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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT 111 q COMMUNITY DEVELOPMENT Permit #: ELR2009 -00221 - TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/31/2009 Parcel: 2S 115AA00100 Jurisdiction: Tigard Site address: 16158 SW 108TH AVE 131 Subdivision: DURHAM PARK APARTMENTS Lot: 36 Project: Brightwaters at Red Hawk Project Description: Install fiber optics for verizon. Owner: FEES 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 -0010 thr• gh S ' 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: dilig da S, ' ' A • , , • 1 _ ► , Permittee Signature: Q Q 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. 0 P 17 7 FIVER Electric& Permit Application .: ,:..'...... Fw OFI10E USEONLY j DOg IL • l City of Tigard _IYYI__ aU,rIY `r e ; k i F X11 -5 SW troll Blvd., Tigard, oo�97g3 VIII 1 bona` 503.639.4171 fat: 503.5 19§0.'. : GA D OdmrYennit: tIGARD In www. -or.90 7' i, j ' �� SION ��� Supp e a MgcECor Internet: lwvw.lianrd or.8av A...) i ` i P v el Soo Mac fo ramnuo+. . , . -TYPE OP WORK ':.., ... •• PLAN RF,Y.IEW V :' ::: S.+ . . El Newoonxtniotion 13 Addition /alteration /replacement Please chock :dl that apply (submit law at 'Dens /tmum checked helots): 0t3tm01ition QUther 0 8aviaeortbodcr4Un antps arnuu: 0 Oulldiii tWit111 1 0 5104es. . ,• (.I whm duo humid* gat h currant Wilms and boatyard:, : :. ::: : :. CATEGORY Or' : CONS RUC "PION.. moots 10,(xla:unps at !St/ tolls at 0 Pkwind buildings. loss to ground, or cscvctls 14,000 O Cnomterct: t.usa a>;dm4urrat ❑ 1- and 2- farnilydwelling 0 Commcrcial/industriai ❑ Accessory building mops Ihr all ouirrinstallations. buildings. 151 Multi-family ❑ Master builder Oth er: 0 pomp. [� {„ y (] Luslallatiut of 75 KVA or .... ::.t }. i ?. ' • ' ' .. . ; (i8mcge!u:ysyxtam trgar,oparamtyred.ygem, " .'. • •JOB SITE- INF.ORhIATION AND LOCATION ': T .' =' _ '`"""`"'( ;. • ❑Athlit martnada( 0 " " "Is ","1•Z " " Job no.: 1 Job siteeddmss: 16158 SW 108TH AVE rueNP occup+ncy City /Stnte/ZIP: TIGARD, OR i3 SIn or more rrs„kwud oaks. 0 Rei k,aal vehicle parks. 97223 0 Neatth•eaw facilities. 0 Supply voltage for more than El Nazardu+s locations. 600 volts nominal. Suite/bldg./apt. no. 129 - 136 I Projcalnanle: BR {GHTWATERS @ REDHAWK DS emu* nrfeeda60O maps or Niro. " - ... :;r t.:.,.': . '• • PEE 'SC 1IEDULE •• i . Cross street/directions to job site: ^ Osoodiwan 19rt I Vat. f , nanl t , ' Now residential single. or Inuttl -A nt ly (Willing unit. Includes attached garage. Subdivision: I Lot no.: 1,000 sq. R. or lose 145.15 4 Tax map /paresI to.: bra. ndd'I 500 sal. ti. or portion 33.40 I I in+itctl a>crgy, tcxidusnal 73.00 DESCiUP•I'ION OP WORK ' (with above sq. It.) INSTALL FIBER OPTICS FOR VERIZON Liuvrcdcnorgy.maht•fnn'ily 7500 2 residicnttnl (Mal ItINn'eni• a.) Services or feeders tnstatintlon and/or rclncutlon 'i Y•'OWNLrR .' ` 200 amps or less 80.30 2 © PROPhR _ ' f ' (2' TENANT •. 201 ails to 400 amps 106.85 2 Name: 401 amps to 600 amps 160.60 2 Address: -- 601 amps to 1,000 amps 24060 2 Over 1.000 amps or volt„ 454.65 2 City /State/ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fox: ( ) 200 omits or less 66.85 I Owner Installation: This installation is being made on property that i own which is not 2 201 maps to 400 situps 100.30 2 i mended for sato, lcasc, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps ^ 133.75 2 Owner signature: ____ p Brunch circuits- new, tdtcrdtion o� cxtensietkper panel " A. Pee for branch circuits with ,.:.:. . 0 APPLICANT ' • • : :. ' - ' • ®CONTACt I'I:It$ON above service or feeder too, 6.65 2 • Business name: each branch circuit NORTH SKY COMMUNICATIONS, INC. R.Foo for bomb circuits Contact name: ERIK SCHENC wirlrou/ service or feeder fee, 4 685 2 lust branch Circuit Address: 11818 SE MiLL PLAiN BLVD STE. 410 _ Each lldd'I branch atteuit (— -" 6.65 " - 2 - Misecliaueous (service or feeder not included) City /State/ZIP; VANCOUVER, WA 98684 Such mundiactarod or modular 90.90 2 Phone: (503) 969 -7729 I Fax: : (866 ) 452 -4853 Reconccontla cc o nly t o n l y natter feeder 66.85 2 E•nlaii; mduorenorthskycomni.com Pump or irrigation circle 53.40 2 CON'PRA4"IOR Sign or outline lighting 5140 2 Business name: NORTH SKY COMMUNICATIONS, INC, e n e rlldtclt ne l . alter limited. allergy panel, alteration. or - Address: 11818 SE MiLL PLAIN BLVD. STE 410 extension. Describe: 1 Paget $75,00 2 City /State/ZIP: VANCOUVER. WA 98684 Each additional bus. ection over allowable in a of the above • Phone: ( 360) 254 -6920 I FOX: ( ) 1- 866-530 -4325 Per i 62.50 tnvcstigannperlrour(rnrmimt � 62.50 CCB Ito.; 14117 i Electrical L -1 54CL Suprv. Lie.: 173LE8 Industrial hint per hour 1111111110E111111111111 . ..• • • • . ELEC ;TRICAL PERMIT FEU ... : •.." .• Suprv. Electrician signature, required: Subtotal: $75.00 Print name: JACK CAGLE Date: 7/29/09 Phut review (25% of permit fee): State surchurgo(12% fce): $9,00 Authorized signature: 4 / /� TOTAL PERMIT PEE: $84.00 . Print name: ETHAN A. DOL P H ~ + Date: 7/29/09 this ( orbit appncnnwr expiry, If a permit is not ohlnlocd wIthlm 180 days after 11 Una Imo ,tempted as complete, Number ui' Iagrwttuax allowed per moth, I:tw 11 Il. cu'emk4li!,C.eanne.t, (alas 0.03106 IirNOtyn(l l O5JCOm/WOO { 1