Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
"(J '' • COMMUNITY DEVELOPMENT Permit #: ELR2009 -00208
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/31/2009
Parcel: 2S 115AA00100
Jurisdiction: Tigard
Site address: 16114 SW 108TH AVE 25
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 obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: CD 11 t V L2 U � Permittee Signature: .1 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.
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REC EIVED
Electrical PermitAlpplication i . c.
Q � FOE'OI�FICEUSEONLY ..: ,;:�.:
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.., City of TigArd �U it Uat ay: ,^ .. . - �I� Pc,.., No,: e • .• r.,�
i r 13125 SW Noll Blvd., Tigard, OR 97223 none: 503.639.4171 teas: 503.598.1960 rj P "p"p��',t,"tk cvicw
►�lx GcrO , Other Nook,
'11 Inspection Lldtc :503.639.1175 IC O� L /h tV 15 Way: I el Sod Pogo 2for
Internet: www,ti4111dur.gov RRUD Ti A( D lcrbtxl: _ or l Aupptememosintnrmnttor.
:' :. .::,.'•• TYPE Olt WORK ;c::": "A- . ;•.-::.f.-; :...' . PLAN REVIEW 'i::: °.:;%r' • : "::'''1
tJ New uonshttciion CI Additioiialteralion /replacetnent Please chock all that apply ( suhmn ; gets Arnim* Whom; checked below):
Demolition ❑ Other: Service or feeder 4Q11 tnlps ell more Balmily; over rllommodel.
whero 1110 Mailable kill earrenl Cl Mnrinw nmi btatyunit.
:: , . :, CATEGORY or (.ONSlI1UCTiON , . . .'... ‘,: ceeerlId (O,WOamps:l I50Mlvtw ❑NoonybuttditiSs.
I •and 2- tannin dwelling Ica to around. or cteecdv 14,0(11 0 Canmterckd•ato agnculmrdl
❑ y g 0 Commercial /lndttsirial ❑ Accessory building amps I othet•btstalhalotns, buildings.
[{ Multi - fancily 0 Muster builder ❑ Other: 0 Pime puntp. 0lnstallntiuttof75KVA
: ;�;'. i', : Cj L•ntergeucy synaa. tarot sepatately&rived system,
''' - JOB 'SITE iNPOR114ATION AND LOCATION "`' •'"
system '''..
.. ..' .. ('AddlUntlarxowtllnMrhta+in( [t "A" IV, "1•] ",'y•5
lob no.; 1 Job site address: 16114 SW 108TH AVE lion "" drifter um=paacy.
0 Sis Of mote IV sklentinf toils. a Rececuit ml vcltteto parka.
City /$tnte/ZIP: TIGARD, OR 97223 ❑ Hcalth•caso facilities. 0 Supply vow fur more Mon
0 Hsxauluut lorptiunv. Goo web; nondrls.
Suitc /bldg,hpt. no, 25 -32 Projeol name: 8RIGHTWATERS @ REDHAWK ❑Servicom feeder 400 mops onmore.
--- ;';%.;•::.: •'.:.' , .:. •- FE€'SC!IBDULE , •
Cross street /directions to job site:
Del ern atnf I Oir, i it., I yawl j
New residential single- or nulltldxmity dwelling unit,
Includes attached game.
Suhdivision: I Lot no.: 1,000 so, R, or less (45.15 ....� 4
Tax nvtp/parcol n0,: lsa, ;WW1 500 sq. R. or "onus 33.40 1
__.. Limited euurgy, residential 75.00 2
DESCRIPTION OP WORK ' (wbh nlxsve eq. 0.)
Limited ideni energy, mult 7500 a •
INSTALL FIBER OPTICS FOR VERIZON
rcvidenlial (witn above sq. 0.)
Services or feeders innadinttonottcrauIon, sad/or minis tia
'I'YrOWNBR 200 amps or less 80.30 2
❑ PRUPAR
.•,I :,- '.. • 201 amps to 400 amps 106.85 2
Natno: 401 amps to 600 rugs 160.60 2
-"" 601 ampx to 1,000 amps ' 240.40 2
Address: Over 1.000 amps or vella 454.65 2
City /Slnie/7IP: Temporary sorvices feeders fnatullitlut , alteration, and/ ar '
I relocation
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Phone: ( ) _ Fax ( ) 200 amps or less - 66.83 I
Owner installation: Thin installation in being made on property that I o wn which is not 201 maps 10 400 amps 100,30 2
intended for sate, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 imps 133.75 2 •
Brunch circuits - new, aileron° a or extension, nor panel
Owner signature: Date:
A. floc ler broach circuits with • • . • • CI APPLICANT'" .. '.:1 ' - O - CONTncr PERSON' above service or feeder fee, 6.65 2 •
Flintiness name: Flintiness each branch chunk
NORTH SKY COMMUNICATIONS, INC, B. Pee for breach chum,
Contact name: ERIK SCHENCK (cc. 46,85 2
lust branch circuit
Address'. 11818 SE MILL PLAIN BLVD STE. 410 Each add'Ibrunch circuit
63 " "�
MisaNianeousJtervico or feeder not included)
City/State/ZIP; VANCOUVER, WA 98684 Each munutitcturcdor 1 90.90 2
Phone: (503 ) 969 - 7729 1 Fax:: ( ) 452 - 4 853 throning, service nd /or fodder
866 Reconnect only 66.85 2
&nail: mdu9rcOnorthskycomm.com Pump orini8otiotcircle 53A0 2
CONTRACTOR Sign or outline lighting '�'~ 53A0 2
Sign clrcult(s) nr limited.
Buxinona name;
NORTH SKY COMMUNICATIONS, INC, energy pond, Aeration, or
Address: 11818 SE MiLL PLAIN BLVD. STE 410 exlatslon, Describe: 1 Page 2 $75.00 2
Cit /S1et VANCOUVER, WA 98684 Each additional inspection over allow, No In an of the above •
Phone: ( 380) 254 -6920 Fax:( ) 1- 866 -530 -4325 Put. inspection 62.50
btvosligntion per hour t:rmtxs 61.50
CC8 Lie.: 14117 Bleclricni Lic.:17 -154CL ; Supt ". Lie.: 173LEB indio prim( per hour 73.75
Steprv. Electrician signature, n;gnitcd: 'ELECTRICAL PERMIT PEES '
Subtotal: $75.00
Print name: JACK CAGLE Datc: 7/29/09 Pion review (25% of permit fee):
AuthorlxctisignaturC: Stole surcharge (12(6 of permit fee): $9,00
• I TOTAL PIiRtvlTTi 6; $84.00
print taut : ETHAN A. I?OL PH Date: 7/29/09 'fads permit uppl endon oxplrvs If a omit h not obtained n4lbin Ib0
days one It inns been m:cealod or complete.
• Number of hrspectIon nhuweu per perm.,
inoorkitngweant imii,c•t',und,Mtp,toe atr).Nefi 4d0.1615171 Itn,t0O Vtvrill
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