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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT 2 COMMUNITY DEVELOPMENT Permit #: ELR2009 -00213 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/31/2009 Parcel: 2S115AA00100 Jurisdiction: Tigard Site address: 16132 SW 108TH AVE 65 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 thro .h • .R 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: f►, _ f ' _ _ k Permittee Signature: Q 9 Acc) 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. .a g E(., EIVED Electrical Permit Apulication 2009 ... _ - .,'. • ,:. ic • • City of Tigard :FOItOIt1rICE . t 13125 SW NMI Blvd., Tigard, OR'9i 3' s • (" n)" d•1GARD II,I'�� k Phone: 503.639.4171 Pax: 503.391),it UG�I \!(� D vislolvl 10 her TI GARD (n *paCtion Line: 503.639.4175 Date Reatly/ny: a Soc hate 2 for tntentet; lwvw.dgt•d•or.gnv NWIRUdrMerIIIIS: Ihrin Supptcntenlol tnrormnden • , - TYPE air WORK'" .. 'r••• . . , . I PLAN REVIEW • . . • CI New conslntetio n In Addition/alteration/replacement Mom check At this apply (wheat 2sets orplens Mow clucked Wow); Demolition ©Outer: E l Smite or (=kr4e,1 amps es more 0 OnlMing overtime stones. 0430 dy acal 4.to loch moon ❑ Pturitwr nail bnntyords. :, CATEGORY OP :CONSTRUCTION , uswals 10,050 cops at ISO Ntho or 0 Flowing buildings. loos to ground. orexere<I0 14,020 0 Cunmloreial•uso agdcttum,J 01- and 2- rnln((ydwelling 0 Commercial/industrial 0 Accessory building woos tbrA other lima actions. httieings. Ei Multi- family 0 Master builder ❑ Other: CI rim mono. 0 inoudluion of 7S KVA or •'• JO)3 SITE AND LOCATION ':+' EjCmegctmy,yrwn, ryermhnmcSccd system. • ❑ AMlitinn nl'ncw neaar hsJ M f] lo "A ", "(i ", "1•T• "1•J ", Job no.; ' — 1 Job sits address: 16132 SW 108TH AVE likIHp uccapanuy. 0 Six nr noire residential mike, 0 Recreational vehielo parka. City/State/ZIP: TIGARD, OR 97223 0 Hcalth.carefacilities. 0 Supply 5011000 (or 'coo IlIStI ❑ Haxor<luus location. 600 0011% nominal. Suite/bldg. /alt, no. 65-72 I Project name: BRIGHTWATERS © REDHAWK OW,'" "Pic. ':' . ..FEE - SCIIEDULR — • . Cross street /directions to job sne: lkoatn1Ua ) f IS. I p'. I roil l l . t -- New residential singtO• or nulltl•rumlty dweliing mull. incluilus altar hod garage. Subdivision; I Ltu no.: 1.000 sq. 0. or loss 145.15 4 Tax amp/parcel Ito.: ( 1~t, add'I 500 sq. It. or portion 33.40 1 _�._.._. looked energy. Iccfdulnint 75,OD 2 DESCRIPTION OP' WORK ' (with above sq. 0.) INSTALL FIBER OPTICS FOR VERIZON Liatitcrtcltorgy,nluJ11 fatuity 7500 2 rccidcnlial (wink *wow. a.) Services or feeders instatintion, alteration, and/or relnustion ' 200 moils or lea 80.30 2 • , il . '•0 PROPER'1`Y.'OWNER ..1 :,. : • .. TENANT - 201 mupst0 400amps 106.85 2 • Nance: 401 amps to 600 amps 160.60 2 601 amps to 1.000 amps 2440.60 2 Addro.vc Over 1,000 amps or volts 454.65 - .... __ 2 City /State/ZIP: Temporary services or feeders InstullalIon, alteration, and/or relocation Phone: ( ) Far: ( ) 200 amps or less 66.85 1 Owner instulinUons This inslnlbuion is being made on property that I own which is not 201 amps to 400 amps 100.:0k 2 intended for sale, lease, tern, or excluulga, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 I 2 Owner signature: Data Annuls circuits- new. alteration, or c_xtenxlon, per panel A. Pee for brooch ciuCuils with ''• ' • "• . ' CI APPLICANT .. 2 .. '. • : " A ' ' • C CONTACT PERSON ' above xcrvica or 6)0 N% 6.65 2 each branch circuit Rosiness atstne: NORTH SKY COMMUNICATIONS INC. O. Poo ror branch circuits Contact panto: ERIK SCHENCK wirharr service or feeder fee. 4645 2 first branch circuit ___ � Address: 11818 SE MILL PLAIN BLVD STE. 410 Each ad d'l branch circuit 6.65 , 2 Misedlanepus (service or feeder not included City /State/ZIP; VANCOUVER, WA 98684 ffuclsmii acturcdormodular 90,90 - 2 dwcllinr', service M OO( leader Phone: (503 ) 969 -7729 POs:: (866 ) 452 -4853 Rccolncct only all i . 2 E -mail: mduarenorthskycomm,com Pomp or irrigation circle MI 53.40 MN 2 _ CON'rRAOTOR ' ' Sign oroutilno lighting 53.40 2 Business name: NORTH circuit(*) or limited- NORTH SKY COMMUNICATIONS, INC. energy hand, alteration, or Address: 11818 SE MiLL PLAIN BLVD. STE 410 extension. Describe: 1 Paget $75.00 2 City /statefZfF: VANCOUVER, WA 98684 Each additional luspeclion over atlowihI inanyof the above ' Phone: ( 360) 254 -6920 [ Fax: ( ) 1 -866 -530 -4325 Parinspocttott 62.50 Grvcsligutloa par hour or rum 62.50 CCB W.; 14117 Electrical Lio.17 ..154C Suprv. Lie.: 173LEB iodusuiret Motu per hour 73.75 ... " • PERMIT PEES '......... Su/vv. electrician signature, required: Subtotal; $7100 Print llama: JACK CAGLE Date: 7/29/09 Plow review (2596 of penult fee): State surdlarge (I2M of pencil (ea): $Q,00 Authorized signature; 4• l TOTAL PERMIT PIM; $84,00 Printnnmc: ETHAN A. DOLPH Date: 7/29/09 'fhb; pacmit uppllensfint oxpleas Ito permit is not Mottled within 180 din% Ace It h;u, bcett Accepted as complete. Nunnwr of ldsp•tdons allowed her pemdl. Boost I n0V'ernatdlil•C•OenulApp.dne 05,3.056 410-4GISr(i taOSx:OWOOSI1