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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT • . COMMUNITY DEVELOPMENT Permit #: ELR2009 00210 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/31/2009 Parcel: 2S115AA00100 Jurisdiction: Tigard Site address: 16120 SW 108TH AVE 41 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 3 OAR 952i.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:C;::› 140 jUk Permittee Signature: App 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. J• RECEIVED Electrical Permit Application 1 9 2009 • t ::. ;; . FOI OFFICE 1 15E ONLY City of Tigard n«'�� "' 1 penal'ra,.. 4 13125 SW Nail Blvd„ Tigard, oiOl4t Tv o TIGARD t3rxnty: ?�QQ O r *' Finn Rcviow I ' Phone: 503.630.4 t71 16m: ?a , NG DIVISID Y OeuY P ■ (aspect ion Lint: 501.639.417 1 ' t `J DM Re t 7IGAilD Won= tvtvw,dgerd -or.gov Nwlncam t ` hee, 1 s e tnforntadort ,.• :!. • • . TYPE 0F " WORK 7::i• '• : .. >'• • . '''•.;..,,,,••: ... t • MAN RrvIEW. `;i:.: ; . ; •'._ _ . . O New eons1>.iollon In Addition /alteration /replacement ' )')c.e: dent: all that apply Csubnin 2 ems ofpinnt wincing checked below): Q OCt 0 Setvtcc or feeder 40 mops or more a anliding over OM) ato.iex. Dotn0111i01t Q Other: -• •, wt. a avaitahlo thae eurtoes 0 Mormon nm . i booty:mi '•r: • '' A' (t'l'GORY•or :CONSTRUCTKJN ( .. t .� , -. , exceeds t6,000amps ISO voltoor a Rioting buxdtage. 1 - dwelling toss topourni,orexceeds14,000 0 Cunm,ercinl•usonjastetihural El Y C Q Commercial /industrial 0 Accessory building reps for all ot tu°nlbaiu„f. bltildingr, n Multifamily 0 Master builder 0 Other: • CI nits p,mq,. C! 1maalhniun ens KVAur `' ` ;-1 : ••' •JOB SITE • INFORMATION AND LOCATION `:-• •` . Cun:rgeucyayatmn. taryoracpvmety ' ' :�: • • •• ❑Acaillim,nMOtygnunr [] "A ",•'(! ^ , "1.3 ", "I.1 ", Job no.: 1 Job site address: 16120 SW 108TH AVE 1tONPof MOM . + y cuy/slate/ZIP: TI GAR ©, OR 0516 Of more fcsiltetltid mth,, a ceru host vehicm parka. 97223 0 Healthcare Luilitici. 0 Supply voltage for more slim O W:minas larutidnr. 600 vole lasagna Suite/bldg. /nix, no, 41 -48 j Project nan)c: BRIGHTWATERS © RE DHAWK 0 SWAM. or feeder 610 emu ormore. :..• .:.:•. %..TEE SCHEDULE' .. i ' - • Cross street /directions to job site: ^ (M „ 1 °tr, I Fro. I 'odic t Now residenliul single• or nudtl•feniily dwelling atilt, Includes attached garage. _ _ Subdivision: 1 Lot no,: 1,000 so, 0, or loss 145.15 w 4 '- -1 L.. a 500 at It. or portion 33,40 1 Tax map/parcel 110,; ..,,.,_.._ i.tmited energy, residentinl - ' DESCRIPTION OF' WORE ' (web game se, a.) 75.00 t Limited residential ntia ( t h Maass .0 7540 2 INSTALL FIBER OPTICS FOR VERIZON residentild (win niru tq a.) Services or feeders lnelnllntlon,olteratl on, and/or rolocellon 200 amps °rites 80.30 2 • • '' PROPEWIY•'OWNER •I :,• :. .. • 0- TENANT • 1 201 dupe to 400 mops 106.85 2 Name: 401 asps to 600 Quips 160.60 2. Address: 601 reaps to 1,000 seeps _ 240.60 _ - 2 _. Over 1,000 mops or volts 454,65 2 City /State /ZIP: Temporary services or feeders Installation, : llerailon, and/or relocation! Phone: ( ) Fax: ( ) 200 cope or less 66.85 I Owner instillation: This installation is being trade on properly that I own which is not _201 mans to 400 tunes 10030 2 intended for sate, lease, rein. or exchange, according to ORS 447, 449, 670, end 701. 401 imp to 599 Rope 133.75 2 Owner signature: - __Date - branch clrculls -new. alteration, or extension, per panel A. Po for broach clouds tvirh • ' . ' © APPLICANT ' • ..,-:.• .- • • • '• ::4 . . ' .. CM PERSON ' above nerviest or feeder fco, each li mas circuit 6.65 2 Businesxname: NORTH SKY COMMUNICATIONS, INC, S. Fee for bomb *knits Contract Borne,' ERIK SCHENCK without zorvicc or feeder feu, - 4685 2 bidet brash circuit Address: 11818 SE MILL PLAIN BLVD STE. 410 _inch add•I branch Omni( 6,65 r- -- , Miscellaneous (service or feeder not included) CltylState/1IP: VANCOUVER, WA 98684 Each lnunufactured or modeler dwctitnlS, Selves sad/or (ceder 90.90 2 Mato- (503 ) 969 -7729 I Fax:: ( 452 -4853 Rcce only 66.85 2 E-mail: mduoral�nofthskycomm C�7lIL..._ Poop or irrig:uiou circle 53.40 2 CONTRACTOR Sign or utline lighting 5340 _ 2 Buseinacs name: Signal circuit(s) or Oohed - NORTH SKY COMMUNICATIONS, INC. energy panel, uhoratiel. w Address;: 11818 SE _ MILL PLAIN BLVD. STE 410 extension. Describe: 1 Paget $75.00 2 City /Stale/ZIP: VANCOUVER. WA 98684 Each additional Inspection over allowable In entente above n Phone: ( 360) 254 -6920 I Fax: ( ) 1 -866- 530 -4325 I b ion 62.50 ve stignnatpuhour(Iltrminr 62.40 CCBLie.: 14117 1 ElectricalLic.i7 -154CL Supiv,Lie.: 173LE8 btdtintiial plant per hour 73,75 • 'ELECTRICAL PERMIT nits •.• ..•- Suprv. lZlcclricinn signature, required: 9ubwtol: a $75.00 Print name: JACK CAGLE Date: 7/29/09 Plan review (25%ofpermitfee): , State surcharge (I2Vb of permit fee): $900 Authorized signnlure. l�� TOTAL Pf;RIAI'r )Y:e: $8 Print name• ETHAN A. DOLPH Date: 7/29/09 This pw•ah opparntlon oxphvs If It permit Is not obin(ned wrote )86 boys der It Ian been nem:pied m complete, r Number ofinspeetiuns pile ed lair ,small. 1:,et thangu'ennG,tnr,Ca4rmA,q:p.noe 0113.1,06 140. 415'(1 tmaFCOav vr;n