Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1 1 11 a, COMMUNITY DEVELOPMENT Permit #: ELR2009 -00218
T t G RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/31 /2009
Parcel: 2S 115AA00100
Jurisdiction: Tigard
Site address: 16146 SW 108TH AVE 105
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 through 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 ByjQ(( 1 ` Q k ! / -L Permittee Signature: C �QQ '
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.
54
•
RECEIVED
Electolcal Permit Application 1 9 200' Fai;oii,iiICE' USE ONLY : ^:.
t City of Tigard t ,IL?6l�� . i 1 peAtel r )6 . G 131..5 SW Hall regard, OR )722 ' �' OFT' G A
�' Phwtc' 303.039,4171 ,4171 Fay 503.59R ` y n � N �i \)iC _. � , °nun onni
TfGARD nspection Line: 503.630.4175 [3�lALL! 1Y1.7 el see iejct
(racily: www.t {yard- ur.gov Su picmc Intnrnmttun
, . , • :. TYPE Cl + WORK "` :'` : • • ' PLAN REVIEW. '��•� .. '":,' ' , . . .
Li New contittielion 1 Addition /alteration /replacement Hoge cheek all that apply (submit ;sets oftslhas wiitcros checked be low):
CI Demolition ❑ Other: where SON ice es r'cdcr On amps DI n i' s 0 nnnnh g over dn,a stories.
where the hvailnble PAWL wool Q Mnnmas and hootyanis,
• ., • . , . - ' (,ATI'(iDRY•OE•CONS1'L0UC•I'LON ; "i _ , exceeds 10,000 amps at ISO sells Q Floating buildings,
.. lets tosnmin4,uresceods1.1,11001 0 ConmlorcLd•nso;1010114(al
0I- And 2- familydwclRug ❑Cotmuercial /inInstant ❑ Accessory building nmps for all other instnitntions. buildings.
1511 Multi-family ❑ Muster builder ❑ Other: 0 Flit (wrap. i (mutilation of 75 Kv, t o
INFORMATION AND LOC
`'.i '.:'..;•', 8ITF, AVON Q,+ecgcnbysys<o,a I1 sV;tpari ty
..... � Q AAdilier nr ucw nuum Asad n( ❑ ^A" •9s:', "1.3" "lt•,l "dsyi.
lob no.: 1 Sob cite nddre et: 16146 SW 108TH AVE How mom. owvrpancy.
OR Q , � • � Sid Or loom residemtiat units, Q Rci:n:ulional vehicle mil,
City/State/ZIP: TiGARD, OR 97223 y llcohlhs.cscreeihtics. ❑ Supply %IONo for more Mats
Q ti aro a ms locutions. GOO volts nosabsal.
Suite /bldg. /411t. no, 105 -112 I Project Hanle: BRIGHTWATERS @ REIDHAWK ci Sclvree or feeder 600 11nbsn or more,
::::.• ....'... ' - FEE SC11EDW B - ' -
Cross street/dircctionx to job site: _ ' ueedpd +m I ON, 1 t+..•. I • roll 1
Nov residential AAnglo. or i iilti•fnnttly dwelling milt.
^ includes attached gar ego.
Subdivision: Lot 60.1 1 .000 sq. lt. or less 145,15 4
Tax map/parcel tout i La. odd 500 sq. II or itortion 33.40 I
Lre led energy. residcnlinl 75.00 2
DESCRIPTION OP worm ' (wins :twte sq. n.)
INSTALL FIBER OPTICS FOR VERIZON tintce<tcnorgy, • fnniily 7500
residential (win' ahem oi, n,)
Services or feeders instdlintlon antl/ar'elocution
200 amps or less 80.30 2
f :7 !' '0 PROPERTY i :.. •.• "0 TENANT -' ':+, 201nui0sto400amps 106.85 2
Name: 401 amps to 600 nips 160.60 2
"""-' """ --'^- 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 coups or volts 454,65 __' ' _ 2
City /State /7,IP: Temporary services or feeders Installation, alteration, anti /or
, relocation
Phone: ( ) Fax: ( ) 200 cutups or less I 66.8$ Ill t
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 whips 100.0 2
intended for auto, leas:, rent. or oak: huge, according to ORS 447, 449, 670, and 701, 401 inn >s to 599 onto 133.75 2
Owner ignatul e; Rate: Branch circa is -new. otter :Won, or extension er anot
A. Fee for brooch circuits with
, . • 0 APPLICANT : -. ".:;:l ' i CONTACT PERSON ' above scrvite or feeder No, 6.65 1E1 •
none: RUSineoo each sta circuit
NORTH SKY COMMUNICATIONS, INC. 13. Fee for branchcilroits
Contort mono: ERIK SCHENCK ■11/1001 service or fccder fee, 46.83
first branch Circuit MI
Address: 11818 SE MILL PLAIN BLVD STE. 410 Etch nttd'l branch circuit 6.6
— • Nliscellattcous (service or feeder net iuciu 4) . _
DilyIStiuefZIP: VANCOUVER, WA 98684 aaclt manufactured or ou'dulur 9000 ._
CI
Pha : (503) 969 7729 Fox: ; { 866) 452 4853 dwelling, scrvirr nmd/Gr teeter
nc
Reconnect only II 60.85
8 -ntall: mduorenorthskycomm,com pomp or irrigation thole 53,40 Mil
CONT'RACL OR Sign or on illno lighting MI 53.40 111111.53
Bu siness 116610; NORTH SKY COMMUNICATIONS INC. en e rndei rcuh( al or alteration, limited-
+ energy pod, ahcr.dion, Or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: Page 2 $75.00 2
City /Statc/ZiP: VANCOUVER, WA 98684 Each addtlionat Ins . ecilon over eltowthloIn of the above
Phone: (360) 254 -6920 Fax: ( ) 1- 866. 530 -4325 Per inspe l e e 6250
hnasti tser hourp hr minl 61 50
CCB Lie,: 14117 Bleetrical Lio.17- 154CL Satin. Lie.: 173LEB htdusuinl plant Per hour 73,75
Sum. Electrician signature, requited: r ' . • • • ' " ELECTRICAL PERMIT REFS .. :
Subtotal: $76,(7)
Print name: JACK CAGLE Date: 7t29/09 Phut review (25%of flee Mil fee):
Stare surcharge (12% of permit fcc): 5$,00
Authnriycd signature: TOTAL PERMIT PM: $84.00
Print tlftito: D ote: 712 9/09 'Chile l e ndt uppilrnticn exphvs if a vomit Is not obinllted within tOO
ETHAN A. DOS P H dnyc nftcr n bas Iron nctopt ;v) al <wmphtc,
• Number oi'lospeel nos s.hluwed tier moth,
1;10atluingV4n uh.wil,C-i'urmiallp•dnr O677106 14i.41S'1911rof7e oosAYrsa