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Permit a q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT 11 1 COMMUNITY DEVELOPMENT Permit #: ELR2009 -00216 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/31/2009 Parcel: 2S115AA00100 Jurisdiction: Tigard Site address: 16140 SW 108TH AVE 89 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 throug AR 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: V l NJ��� Q Permittee Signature: Q _ 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 .11,i L., 2 9 2009 Electrical Permit Applicatio . . . - - IC USEO .. City of Tigard CITY OFTIGARD E m : , , �. I � �Ir' l !� 13125 SW Kill Blvd., Tigurd, JNG DIVISION • • Phone: 503.639.4171 Pax: OhcrPornh, TIGARD Inspection Line: 503.630.4175 Onto Ready /ray; ■ IIIMI 1 See Page 2 for Inremet: www.tignrd - or. Jov Nelficdtn9Ctnist: Supplcma0ni Information TYPR rats WORK PLAN Rrvlew ,.,..: '. ' ❑ New construction Ifl Addttiort /allerutioa /reirlaeelnenr Plcaaaeiwck ,III Oat imply (submit 3scuofpun.tditcros a Sc1•404 m annum feeder 405 p owe 0 Otdhiit% raver hen strides. ❑ UCInOhtlOtl ❑ Other: wine In :tv, ilnhlc fault curtain 0 Marinas and hneyerds. . `•, ' :. CA'fF:GQRY ,or CONS'1'RU(_ ION • '. execafa 10,000 ,ulpsm 150vulisor 0 Noting building. lets to ground. or cxccedr 14.0(0 0 Cuum,orclal•u>o agrlcut ❑ y g [] Commercial/industrial Accessory building 0 1- and 2-family dwelling ❑ Y b ramps knoll otl)crhh.m0huiuus. building, C Multi- family £3 Master' builder ❑Other: aPitoi>ana,. 0Intt;dhaionof75KVne JOB SITE • INFORMATION AND LOCATION '. ❑G,ncrgcn5y.yxton,. insetscp - QArfditinn of raw moat ln:mi of r2"A" "1,' "I.3" "1.1" Job no.: Job site address: 16140 SW 108TH AVE 1(tUHp Of MOM, )xap:acy. 0Sl.x Of More resd■enlial anise. 0 itecremional vehicle parks. City/State/ZIP: TIGARD, OR 97223 ❑ Hexhh•caro rnciiniea. 0 Snpply cease fa' rare titan C Hn''n lime loninium. MO volts nontiunl. Suite /bldg. /apt, no. 89 -96 Pmject name: BRIGHTWATERS @ REDHAWK 0 service, or tccticr(00 arms or ntrc. __ ..' ' - ; '.. FEE SCHEDULE . • . Cross street /directions to job site: umcr)itiem I Qtr. I (co 5 Toot I r "" New rosidentlul single- or miiitl•farnlly dwelling milt, Includes (Method gat age, .Subdivision: Lot no.: l.000 sq. IL or loss 145.15 ,...,_ 4 Tax map/pat-cot no.: i 03s. 04141 500 sq. R. or ponioo 33.40 I Limited energy, residential JS.00 ? DESCRIPTION OF WORK ' (w111 lOevesq.5.) _ INSTALL FIBER OPTICS FOR VERIZON Limited anorgy,mala- ISemily 75.00 7. -- residential (wah;asne N. fl.) i Services or feeders inslallnifon, ulterntlon, nnri/ne relocation 200 stops or less 80.30 2 '-(] PROPER'l'Y.'OwNF.R .. .. - ID' TENANT • ` 201 amp; to 400 coops 106.85 2 Name: 401 naps to 600 amps 160.60 2 -- 601 amps to 1,000 mops 240.60 2 Address: Over 1,0601101N or volts 454.65 _ u. 2 City /State /ZIP: Temporary xcl'vICCO or feeders Installation, alteration, and /or relOCatiOn _ Phone.: ( ) Pox: ( ) 200 amps or less 66.&5 1 Owner instnlintion: 'This instalhuion is being made on property thal t own which is not 201 amps to 400 mops 100.30 2 • intended for side, dense, real, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 5 Daps 133.75 2 Owner signature:. .____.. Brunch circIR : - new, Otcration, or extension, ner panel - ._ ---. Data: A. Pcc for branch circuits with © APPLICANT' ••• '.::.1 • ' 000NTACf PERSON above service or feeder fee. 6.65 2 each branch citcnit Rusinessmono: NORTH SKY COMMUNICATIONS, INC. B. Fee, for branch circuits Contnct name: ERIK SCHENCK ,rrtoniscrviceor fee, 4685 2 lirsi branch circuit Address: 11818 SE MILL PLAIN BLVD STE. 410 Each Ad' I branch circuit -V 6.65 tNdscellaneous (service or feeder nut Included) City /Shute /Z11); VANCOUVER, WA 98684 Each manufactured ormodular Phone: (503) 969 7729 I Fax; : 86 dwgllin3, service n»dtor feeder 90.90 2 ( ) 452 4853 Rccomica only 66.85 2 E•tnail: mduort(�/' sort skycofilm.com Pomp or irrigation circle 53,49 2 CON'1'RACfOR Sign or 0(11111)0 lig03Ing 53.40 2 ' Business name: NORTH circuits) or limited. NORTH SKY COMMUNICATIONS, INC, enemy pod, aheraliun, Address: 11818 SE MILL PLAIN BLVD. STE 410 expansion. Describe: I pays 2 $75.00 ci(y /state/ZIP: VANCOUVER, WA 98684 Each atkihionat tarpection over Atom We to any of the above ' Phones ( 360) 254-6920 I Fax: 62.50 i Fnx: ( ) 1- 866 -5 -4325 Itwcslignliatt per hour° hr mint - 6250 • CCB Lie,: 14117 [ Electrical Lie.17 154CL s Lic.: 173LEB fndngtin 90101 pet' hour 73,75 - ' PERMIT BEES Suprv. E•Icctricinn signature, requited: 4. Subwlal: £75.0Q Print name: JACK CAGLE Datv: 7/29/09 P11t11 review (25% of permit fee): State surcharge (1290 of permit fee): $9.00 Authorized signature: i - TOTAL PEittdvll'r ME: : $84,00 Print none ETHAN A. j?OLPH Date: 7 /29/09 `thus punk 0spiro$ If it vomit Is not obtnI,cd within ISO drys ratter It tau Brea decepre<I Mt euaiHree, • Ntnubcr of itspcclluni al laved ite' pennll, l(On)l1m0V'ct tabs -G ucrnhAlhp.anc 05/37(06 1OmJ615T(1 1iI1.VLx)DNVtht