Permit •
•
p CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2009 -00223
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/31/2009
Parcel: 2S115AA00100
Jurisdiction: Tigard
Site address: 16164 SW 108TH AVE 145
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 $84.00
Intercom /Paging: N Landscape /Irrigation: N Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through AR 952 -- 0001- X 0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
� Issued By: ) VIJL (\Q l V�.� Permittee Signature: CUL _
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
RECEIVED
JUL 2 9 2009
Electrical Permit Applicatio a : OR'OF 1i10E USE
City of Tigard LITYOFTIGARD ItcrCr -. jr: . -
13125 SW Hall Blvd., Tigard, o f9A$ 1LDING DIVI SI01�t >• te/llr:
•ji fcnnil No.: d e P' OA , 00 ,10
t � ('hone: 50 3.6394171 Fax: S 03.S.19G0 flan Rceio,v olhvt Pcouil.
l)alcrny:
J IGARD inspection Line: 503.639.4175 Dane Rcady/tty: /n' % Si Sec Pep 2 for
interltet: rvWlv.tiyal'd or.gov NolifcdrMenln4: Supplcmetdol lnfnrnmtton • _ TYPE Ole WORK - . ,. :'PLAN REVIEW •r %. '.''•` . . .
ID New consht +etion l]+ Addition /ahcration /replecemeti Poor check all ihat apply (suhnth 3 sets nl'pim,s w/iteuto checked bc(o,v).
�I Demolition ❑ Other: ❑ Sctvlee or fader (00 omps or non 0 Oulliiing over i .ctorrev.
srhem me available daub ttnrem ❑ Munttas and h ,iyards,
. • CATEGORY •OC :CONS1'ttUCTiON exceeds 10000 :opsa1I50 volts or ❑ Flouting Uuitdiugs.
0 1 • and 2•I':tmily dwelling ❑ Commercial/industrial ❑ Accessary building mops to yruuud or excvedr 14.000 ❑ C buildings,
:d•wro ag
nu ps for ell oho Iminlhaions. buildings, .
!1l Multi- 6t nil y 0 Mater builder p Oilier; 09itn penal. p tn ((VA or
SITE INFORMATION AND LOCATION ❑ Bmergcn .cys o larger separamty derived sy; lmu.
JOB SIT
—_ ❑Add,t,`;`rncwnlnlm 0 "A "•'11" "1a " ^1.3
Job no,: Sob site address: 16164 SW 108TH AVE 100HP or 10111\1. tasnpnocy.
0 Six or more desideittiul unilc, 0 Rccmodunal vehicle parks.
City /State/ZIP; TIGARD, OR 97223 0 Hcanh•carofoci(itier, C3 Supply voltage Coo 010(0 atoll
❑ Hr .aaia4 locvItono, /100 vntls nonlinul.
Suite /bldg. /apt, no, 1 45.1 52 Project none: BRIGHTWATERS @ REDHAWK ❑ tiervlco llr (00d0600 mops or nun.
FEE SCh EDULE '. '
Cron s1(ect /dircctiuns to job silo: Oe. i f)ir. I rec. i •loot I .
`-` New residential single• or iii Illdendly thrcllll % unit.
Intl inlioS allotted garage,
Subdivision: Lot no.: 1.000 so, ft. or loss MI 145.15 ` -^
Tax map/parcel no.; -- -- I'Ou, add'I 500 sq. F. or Iron inn 33.00
- — - Limiest cncryy, rcttdlcnlinl 7500
II
DESCRIPTION OF' WORE( (whit above ct,li.)
ed INSTALL FIBER OPTICS FOR VERIZON Ltt resii null esx.in,) III 75.00 II
Services or feeders installation alteration, and/or relocation
200 amps i less 06.35 2
`C] PROPERTY L7 T�,NAN'f 201 Harps h, 400 am s 106 85 2
Name: 401 amps to 600 amps 1 160.60 2
601 amps to 1.000 amps 1 240.60 _ 2
Address:�� Over 1,000 amps or vets 154.65 2
City /State /7AP: Temporary ser vices or feeder,: Installation, :dterntlmt, end /or
. ._ relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1 1
Owner instultntion: This instnilation is being trade on property that I own which is not 201 mops to 400 naps i (00.;W 2
intended for sale, lease, rein, or exchange, according to ORS 447, 449, 670, and 701. 401 :Watts to 599 mttps I 133.7 2
Owner signature;. Date; _ Brunch circuits new, ulteratfon, or extension, per panel
A. I' ce for branch circuits oat/u
0 APPLICANT ' : . i4 ' • - 0 CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Rustiness value: NORTH SKY COMMUNICATIONS, INC, 3. Fee roc bcanelt ch'cuits
Contact name: ERIK scrviec or f eeder f ee,
ER IK SCHENCK 46,85 2
Ian nt brtnch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 cut, awl branch circuit 6,65] i 2
"•" Miseellaacoas (service or feeder not included
City /State /ZIP: VANCOUVER, WA 98684 tel muni0rchacd or nodular
d,v hint, service and/or feeder 9090
Phone: (503) 969 -7729 -- 1 Fax :: (866 ) 452 -4853
Reconnect only 66.85 _ 113
c• m ail; - .mduorenorthskyomm Pomp or irrigation circle 53,40 2
CON9'RACEOR Sign oroutllnc lighting 53,40 2
Businessn91n0: NORTH SKY COMMUNICATIONS INC, energy panel,altertiatitcd-
4...�... energy panel, alteration, or
Address: 11818 SE MiLL PLAIN BLVD. STE 410 extension, Describe: 1 Page 2 $75.00 2
ChyIState/ZlP: VANCOUVER, WA 98684 Each additional Inspection Over allowable Intn of the above
Phone: ( 360) 254 -6920 Fax: ( ) 1- 866 -530 -4325 Gnve t "It "lion 62.50
tvcsligntien per hour (! hr mien 62.50
CCB Lie.; 14117 Electrical Lic.y7 -154C Supiv,Lic.: Industrial plant per hour 73,76
"ELECTRICAL PERMIT EIS
Suprv. Elcctricinn signntt+rc, required: Subtotal: $75
Print enure: JACK CAGLE Date: 7 /29/09 Phut review (259f,ofpermit fee):
Sate rorchtsrgc (12'7o of pcnoil fee): $9,00
Authorized signature: � / d r") TOTAL PERtvll'r PIM: $84.00
Print nnme: ETHAN A.. DOLPH Dote: 7129/09 'flits pornllt oppllcattun minim If a comb Is not Ambled within ISO
dnya after a ti bunt nawptod av cwnpletc.
• Nvollwr of inspccilon; nlloweo per nch&
i90onom eraatata,CR•nnt4pp.4nc os/:n% 44046 1S1'01 /110'000VWfin