Permit •
q CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
' COMMUNITY DEVELOPMENT Permit #: ELR2009 -00215
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/31/2009
Parcel: 2S115AA00100
Jurisdiction: Tigard
Site address: 16138 SW 108TH AVE 81
Subdivision: DURHAM PARK APARTMENTS Lot: 36
Project: Brightwaters at Red Hawk 1
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 through OAR 952 -0Q1 -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: GO 1111 Ilik • A 1 _ I . Permittee Signature: , 0 , . 4. c
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.
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RECEIVED
Electrical Permit Application JUL 2 9 2009 . F(ii�;ott�IChUSEONLy .: . .: :•. ;
City of Tigard Iff ICEME� ���.•.r�h� *I kS
" 13125 SW Hall Blvd., Tigard, OR 97 � OF TIGAR 1 Pion Review
' ~,' Phone: 503,039.4171 lax: 503. 1etlir OIIerPennit:
FI GARD insiact ion Lloe: 503. 639.4175 ID DING DIVISIIA7 laeRcadytny:
J nip: BI SMIMgctfor
rntcrnct: www.dgnrd- or.gov NmiReJ/Mahuc: `' I q 1 SupplcnumN Information
�i: . TYPE OP WORK'... , :'. '. '`' • .. : PLAN REV.IEW.'. '..... • .
El NUN construction a Addition /alteration /replacement PInoo cheek :dlI nfl,Hi swill.
t...r Demolition ❑ Usher: Q SCIV ICO or footice on amps ut 11% CI RAMS aver nhtvc stwtee.
.•- n-- ; -�+. •
Om 4110 ;Iva ilahte latt It vacant Q Morino awl boatyards,
• .:' +: • CATEGORY •OP :CONS I'RUC'I'ION ., • .. exceeds 10000 amps to i SO ado w ❑ RMaan bulklinrt.
Iuss to ywoml, or cacultlr I4,0(10 0 Conmrotrlal•uso agr,cuhand
0 I - and 2- family dwelling ❑ Commercial /industrial 0 Accessory building 1 Napa lurnil other{astalkntuns. buildings.
o Multi - family Cl Master builder ❑ Other: f] rho not.. CI tnsmllatnn of 75 KVA or
•.. JOB SITE INFORMATION AND LOCATION (] enlergetxy syr+ont, larywrrepantety
Q MAN kit OfACW IMO( lnadnr 0 "A" "II", "IA" •'I.3"
Job no.: I Job site addicts: 16138 SW 108TH AVE I VOW or I11(IIw. rn;4rlpa
QSIX or more residential oldie, O Reemad vdtielo Nolo.
City /State/ZiP: TIGARD, OR 97223 q Heahh.c.re fao0ltter. CI Sorely votwgefor otore dim
❑ Wanton lucaUen . 000 volts semht li.
Suite/bldg./apt. no. 81 -88 1 Project ante: BRIGHTWATERS @ REDHAWK C)sarvloofreodcr6n0
""' :; :; :• %" . "; '
Cross sttCCiktir0etions to job site: iHrcrgllrn ' I OW. I 1'ce. I 'thin I •
Now residential uinglo. or mutt•fnmlly dwelling cult,
100111404 attached garage.
Subdivision: 1 Lotno.: l.000 sq. A• (if toag 143.15 M- 4
Tux snap /pare el no.: I3a, odd l 500 sq. Ii or portion 33 .40 1
United clergy, residential 75,00 2
DESCRIPTION OF WORK • (with alms ru, fi.)
INSTALL FIBER OPTICS FOR VERIZON Limite4lawrgy, molt{- fondly 7500 2
rest:km(1ot (tvuh oboe ty, n.)
Sorviees or feeders Insflllatlen and/or relocation
200 amps or less 80.30 2
• • 1:3 PROPERTY. •'' `'I :,.. . '.0' TENANT ' t' 201 mops to 400 mops 106.85 2
Name: _ 401 maps to 600 amps 160,60 _ 2
601 mons to 1,000 naps 240.60 2
Address: - Over 1,000 amps or volts 454.63 -_ 2
City /State/ZIP: Temporary her vieen or feeder* Insiailetlnn, allocutlay a"d/nr
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I I
Owner installation: This installation is being made on properly that 1 own which r.• not 201 amps to 400 amps : 100.30 2
intended for sato, lease, rent, or exuhnngu, according to ORS 447, 449, 670, and 701. 401.iIhl 0 to 509 *stns 133.75 2
Owner aignntrne; ._ __ ._Data Drench circuits - ue +v, alteration, or cliteunlout, per pane!
A. Pee for branch ciseuils with
' • ❑ APPLICANT ' • : '• =;pi • '.-in CONTACT PERSON ' above service or feeder fee, 6.65 2 •
Rosiness Homo: each broach circuit
NORTH SKY COMMUNICATIONS, INC, 13. Pee for branch circuits
COMM name: ERIK SCHENCK without nervicc 4685
Rust branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each WW1 branch cheek 6.65 2
Mioe.cllnncous (service or feeder not Included)
City /Stale/ZIP; VANCOUVER, WA 98684 Each menuracorcd or modular
90.90 2
dwe0in t , service nnrVOr feeder
Phoney (503) 969 -7729 I Fax; : (866 ) 452 -4853 Reconnect only 66.85 2
email: mduortanorthskycomm.corn Peony or irrigation circle 53.40 2
L'ONfRACTOR ' ' •• • • Sign oroul lino lighting 53.40 2
Butsinans name; sigma ci rcuit(s) 4r limited.
NORTH SKY COMMUNICATIONS, INC, energy pate, alteration, or
Address; 11818 SE MiLL PLAIN BLVD. STE 410 csteosion, Describe: 1 Paget $75.00 2
City /Stato/ZIP: VANCOUVER WA Each additional inspection over allownWe to a of the above
Phone; (360) 254 -6920 FOX: ( ) 1- 866- 530 -4325 Per inspection 62.50
Glvcadgndatlller hour(' urndm 6250
COB Lie.; 14117 I electrical Lic.i 7.154CL Suply. Lie.: 173LEB hidustdnl plant per hour 73,75 M '
• ••• - • , "ELECTRICAL PERMIT FEES •'- ••• •
Suprv, Electrician signature, required: Subulal: $7100
Print nnnlol JACK CAGLE Dato: 7/29/09 Pine review (25% of permit foe):
State surcharge (1250 of pcnnii fees $9.00
Authorized signature: 4r .• 0 TOTAL P(intvll'r FBL': $84,00
Print "nine: ETHAN A. DOLPH I Date; 7/29/09 ' 'lKtlh permit eolitfcnt4un osplrer If u purmll Is not obtained within At0
toys nfler II has been ucceutpl 4s COMPleir,
• Nualbrr 011114144110Iti ulluwed PC( pomd•
IAOo ihhinge'ermkdat.c.P.rm',\pp.one *lit V0o 44114001r! huh ncOatAVS >n