Permit CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
`• 2 COMMUNITY DEVELOPMENT Permit #: ELR2009 -00225
T t G' A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/31/2009
Parcel: 2S 115AA00100
Jurisdiction: Tigard
Site address: 16170 SW 108TH AVE 163
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
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 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 By: LI & . _ �' ) i t , 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.
r
A
y RECEIVE.
Electrical Permit Apptication 2 9 2009
FURS OIrI/ cE USE ONLY ., . :. `:,. .
N . City T� Drd f IGARD kat v
, t y s Duo/ : ycnnd No,; OM ' 0O I' 'J
13125 SW Hall Mod, Tigard, OR 97223 DIVISION lion ito /kw
8 ' Phone: 503.630.4171 Fox: 50349PM960 Dalern °now Panrdn
Llnv, 503.639.4115
'P1riARD inspection Dalc Ready /ay: 61ralsnge
ln!lumen tvww.dgind- or.;ov Nwificd / Methah tic l fi,pS •
r,�� TYPE OP WORK `,. . . ' :' ' .4' ` rPLAN RrV.01W `:' ,
0 New construction ` • O Addition /alteration/replacement Nose chock MI that apply (submit 2 tog Arnim: eddcios cheered hetow):
Osamu or feeder 400 nips at room 0 Building over three stoics.
L�Demolition ❑Ulhct
whom dal available Emit cuncru 0 Mnri,us ml tunry:wls,
: t CATEGORY •OF CONSI'RUC'I'ION , . •...... exceeds 10,000 amps :a ISO MI or CI Floating buniliose.
tees us ground. or exceeds 14.0110 0 Conmrarcha•uro aeltebhuml
[l I- and 2- family dwelling 0 Commercial /industrial ❑ Accessory building (11014 rumps rerun oilier inslaltmions. buildings.
f Muiti•fatnily 0 Master builder Cj Other: 0 Pito pump. 0 lnm;dlationof 75KVAw
•'• JOB SITE INFORMATION AND LOCATION ` Cln +tur11ancysyua,n. largerselxt,ate(p (system.
' []Mlditimtnl+rownounrht:ulof [l "A ", "li.', I•'! "I•J "
Job no.: Job site tRidtem : 16170 SW 108TH AVE Igllip or mm. occupancy.
ask City/State/ZIP: TIGARD,Oft 97223 j i i c B .cw M c t u i c o . oak, 0S u p p WWnaIvebis4Cpa tlu
0 Ncatsh•cxte hcilide 0 Supply volargo for more thus
0 Haesabnut locolion:, GOO mule ttatiuwl,
Suite/bldg./NA, no, 161 -168 1 project name: BRIGHTWATERS @ REDHAWK 0 Sark* orfootler400 Mitt ormore.
--- •• ?• . •.FEE•SCf1EDULE :
Cross street /directions to job she: tir.rrtnm +n I Otr• I 14 I 'mug t
Now rusiduntlal single- or multi - family dwelling out.,
Includes attached garage,
Subdivision: Let no,: 1.000 sq. It. or less 145.15 ~ 4
Tits Inup /parcel IIO.I FA, add'l 500 sal, fft or portion 33,40 i
Limited energy, tesittetuinl
75.00 2
DESCRIPTION OP WO1tIC ' (with.above sq, ft.)
INSTALL FIBER OPTICS FOR VERIZON LII re P l 75.00 2
Services or feeders inslatiation and/or nektentinn
200 amps or less 80.30 2
• ..•C7 PROPERTY•OWNER . "'l •, • ` ,• • •Ej TENANT " -: ∎. 201 amps to 400 amps 106.85 2
Name: 401 nnipo to 600 amps 16040 2
601 otnpo to 1,000 amps 240.60 2
Address: Over 1,000 amps or nolts 1 454.65 * 2
City /State/ZIP: Temporary senior or feoderc instullatiun, alteration, aud/tst•
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 I
Ownr:r installations This installation is being made on prop hat 1 own which is not 201 amps to 400 amps 10030 2
intended for lute, lease, real, or exchange, according to ORS 447, 449. 670. and 701. 401 amps to 599 amps 133.75 2
Brunch circuits— new. alteration, or extottmieti, per panel
Owaol' signature:_ Date: A. free for brooch circuits wild
• • • • 0 APPLICANT ' . : :•- . : ';.i • ' 13 'CONTACT PERSON ' above service or feeder l'co, 5.65 2 '
each brooch circuit
Busineso name; NORTH SKY COMMUNICATIONS, INC, D. Fee for brnncli cirCalta '
_Contactnamo: ERIK SCHENCK wuhols/ service orrccderfee, 46,85 2
first branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 - Each add'I branch chrxlit 6.65 1 2
Misoollaneous jservico or feeder not Included)
City /State/ZIP: VANCOUVER, WA 98684 Cad manufacture ormodular
cwallinr„ mrvicc and /or feeder 90.90 2
Phone: (503 ) 969 -7729 I Fox:: (866 ) 4524853 Recomnoct only 66.85 2
6•11i mduarenorthskycomm,cotrt Pu ny or inn utiou circle 53.40 2
CONTRACTOR Sign or oadine lighting 53.40 2
Duxinoxs name: NORTH SKY COMMUNICATIONS, INC. Signalcireoll(s)
energy pool. alteration, or
Address: 11818 SE MILL PLAIN BLVD. STE 410 exIention. Describe: 1 Paget $75.00 2
City /State/ZIP: VANCOUVER, WA 98684 Each additional Inspection over allow niloIn ante( the above •
360) 254 6920 Fa ( ) 1-866-530-4325 Pa 62.50
Phone: ( - � invcstisnti hour (1 Or man) 6250
CCBLie.: 14117 I Electrical Lic..7_154CL Supiv.Lie. : 173LEB industrial ixrhour 73,7,
Sum. Gicctricinn signature, 'winked: / . ' * •" ECTRICAL PERMIT FEES -- ••••
...111iii∎r. " Subtotal; $79.00
Print dime: JACK CAGLE Date: 7 /29/09 Pl review (25% of permit fee):
Sudo surcharge ((25h of monk NO $9,00
Authorized signature: TOTAL PERMIT ittoL $84.00
Print " e: DOLPH 7/29/09 'Ills permit application uu pimr tra vomit Is not oblolurl Ohio 180
ETHAN i u 7AN A,_ DOLPH days after it has bon ncn;ptet alt ivmptek•
• Numhor or inspectiu+u tome hot moth.
t000ttowor It ls101.onwoO \pp.nnr &92m0G 4.Hl3515r0141.VCostnvral