Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
t COMMUNITY DEVELOPMENT Permit #: ELR2009 -00224
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/31/2009
Parcel: 2S115AA00100
Jurisdiction: Tigard
Site address: 16166 SW 108TH AVE 155
Subdivision: DURHAM PARK APARTMENTS Lot: 36
Project: Brightwaters at Red Hawk
Project Description: Install fiber optics for verizon.
Owner: FEES
Description Date Amount
DHP TERRACE LLC &
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 - 0010th •ugh 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: ` � yam , L _ Permittee Signature: Q 0 . yys
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
RECEI ED
JUL 2 9 2009
Electrical Permit Application mernr.
D FOR;o11ICE USE ONLY
CIE of Ti A rd CITY OF TIGARD ita..1 ,
Ii tsl2 SW Hail Blvd., Tigard, O �Z tv R4r $ >•tany: I e `lp aq
' /' Phone: 503.639.4171 Fax; 503.598. f9G(1 ale r ow other Pcatdl:
1)
ins >ectlo Line: 503.6304175 y _ ti , Sec Page 2 for
f I GAIT U 1 Date Rwdylii : lur
internal: www.dgvnl.or.gov Nutlficd(Mcdiud; e5 l Supplemental Iarormndo.e •1 4 . : , . ‘-' TYPE OF WORK " ,. . • : ALAN REVIEW. '.;; .. ,.. . . • . •
tR Newuoiivimotion '4 Addition/alteration/replacement Men chock WI itko apply (wadi 1icts aliases wiitcmr checked bciuw ):
0 Scioto or cooky 400 amps or mess ❑ MOWN over IMO statist.
Cj Demolition Q Other: whom. Oa awu4,dic iltoa carrot CI Muimar and M,mywdx, • • '::' ::,:.:'•!'...:::.... ' or ', CATEGORY r CANS')'ItUC'I'ION exceeds 10000 :Imps at 150 -tits or ❑ melting laitkiugs.
leis to ground. or exceeds $4,000 U Coiunwrahn•usc agdndmnat
❑ 1 - and 2-Bundy dwelling ❑ Commercial/industrial CI Accessory building amps 5,r nil oilier iustalhoiooi. buildings.
a Multi - family [J Muster builder ❑ Other: a Piro pun C I hla :dlstion of 75 KvA or
� ..a 8 . 7nsa 1 sepualcty dadved xystent,
.• . '',••!.:!"':‘:
......,1013 '•.iUB S1TF�iNI ?URlv1ATION AND LOCATION `' . QA<klltinaninmvna>t fnrinadar ? »» .,l ^,
Job no.: i Job do oddeotti: 16166 SW 108TH AVE 1WHPorslum tUllpwu:y
0 Si.( or orate taktoodut unite, 0 Ramona ail veltuAa pxkv,
City /State/ZIP: TIGARD, OR 97223 CI Health•croo facilities. 13 Supply vinic8o for more thus
❑ H1'0111041% locations. 6110 voas no/IOW.
Suite/bldg. /apt. no, 153-160 I Projectnatnc: BRIGHTVVATERS @ REDHAWK ❑ Sorvieonr ruder 600unpsurmom
.' . • ' .P»E •SCIICDULE - E ' • ' •
Cross strcct/directions t0 job site: nuerbrmsr 1 00 I tee, I road l •
New rsshit :O ul single. or utuitt fondly dwelling unit.
Includes attached gar ago.
Subdivision: I Lot no.: 1,000 s0.0. or lass 145.15 4
I:'a. add'= 500 sq. U. or portion 33.40 I
Tax snap /parcel no.: Limited energy, residential v
DESCRIPTION OF WORK ' . (writs above 0$. n.) 7100 2
INSTALL FIBER OPTICS FOR VERIZON Utnitcticnorgy,nahl- comity 7500 • 2
resfdunthU (widlolsrruAt, a.)
Services or feeders installation, alteration, and/or relit. ?thou
200 amps or less 80.30 2
' :, ''O PROPEWIY• ..'.. : ..•CI' TENANT " 201 106.85 2
Name: 401 amps tcs600 snips 160.60 2 • 601 amps to 1,000 amps 24040 2
Address; Over 1,000 amps or volts ^~ -454.65 _ 2
City /Srate/7� IP: Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner insttdintion: This installation is being made on property that 1 own which is not 201 mops to 400 gim 100.30 2
intended for sate, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 cans 133.75 2
Owner signature: _ _____• Date:
Branch circuits - new, itheratioa, or extension, per pdnol
A. Pee for brooch circuits Ora
• ❑ APPLICANT • • •:. • : ' In CONTACT PERSON ' abuse xo vice or 'butter t&•o,
•
each branch circuit 6.65 2
Business name: NORTH SKY COMMUNICATIONS, INC. 0. P.ee for broach eimuitx .
Contact name: ERIK SCHENCK without service or feeder feu, 4685 2
first branch circuit
Address: 11818 SE MILL PLAiN BLVD STE. 410 Each add'1 brunch circuit 6.65 2
Miscellaneous (service or (ceder not it eluded)
City/State/ZIP; VANCOUVER, WA 98684 Each manufactured or modular
dwelling, service and/or feeder 90.98 3
Phone: 603 ) 969 - 7729 I Pea:: (866 ) 452 - 4853 1 only _ 66.85 2
B• mail :_mduor C(D.northskycoI11t71,COR7 Pomp or irrigation circle 53,40 2
CON'l'RA('TOK 'Sign or outline lighting 53.40 2
Qlii:inoas ilallle: ignal circuit(x) ar Etulinil•
NORTH SKY COMMUNICATIONS, INC. iNC anew panel, alteration,ur
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension, Describe; 1 Paget $75.00 2
City / State/ZIP: VANCOUVER, WA 98684 Each additional Inspection over allowable toun of the above •
Phone: ( 360) 254 -6920 1 Fax: ( ) 1- 666 - 530.4325 Per inspection 62.50
Gtvusligtttitnyler hr mini 62.50
MB Lie.: 14117 I Electrical Lio.i1 -154CL Suprv. Lie.: 173LEB lndushtiid plaint per how 79,95
, •ELECTRICAI. PERMIT FETES
Suprv. Electrician signature, required: subtotal: £75
Print name: JACK CAGLE Dog 7/29(09 Pia review (25% of permit foe):
State surcharge (1236 or WWI fed): $9,00
Authorized signature: G� /` J TOTAL Pfitt8/11T PPE,: $84,00
Print name: ETHAN A. DOL PH I Date: 7/29/09 This permit uppifratlun oxr4rar it a motif is not obtained amain 180
days Ass 11 has been npvidtsl As somplets.
• Number or In.pcedwu illaw ins pena16
I: ieoanfneannb ,ail,C.•rr.rmt.tpp. per ntr25t06 440 4615'1Y11/nSAMAYlill