Permit °° CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
', COMMUNITY DEVELOPMENT Permit #: ELR2009 -00226
T t G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/31/2009
Parcel: 2S115AA00100
Jurisdiction: Tigard
Site address: 16174 SW 108TH AVE 172
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 t ough e • R 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.66999 or 1.800.332.2344.
Issued By: A j N. _ (_ Lam` Permittee Signature:
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.
1
RECEIVED
r'
Electrical Permit Application JUL 2 9 20 ••
Fait O t kEICKUSEONLY • ''• ' : 1
Cat: of Tigard CITY OF (IGA - ,I ; I� • - . ( d °
Y g vean Mn.:
T
11 g 4 13 1•lSU ., T I IT rd, OR 722x1{1 I I I CW' r DIVISILQSMIIIIIIIIIIIIIII ` Phwre: 125 503.SW 639.4171 tllvd 1:1x; 503.59 Orl+erPermit:
inspection Line: 503.6324175
f IGARp N UtaaReadytpy: 1 t o e * l'or
Internet; WW1Y,li�+nrd - OrtnV NmineA(Mathed; � Ruppnon+c + +leI lnformngvn t
El p � TYPE OF `WORK .. • • • '.'z.:,'• r PLAN REVIEW. 4;:; ..
El New conStrtletion CI Additiori /allcralion/rcplaceincnt P1505C check, Oil lust nlry>ly ( Submit 2 M of plans «Mem abaci:a Wow):
[] f)emo(ition Q Other: 0%vice or wetter 403 amps or mme ( nallAtug ova•nu uto.
s:o tat.
whore the available Auk emwnt 0 Mnrilwt amt boatyards.
•+ 1, CATEGORY •Oh' CONSi'iwc i'ION 1 cscv xis 10,000 amps al ISO tilts or ❑ Nutting buildings.
Imo' to tem/M, ors/cook 14,1)00 17 Cnannotelxl•nco adriahur.Y
0
ti
1- and 2- ihlnily dwelling Q Comnlei'cial /lndustrinl Q Accessory building mtips tor all othariaslmlintions, buildings.
12 Mt1111411112q 0 Masher builder 0 Oilier: LINK Imngt. Q LSgtdhnion of ?S KVA or
C � ; ::_ ElE ergeaeysystem. largcrsepammlydethed
" •
' 'SITE - INFORMATION AND LOCATION n•,•.:• Mkifl ❑ nl'nownt+lnrlonlM ,,, 0 „ r. , 1•'t° „ I , a
Job no.: 1 Job site address: 16174 SW 108TH AVE i00Hpor occupancy.
El six or mare residential antis, D Recmailool vehicle park%
chy/State/ZI P: TIGARD, OR 97223 C) Koblerat Witter. O Supply mew for more flute
❑ Hammhntt Iw:plions, 6110 volts nominal.
Suite /bldg, /apt, no 169 -176 1 Project name: BRIGHTWATERS @ REDHAWK l'JS +arvaomfeo dcr6t0 "VI e n
•: >,,.:,..' • . .FI;E•SC(IEDIA.E . ; : . . • Cross street /directions In job site: I)rurhutsn ) Ole. 1 FM. ) Yt•d L .
Now residcntlttl ldngto• or tnuItl•fandty dwelling uult,
Iaclndas attached garage. _
Subdivision: Lot no.: 1.000 sq. IS or lose 145.15 4
Tax map/parcel uo.. 15a. atklsl 500 xtt. IL or portioc 33.40
- - — � DPSCR3Pf[UN OF WORK I.imiiodanargy,r4siduntlal 75.00 2
(vim almse Mt. 5.)
INSTALL FIBER OPTICS FOR VERIZON i. imir «IClxirxr, omld•fmnlir 75,00 2
residential (with Move at. n,)
Services or feeders inst llintlon audio Macedon
on
200 amps or lase 80,30 2
• '' Q PROPIR•I''a' OWNER •• ••I :. ••• '1:3 TENANT 201 mops to 400 amps 106.85 2
Name: 401 amps to 600 amps (60.60 2
Address: 601 amps to 1,000 amps — 24000 -_ 2
Over 1.000 amps or volts 454.65 2
City /State/ZIP: Temporary services or feeders Installation, alter; mild /or
relocation
Phone: ( ) Fax: ( ) 200 amps or ierse 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 mum to 400 amps 100.30 2
intended for sate, lease, rent, or exchange, according to ORS 447, 449, 610. and 701. 401 amps to 599 amps 133.75 2
Owner signature: _Date: (Branch circuits - new. ulterntto�t, or extension, per panel
A. Pee for branch circuits with
• ` • Q APPLiCANT . •' : ' • ... ' • . "0' CONTACT PERSON ' above service or feeder fee •
each branch circuit 645 2
Business name: NORTH SKY COMMUNICATIONS, INC, fi. Foe tor branch chcaits '
Contnctnance ERIK SCHENCK ci withouttxrvice feeder fee. 4685 2
Best branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 . eaadd'i branchciteuit — 676T ` - - �?
Miscellaneous (service or feeder not hiclp0ed)
City /State /ZiP; VANCOUVER, WA 98684 Such inanutitcturcdormodular 9090 3
Phone: ( ) 452 -4853 dwellinn, service oiler feeder
(503) 969 -7 729 I Fax ; 866 kronoretonly 66.85 2
E•ma • -
li: dU0 ,11'h Pam ot'ini Yuuu circle 53.40 2
—II•• ' -
S- y_�OL11CC1�� 7777 _ N u
CONTRACTOR ' • _ . . Sign Or asthma lighting 53,40 2
Business mmne; Signal circuit(%) or limited-
NORTH SKY COMMUNICATIONS, INC, energy nand alteration, or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension, Describe: 1 Page 2 $75,00 2
Cily/Slato/ZIP: VANCOUVER, WA 98684 Each additional inspection over allownblo In any of the above
Phone': ( 360> 254 -6920 [ Fax: ( ) 1- 866 - 530.4325 Per Iaspct Qlvostlgntica ' 62,50
nn per Ilene 0 or moo 6230
CCB Liu,; 14117 [ Electrical Lic.a 7 -154CL Suprv, Lie.: 173LEB indtlsldni ph101 per hour : 73.75 _
• •• • • "ELEC:TRICAL PERMIT PEES -- = •• •
Suprv. Electrician signnntro, requited: Subtotal: $75.00
Print nnlne: JACK CAGLE oak:: 7 /29/09 Plan review (2S%of permit fee):
State surcharge Orb 5 orpennit fee): $$
Auttiori'red signature: TOTAL PERMIT 1,111i: $84,00
Print mune: rr 11 Dat 7/2 9/09 This p ermit uppilrntlan expires If a (moth Is not obtained nitulo 150
r=TH9N A. s.C H days oiler li has been wooled ar oemtpletc,
• Natalia of inspections allowed per em elt,
ladsau5. lJ'ern4ssun,C•ICmaa,y,p•nne 051:1106 4103615/ J/ls.coav Spin