Permit •
CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
`• ' , COMMUNITY DEVELOPMENT Permit #: ELR2009 -00204
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/31/2009
Parcel: 2S115AA00100
Jurisdiction: Tigard
Site address: 16100 SW 108TH AVE 173
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:
NORTH SKY COMMUNICATIONS INC
11818 SE MILL PLAIN BLVD, SUITE 410
VANCOUVER, WA 98687
PHONE: 360- 254 -6920
FAX: 1- 866- 530 -4325
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 AR 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: _0 ( 1(1 Q Permittee Signature: J� (1
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 .. 9 2009 - FOR OFFICE USE ONLY �; • _. ..' • ` ', • `,i
City of Tigard ..r 4 M EM pt �g. ooOd/
— y 13125 SW fiat. Blvd., Tigard, OR 97
`N 22iiTX OF TIG au •'. ....: 503.639.4171 tax: 503.59& G a y; v ew Other Month
tI JARD Inspection Llne; 503.039.4175 BUILDING DIVISIO tit Jeriµ � la See Nye Efor
Intone www,tignrd or,gov NwifrcdJMcah�nl: l` r Sul,pleme. taI Information
• • " TYPE OF WORK ''',.. .... ". • s.• PLAN REViEW `; •• . :' •
0 New eonstntetion CI Addition/alteration/replacement Picnntril ail ,hit apply (suhn,li 2 sets Moto* whitost. olsool 4,wtuw):
0Sem or feeder 4U11 amps or mwe 0 nutlihtg nvar t h toe sables,
Cj Demolition 0 Other: whore the available lash current i_1 ■nr.,us ail b wy tads.
. , . <. CATEGORY •0E CONSTRUCTION , , '''...i •`..: ' ' ;:...'. excecls 10,000 amps at ISO who or ❑ Mooting bultdiugs.
ten to ground. etexecsels 1000 [.] Cunnttorckd -use agreal
❑I - and2- fatnilydwelling IiCornmercial /industriat 0 Accessory building mope lot nil otherinsintheiu be
I] Multi - family ❑ Muster builder EI Other: 0 Fitc POMP. 0 ,na:dlases of 75 KVA Or
''''' " .•' OB SITE -INFORMATION AND LOCATION `: t)ercrgotceycyslwn.
larger derived systole,
f�AJditMnefncwtmxnr d "A " "Kr", “v"1•3
Job no,: Job site ad dress• 16100 SW 108TH AVE 11H1H1, ormom. occe
Q Six or mute residential units, ❑ Reemuaunal voldelo patios.
City /State/21P: TIGARD, OR 97223 l ‘0,b ❑ Health -onto faoilitiea. 0 Supply vaxnto for more than
0 Hararduts locations. 600 vas mogul.
Suitc/bldg,/npt. tt 6'iCE Project name: BRIG HTWATERS 0 REDHAWK ❑ Service el (ceder 600ut, e a na
.,; . :3 • . : FEE SCHEDULE •
Cross street /directions to job site: Mother/at 1 Om 1 rte. I •''nhd I
`—` New residential single. or multi- family dwelling unit.
Includes nttnclted garage. _
Subdivision: Lot to.: 000 so. lt.orless 145.15 4
-
Tax m /parcc t u0.: Ea. ndc'l 500 eq. It. or pottiest 33.40 I
Limited fined cilegy, residutu(at 75.00 2
DESCRIPTION OP WORE ' (widr nrarae sq, 9
INSTALL FIBER OPTICS FOR VERIZON Limital tnnnily 7500 2
roridetaiai (with Iowa 44, n.)
_Services or feeders Installation, alteration, mul/nr relocullun
200atnpsorless 80.30 2
D PROPERTY :OWNER " l : • .. •.0' TENANT • . - 201 amps 10 400 amps 106.85 2 '
Manta: 401 amps to 600 amps 160.60 2
601 amps to 1,000 seeps 24060 2
Address: Over 1,000 alto or volts 454.65 - 2
City /State/11P: Temporary services or feeders lnstattxtiun, alteration, stud/or
relocation
Phone: ( ) j Fax: ( ) 200 amts or leas 66.85 I
Owner Installation: This ins lailmion is being made on property that i own which is not 201 amps to 400 mss 100.01 2
intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701, 401 ;nags to 599 amps 133.75 3
Owner signature: Dale:
Branch circuits - new, alterado �, or extension, per panel
A. Pcc for brooch circuits wire
.'-.' . 0 APPLICANT'' ;.•••': • ' .. rs CONTACT PERSON above service or feeder fee,
665 2 •
each brunch cimuil
Rosiness name: NORTH SKY COMMUNICATIONS, INC, 1. Pee forbrancb circuits --
Concoct nalne: ERIK SCHENCK withour service or feeder fee,
first brunch circuit 4(x85 2
,...
Addicts: 11818 SE MILL PLAIN BLVD STE. 410 each add'Ibroach circuit ~ 6.6. 5 _ - 2
Miscellaneous (service or feeder not included)
City /State/ZIP: VANCOUVER, WA 98684 Each manuftcturcdormodular
90.90 2
dwelliup. service stud /or feeder
Phone: (503 ) 969 - 7729 I Fax: : ( 866 ) 452 -4853 Reconnect only 66.85 2
E -mail: mduorenorthskycomm,com pimp orinigatiouchyle 53.40 2
CON'itRA('TOR • Signor outline lighting 5140 2
Business nanJec
Signal circuit(*) or limited -
NORTH SKY COMMUNICATIONS, INC, energy panel, ohoattion,or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension, Describe: 1 NV 2 $75.00 2
City /State/ZIP: VANCOUVER. WA 98684 Each additional inspection over allowable In an of the above •
Phone: ( 360) I Fax: ( ) 1 -866. 53 -4325 Per inspection 62 50
254 -6920 r
Investigation per how (1 armlet 6150
CCB Lic.: 14117 1 Electrical Li c . . 7 -154CL Suprv, Lic.: 173LE8 1 ' 1 ' 41 ' 1 ° 4 " 1)61.11"r 73.75
• *" • ELECTRICAL PERMIT PEES • ... .
Suprv. Electrician signature, required; Subtotal: $75.00
Print Manse: JACK CAGLE Daio: 7 /29/09 Phut review (25% of permit fee):
State surcharge (125b of permit fed): _ $9,00
Authorized signaluro: ,r , .0,Air TOTAL PERMIT PEG: $84.00
Print norm: ET D 7/29/09 'fhls or roll appBcMbm oxptmr If a permit is not obtnh¢d Millie 110
.� HAN }�� DOLPH days after a raw bees accepted es wmteletts
s Number of htspec allowed per pastel',
imeseaiogubrrah et,C.hunua,tpp,cme0.03556 JJh.a61rl'ttunS/COMtnvell
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