Permit •
•
p CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
s' COMMUNITY DEVELOPMENT Permit #: ELR2009 -00232
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/31/2009
Parcel: 2S115AA00100
Jurisdiction: Tigard
Site address: 16194 SW 108TH AVE 217
Subdivision: DURHAM PARK APARTMENTS Lot: 36
Project: Brightwaters at Red Hawk
Project Description: Install fiber optics for verizon.
FEES
Owner:
DHP TERRACE LLC & Description Date Amount
DHP ANNEX LLC, BY AKAWIE & LAPIETRA PC, Restricted Energy Permit 07/30/2009 $75.00
13 HERON DR 12% State Surcharge - Electrical 07/30/2009 $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 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 - 0010th ugh 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 By: OAQQ t Permittee Signature: �X�C, APP 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.
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RECEIVE, . . . .
Electrical Permit Application FOR OUNCE USE MIN • .. ... •
• • . • .: . •, , ,., ' . -, •'.
- ":- City of Tigard 2 9 2009 II,IL. Itet.ViVOli
PC(Iltil NO.:9 k a , o oq , 0 003g.
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14 I , ,. 13,2s sw Kill Blvd., Tignnl, OR 97223
pl Rev ,
Rhone: 503.659,4171 lox: 5°159UIT OF TIGARD u'll`Th. iew Y: 00. main:
•rIGARD Inspection Line: 501439.4175 u.ue RoaclY/Br 21 See Page Z for
Internet: ww
w.tIgard-or o UILDING DIVISIO
gov utlfiedtMettinil: j44 t1C ) Supplemeolol lorlormothos
.
0 New comantction 1:1 Addition/Aeration/replacement 010ine t twek ;iii lime apply (sublitil / suit nf plans wiitaing oneckcil *claw):
0 Service or fettle( AM amps in nose CI (UMW% over dove slOACI.
0 OCO110iiii0O El Other: Micro no available hull Correia 0 Minims cod booty:was,
' -;'.:::'.:.' ,':' ..:.:- ., .:',: : ..':' '''-• CATROORY or CONSTRUCTION ,. '1 '''.ii ...: . ' • ; ...::' .'. • moods 10,000 map: al I$O volt,: (ir O f laming Inahlitio.
fuss to ground, of OnCot, 14,040 0 Coultuerchl-o.o vleolturat
0 i v and 2-Tamil y dwellina 0 Commercial/industrial 0 ACcessory building amps tor nil Wiwi iusikllations. builtlingi.
C:) Multi-family fp Master builder (3 Other: °Pim now. 0 loslalhoiuo of 75 KVA or
Ingot scparattly derived Ili tom,
'''..' •, '.'.::'"-..:;:...: ....- I0113 SITE- INFORMATION AND LOCATION ':.:',' .:'•• '. '.', :•••'.' '. '..; ::• FIAEZlirtt,7,:::,,,';',Ant Inatl of 0 "A", "Ir. "1:.1". .. •:t".
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Job no.: Job Site athlfM: 16194 SW 108TH AVE 1(n)HP or move. oucopitny.
0 SiX or num resirlcotiul uein, 0 Recreational ecliicic parks.
City/State/ZIP: TIGARD, OR 97223 0 FleAlth.calo rmeilitics. 0 Supply KMago for mote that'
0 Has:Wows loLinionv. 600 vau nominal.
Suite/bldg/apt. no, 217-224 ] project name: BRIGHTWATERS @ REDHAWK CI Nereico ot feeder 600 mom enlace.
• : •:.. •-• --. • ' •:. • ' PEE 'SCHEDULE ' :. ' ' ' •
Cross streelkiirections to job site:
Docerothn I 9Iy. 1 F.. I Tool I
New residential single or mu I tl.tantlly nwening mitt,
-
Includes attached gat
Su lidivision: Lot tto.: 1,000 so. 11. or less 145.15 4
La, Aril 500 sq. 11. or portion 33.40 1
Tits map/porcel no.:
Limited allergy, resitlanilnl
7500
DESCRIPTION OF WOR th a
K • (wibove sii. u.) . 2
Limited enotgy, inulti-ruinily 75.00 2
INSTALL FIBER OPTICS FOR VERIZON re,i,i.miiii (with ms,, s IL) ,
Services or feeders installatIonolters don, mid/or rebiestion
200 awlps or less 80.30 2
'0 PROPERTY• ..' 7 1 s.. • ' ' -. ' TENANT ' ' s' ': •'' 201 amps to 400 amps 106,85 2
Name: 401 snips to 000 amps 160.60 2.
-....
601 awes to 1.000 :imps 240.60 2
Address:
Over 1,000 amps or vol - le 454.65 2
City/Sime/ZIP: Temporary 40t viCO w or feeders InOullatIon, AteratIon, end/em'
, relocation _ ..
Phone: ( ) I Fax: ( , ) 200 amps m lesl 66.85 , I
Owner installation: This installation is being made on properly that I own which is 101 201 snips to 400 amps 100.30 2
intended for sale, lease. roil, or excluinse, according to ORS 447, 449, 670, and 701. 401 amps to 599 limns 133.75 2
Drench circuits - new, ulterattog, or extension, per panel
Owner signature: Date:
_
_ A. Fee for broach circuits trial
'' ' 0 APPLICANT . :. ' ' ' : . 1 ' -- El CONTACT PERSON ' - : ' above service or feeder feo,
6.65 2
ea
FIlit'ann5 h hrstieh circuit o' NORTH SKY COMMUNICATIONS, INC. H. Foa for Minn circuits
wiihoui service or feeder fee,
Contact name: ERIK SCHENCK 46.85 2 first brooch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 hitch ad II' I branch citettit 1 6.65 • - .5 --
- Miseetloncous (servico or (ceder not itceluded)
CitY VANCOUVER, WA 98684 Each inunufactured or inodular
90,90 2
&elf*, service and/or feeder
Phone: (503 ) 969-7729 I F": ' ( 866 ) 452-4853 Reconnect only 66.85 2
5 • 111 aili mduorenorthskycomm.com , Pomp or inigation circle 53.40 2
.. - ' ' Sign or outline lighting ' 53.40 2
Sigma civouit(g) or lituilcd•
B "me: NORTH SKY COMMUNICATIONS, INC. energy panel, oh eral ion, or
Address: 11818 SE MILL PLAIN BLVD. STE 410 exieiwion. Describe: 1 paso2 $75.00 2
City/State/ZIP: VANCOUVER , 98684 Each additional Inspection over allowable In snot the above •
POI' 414)0000 02.513
PhOne: ( 360) 254-6920 I NC ( ) 1-866-530-4325 foveotgotion per hour(' lir alio .
62.50
CCB Lic,: 14117 I Electrical Lic.1 7_154 cL Sup+. Lic.: / 73LEB , industrial plant 1>er 1101W 73.75
"- .: - . ' • - ELECTRICAL PERMIT PEES ' ' ... •-• " ___ ..
Stsprv, Electrician sigonture, required:
Subitna1: $75
Print name: JACK CAGLE Dm: 7/29/09 Plan review (25% of permit fee):
Stoic surcharge (12% of permit fcc): $9.00
Authorized signature: ,... -- TOTAL paw rr ma:: , $84.00
P " " rum. ' ETHAN A. DOL PI-I Dote: 7/29/09 'flits licit-nal application oxplivs If :4 Dorton Is not obtalittlt mono 180
days dice 0 Wu been occeplea ili ogimpletv.
• Sulk, of laweilting allowed par notinli.
imwil.fingymnit4lii.C4voini7nn.anc 0923405 nut 4GIMIliOtiCOMVI;11