Permit •
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
g COMMUNITY DEVELOPMENT Permit #: ELR2009 -00220
T! iARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/31/2009
Parcel: 2S 115AA00100
Jurisdiction: Tigard
Site address: 16156 SW 108TH AVE 123
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
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
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 throug OAR 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: VAQ1` �X ( /" 1 Permittee Signature: XX .-
OWNER INSTALLATION ONLY YYYY
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.
VEIL
Electrical Permit Application i
lO FU1iU111 USF.QNLY
. City of Tigard y . '
's 13125 SW Hall Blvd., Tigard, OR 97223 '" V
Phone: 503.639.4171 Fax: 503.598.1960 JARD lifili Oilier
TI GARD Inspection Line: 503,639.4175 , *'IcIL IOar Rcadymy: IL la See Pugt2for
finomW: www.dgard- or.Snv .. - _- ..... . Nunaedlo CIOtul: t 1�(*' ' Supotenteniat lnfermatluu
' TYPE OF WORK '::,:•..:: . .. `•` • :', '..-1'.:." • 'r PLAN RLVIRW ' • . .. .
0 New constateiion f4 Addition/alteration/replacement Ploaxe chock all 1101 moldy auhaill a Ftte nl'Plans whims cl,t keillelowl:
[ Demolition 0 Other: ❑ Smiled or acder 451 ally ar more 1] flu h ug rwci di roc stories.
wiwiC tin available rut eaeent 0 Malian add hnlayards•
, •:...,'. :. CATE6( >RY•olt CONS1'RucTioN, ; • exceeds t0•000auutuat 1 $0srslisor a Floattngbuitdt ugs.
- loss to smoKr, or eaeuedu 1 0 Col ICtd•tua agdmdurrul
El 1- and 2- fnrnilydwel €ing ❑ Cot tereiat /intfustrint ❑ Accessory building mops fur all othertuslatbatun, hnildings.
E1 Multi- furnily [I Muster builder 0 Other: CI Pitc piano, 0 last :Illation of 75 KVA or
•'...' • 'JUII SITE iNF.ORNIAT1ON AND LOCATION ': :§ •; : ❑ Lnxrgctsystom. iartaoepaatclyrsyutmn. • C] Addittnn of uy a0ty minnr II Mt of 0 "A" e " l ' " 1.3 •' du 1.3 lvCnl
Job no.: 1 job rite address: 16156 SW 108TH AVE nWHPornx1r11. occupancy.
Q Six or nurc reside:WAS units. Q kcrruutinnal vehid0 parks.
City /State/21 P: TIGARD, OR 97223 0 1 4 e a m s - e a , a mein ntr. 0 S.pply vtsllop roe more duau
0 thxanbuls IUCnlitnrl. 600 vaII rtnulinat.
Suite/bldg. /apt. no. 121 -128 1 Wrajectfuuue: BRiGHTWATERS O RPDHAWK 0 Service ut two- 400
.... PEE 'SCHEDULE .. •
CrMSM sheet /directitnts to job site; iem-los 1 9tv, I too, i mud I
-- Nev i rusidcntlul single• or andibfxntlly dwelling null,
includes attached garage,
_w.
Subdivision: Lot no 1,000 sq. 1), or Icss 145.15 4
Tux mop /parr to no.:
.�... Ga. edit t 500 sq. ft. or portion 33.40 t
Limited energy, residential 75.00 2
oEsCRirr'ION OF WORK ' (With abu+c s(12.)
INSTALL FIBER OPTICS FOR VERIZON Lnn;tt<ltno,sy, mold- rrtn,i'Y 75.00 2
residential (wide nivleo sq. n.)
Services or feeders inslullntion audlnr Mocutleo
200 amps °ricss 80.30 2
'0 PROPER'l'Y.'OWNER '''l ' • -. Et TENANT - 401 amps to 400 amps { 106.85 2
Name: 401 amps tut 600 511124 160.60 , 2.
601 mom to 1,000 ;nuns 240.60 2
Address: Over I,O0D amps or volts - 454.65 2
City /Stale /ZIP: 'funspurnry ser viced or feeders Inatulfattun, ;dfcndlon, and /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1
Owner instalintlon: This installation is being Made on property chat I own which is not 201 amps to 400 anyld 100.30 2
i nttutded for sale, lease, rein, or cxchttngc, according to ORS 447, 449, 670, and 701. 401 maps to 599 umpd 133.75 2
Owner signatul e; _Date: Branch circuits - new, alteration, or extension, per panel
A. Ice for brands circuits wi(Ii
0 APPLICANT • •••• •' • : • '''(:) PERSON ' above service or feeder l'co, 6.65 2.
cacti broach circuit
i tudnes' nant NORTH SKY COMMUNICATIONS, INC, 13, Fee for brunch circuits
Contnctname ERIK SCHENCK wiUrouf scrviccorfcceier fee, q(1,85 2
_ lint branch circuit w
Address: 11818 SE MILL PLAIN BLVD STE. 410 li:tchadd' 6.65
° °° - - - -- - hlisecllaaeous (service or feeder nut included)
City/Suite/ZIP: VANCOUVER, WA 98684 Each manufactured ormndulur 90.90 2 '
dtaafline, service andf0r fCCdCr
Phone: (503 ) 969 -7729 I Fax: t (886 ) 452 -4853 Rcco,aloot only 66 .85 2
6. nlall: Pomp or lido:tioneireta 53.40 - 2 -
Ct1N'i 1tACTOR Sign or otul6,o lighting 53.40 2
Businos natno: gnal circu;t(s) ur li+uitc4-
NORTH SKY CC3MMUNICATiONS INC. Si energy paid, altoraliott or
Address': 11818 SE MILL PLAIN BLVD. STE 410 a iens;on. Describe: 1 Page2 $75.00 2
City /Statc/ZiP: VANCOUVER, WA 98684 Ench additional luspectionovera ltowuMolnan of the above
Phone; ( Per inspection 62.50
Pho
360) 254 -6920 f FOK:( ) 1 -866- 530 -4325 invcsligntlnn per hour tl t:rmint 62.50
CC8 Lie.: 14117 [ Rlec(rienl Lic.:17 -154CL Sollly, Lic.: 1731E8 Industrial pIme per boor 73,75
• " PERMIT FEES - .
Suprv. Electrician signature, required: Subtolni: $75.00
Print mu ne: JACK CAGLE I Date: 7/29/09 Ilion review (25% amnia fco):
Stale surcharge (12% of permit fee): $9.00
Authorized COTAL PERMIT Flit;:
s -___ $84.00
Print untrue: MH�s Date: 7/29/09 714 math uppilrnituo °spires If a punnll Is not obtoined %Albin 180
T P H days utter 11 bar been netcolta air campletc,
. Yunlbt: r ot'inspeciluns Allowed per perndl,
h tWitti dsl'cnundkt•C•u'ro t1p.lrc ou3.W6 410 .141S'10 /f11.4.YSt.uwbn
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