular 90.90 2 Phone: (503 )969-7729 I Fax:: ( 866) 452 41353 deed llin, service and/or feeder Reconnect only 66.85 2 E'inail; mduorc northskycomm,com Pump orirrigativucircle 53.40 2 Ct)N'PAAI T(1R Sign or outline lighting 53.40 2 Businosa nettle: Signal citcuit(s) or limited- NORTH SKY COMMUNICATIONS, INC. energy panel, alteration. or Address: 11818 SE MiLL PLAIN BLVD, STE 410 extension. ()ascribe: 1 Page 2 $75.00 2 City /State/ZIP: VANCOUVER, WA 98684 Each additional Inspection over allownhloht any of the alrove Phone; ( 254 -6920 �+''' «ion 62.50 360) Fnx:( ) 1- 866 - 530 -4325 inves Boor(' hrmini 6230 CCB Lie.; 14117 electric Lic.r1 154CL- snp LIC.: 173LEB induabia)plant,xr 73.75 • Supty. Electrician xlgnnurrc rt tplilctl: ' • • :. • ELECTRICAL PERMIT PEES • • • • • • Subtotal: $75.00 Print enme: JACK CAGLE Date: 7/29/09 Mutt review (25%of perish( fee): Slate surcharge (12% of pcnnit fee): $0 Authorized signature: ^,ta 1 TOTAL PrSRMrr trrti: $84.00 Print nnine: ETHAN A. DOLP H 1 Date: 7 /29/09 'fills garnet upplrrnrluii oxplrvr it a !moth is not obtained wit Ida 180 days otter II user been 11CMIed ar uumpictc, ` — . Nu mina ul 'blspccduru idiom tierpermit. moll lI 5Nenak0nl.C.l'em isAppaer 050 1106 44044lSIV IaoSlCWdrwsin