Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
�t 2 , COMMUNITY DEVELOPMENT Permit #: ELR2009 -00209
TI GARO 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/31/2009
Parcel: 2S 115AA00100
Jurisdiction: Tigard
Site address: 16116 SW 108TH AVE 33
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 through OAR 952 - 001 -0100. You may obt copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: V�` t L f�9 �Vi Vi uLLl 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.
?e l°
RECEIVED
Electrical Permit Application !L_ 2 9 2009 iOROFz USE ONLY '.::;, __, `
City of rTlgslyd
OF D �� _� . . . +.
13135 SW HMI Oivd., 7igurd, OR 9?Msy
r `t � ' Phone: 503.639,4171 Fax: 503.S Oikec Penult:
r1GAaLI Inspection Line: 503.639,4175 BUILDING DIVISIO 'IatORrad RI Sec tagc2
rntenrar: www.dgaid- or.gnv Nunncandochue: .0L4 Suppkno toe tefarmnllwt
' f: . TYPE AC WORK '7': -l'' : .;i : \ :• , "':'...".....•:.1 . ..: PLAN RitVJRW Ni:.:'::::':' ' • .. • I . . •
❑ NOW Construction 121 Adritioi'/alterationfreplacemont mom check :6i that apply (submit 3 sets atpiens whims ul rckcd f,cluw):
a Service or Coder AM amps to fate a (Wilding overtime storicS.
❑C)Cm01iti0n [I Other:
where an availahla null cauau ❑ Manna nod batxyuds.
:;,:.. '• CATEGORY •(W CONSTRUCTION exceeds 10000 amps at 150114r:et ❑ Pioniingbuildings.
El i- anJ2- I'nmilydweliin lam togrvunJ,orexcecds14,0110 0Cunnnirclal•uso
g 0 Commercialiintiustrial ❑ Accessory building crops lurnilodmr instntluriunr. buildings.
GI Multi- family 0 Master builder ❑Other: °Fito ptntyr. ❑ !atoll/dies of 7S KVA 01
:' ''' ^'':1 .: ••. SITE•INFORMA'1'iON AND LOCATION Qeawrgctcysystmn. largcrrapatamtydcrlvedsystont.
. • QAldflinonrnew i' verloadal ❑ -1" "F', "t•1" • 1"1
Job no.: I Job site address: 16116 SW 108TH AVE ia6Hp ur n "'ro' r•� me nu.'
Q Six or mum residemiul unit 41 Rcomional whisk parlor.
City/Stott/ZIP: TIGARD, OR 97223 0 Hoatth cmo racilaics. 0 Supply vuta.gc tar aura ibm
0 Hxzantous laralions. 000 vales nominal.
Suite/bldg. /apt. no. 33 -40 Project name: BRIGHTWATERS Q REDHAWK ❑ Service, nrfoodardooamisursaws.
• , . . ; t :' • ',,'•, '•-FBE'SCIIEDULE '• ' • • •
Cross stteetAtircctions to job site: ovrMtntna 1 otv- 1 rot•. I 'nmti 1
-- — New residential single- or umiltt•fandty dwelling null.
laciudes Attached garage.
Subdivision: f Lot no.: 1,000 sq. il. or less 145.15 4
i
TIM tulpfpart o! Ito.: s. add'I 500 sq. ii. er ponimt 33.40 l
Limited energy, residential 75.00 2
DCSCRIP'fiON OP WORK ' (with abaft et. 10 _
INSTALL FIBER OPTICS FOR VERIZON
Limited wow, niuht•falnily 75,60 2
residential (with alma sal. n.)
Services or feeders insiallntlon, alteration. and/or r'ehiradloa
200 amps nr less 80.30 2
''' ''' PROPI RTY : OWNER • ' ' .-.L:... ; - • ' .....0. TENANT ... • • 201 amps le400alnpc III 106.85 2
Name: 401 snips to 600am x 160 2
—'""" 601 snots to 1,000 amps 240.60 2
Address: Over 1,000 maps or volts 454.65 2
CityfStalc/7IP: Tesuperery cervices or feeder. ins(nifatIan, tdtorudon, and /or
relocation
Phone: ( ) l Fax: ( ) 200:nnpt or leas l 66.85 I 1
Owner Instldintlun: This inslnllrttiOn is being made on property (hal !Own which is not 201 amps to 400 amps I 100.30 I 2
intended for Wu, lease, rout, or exchange, according to ORS 447, 449, 670, and 701. 401 c to 599 snipe 1 133.75 I 3
Owner xiS0 It • Date: Brunch circuits- new, Migration, or extension, er panel
A. lien for branch ekcuilc with
:' . ❑ APPLICANT • : :.',• ".:r1 ' ' '" to PERSON' above service or feeder fee, 645 2
H usinesx Hanle: each branch circuit —. _, ___
NORTH SKY COMMUNICATIONS, INC. 0. Fcc ror brooch circuits
Contact narrow ERIK SCHENCK triurwn rsrvicc OSrccaIcr tee, 4685 2
ilia branch circuit
Address: 11818 SE MILL PLAIN BLVD STE- 410 Each WO branch circuit 6.65 ' --
MliccItaneoas (service or feeder net included)
City /StatcrZIP; VANCOUVER, WA 98684 such munu0t tared or modular - 90.90 3
452 -4853 rhvalliieg, service antler feeder
Pilontl: (503 ) 969 -7729 I Fax :: 8 Reconnect only - 66.85 2
&mail: t • 4 4.11, - .:11. 1 11.111 - . •16 At AA • to Ptnlporirriyatloncircle 53.40 2
CON't`RACTOR
sign or uudlne fighting 53.40 O '
Bultlnassnam' NORTH SKY COMMUNICATIONS, INC. Signal circui((s)rrliwilod
energy panel, oliertnien. or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extaision. Describe: 1 Page2 $75.00 2
City /StaieJZIP: VANCOUVER. WA 98684 Each atSdltiomsl lissection eve,' allowable In In of the above •
magi
Phone: ( 360' 254 -6920 Fax;( ) 1-865-530-4325 Per inspection IIIIIII 62.50
Invardgation per hour (t hr mho Ili 6250
CCB Lie.: 14117 i Electrical Lic.17- 154CL: Suptv.Lie.: 173LEB Iildlrstdnl plain per hour 11111111M91
...:..'•EsLECTRICAL PERMIT FEES - - :' ••.- •
Supra. Electrician signature, required: -, ' r Suixulal'
+ $75.00
Print name: JACK CAGLE DOW: Phan review (25%ofpermit
�� State surcharge (12% of permit fee): $9,00
Autitol'ized signature: .,r�J.;',..._ ter n TOTAL PtIOMIT viii,- $84.00
Print mum ETHAN A,,pOLP H Date: 7/29/09 'r'h parade up lIrAIG 11 05 ken fib purmh Is not obtabled Wan sae
days after It alas bren nervpted as eumpletc.
• kmuber ol'inspecrbns utluwad leer peradi.
I05pfkgsbs ern IAIII,C•lismi0ppdnc 01/33106 U0- 461plol taaca.tAvlilt
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