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Permit • CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit #: ELR2009 -00180 Date Issued: 07/10/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S102CA01300 Jurisdiction: Tigard Site address: 9915 SW FREWING ST 29 Subdivision: Lot: 0 Project: Orchard Park Project Description: Install Fiber Optic for Verizon 29 - 48 FEES Owner: Description Date Amount SUSNJARA, MARKO A/BETTY M 16225 NE EUGENE CT Restricted Energy Permit 07/10/2009 $75.00 PORTLAND, OR 97230 12% State Surcharge - Electrical 07/10/2009 $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 Landscape Lighting: N Medical: N Required Items and Reports (Conditions) 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 OA 1 -0100 You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.32.2344. Issued By: Permittee Signature: �^ 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. RE CEIVE D Electrical Permit J c at i o n � ZO"9 F LIlCl USE ONLY:: :; ...J Citp of ri� OF T i qR ' Permit No,: L t 13135 SW li;dl 1 1 � . f A s' Phoncr 503.639.4171 F ;tx: .S4R/ � �lo A , O,,,..„ mil: TIGARD inspection Lime: 503.6394175 /Y DataRcady /ny: ® y� Sec1pileEfor Intern tv Internet: tvtv.tignnl- ur.gnv NotIfitd /MCnnel: Supplcn,agnl Infocmallou � Q NdW COnUtlletia0 CI Addition /alteration /replacement N o . . chockallthanalIly(auhmit 2 too PI plans w /itntnr checked l>oiow): Ej UCtnolitiOtl Q Ultref; 0 Senlee or Peter 401) twos to note El 00011111e over tIto.,0o,let. where no tt B@ahlc (null corm! 0 Mnrinui nail hitty:vat, .. CATEGORY OF_ CONSfKUC'TION ` a eta's 10,000 tu nl 150%v>II> or 0 Molting bulltitTt. lets to gtvuott, or eacccdx 14,000 0 Cnunwtrclal•orc agttellinlrn) ❑1 arid 2- fainilydwelling ❑Commercial /industrial 0 Accessory building amps fur nit other itrlilluioot. DuilOingi, 0Muhi- family 0 Master builder ❑Ocher: El Plc pump. 0ln,3:d10i0n0171t KVAor • .1013 SITE INEURfv1A'f10N AND LOCATION (]en ccgm,cy a nml. larger squoccly dedvcd>yelmn. . (]Additinuml'ne 0 ^q•' "(,;' •'I.2 ","I.1" Job no.: Job silo addicss: 9915 SW FREWING ST ugro or mom lx:cmpanoy, 0 Six or AWN residc4lial (Attu, 0 Itecn•miuoal vehicle p:uka. City /S{0(0/ZIP: TIGARD, OR 97223 0 Heoith•cuc facilitic>. 0 S, mule for OWN thatt - -..... 0 Ha'Zaitluur loadiuux. 600 Mils nominal, Suite /bldg. /apt. no, 29 -48 Project name: ORCHARD PARK O Servit'o Of fectcr 600 nmpt Or mnrc. '..FEE 'SCHEDULE ' Cross street /directions to job site: _ 0ac t Ntnn ) L. - I Qiv, I rrc, I 'Nut New residentlal single- or'matl•fantily dwelling watt, lisclud us attached Rat age, Subdivision: Lot no.: 1.000 sq, 11. or less 145.15" 4 Tux atop /parcel no.; En. Aril 501J xq. It. or ponder 37,40.......`....... - . Limited energy, Icsidcn al 75 .00 DESCRIPTION OF' WORK • (will, al>uvc sq. n.) ? - INSTALL FIBER OPTICS FOR VERIZON L;I °;` °<1anoly,mmhi -'' °any 75,00 2 ' esidenti _ al tvhhut we,v Services or feeders inelallnllon alteration, nucdnr rclaeutlon 200 amps or less 80.30 2 • _ ©PROPER'L'Y: OWNER • [ ' TENANT 401 amps to 400 :Imps 106.85 Name: 40101110.1111600 amps i 160.60 2 -- 601 .reps to ism Amp, 240.60 _ 2 Address: Over 100 amps or volts 454.65 2 City /SUUe /ZIP: Tvmporary services or feeders installation, alternion, and/o• relocation Phone: ( ) Foe: ( ) 200 amps ov lave 66.85 1 Owner Installation: This installation is being made on property that I that which is All 201 amps to 400 amps 100.30 2 intended for sale, limo, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 .1111(1.1 10 590 1111105 133.75 2 1111111th circuits - not, alteration, or extension, per pone! Owner signolvee: p A.I'rco for branch circuits wit ' 0 APPLICANT .7 CONTACT PERSON above service or feeder I'm 6.65 0 Ruyincss name: NORTH Minch circuit NORTH SKY COMMUNICATIONS, INC, 9. Fee far branch circuits ' Contnet name• n'irhotd tcrvicc tx feeder fee, ERIK SCHENCK first branch circuit 46.05 '- Address: 11818 SE MILL PLAIN BLVD STE, 410 Each add' Ihnmehciwttit I _ 6.65 tvliseellaneous (service or feeder not included) City /Stole /ZIP: VANCOUVER, WA 98684 Bock manufactured or modular c)tvollin�, service owl/or fee ter 90'90 2 Phone: (503 ) 969 -7729 Fox: ( 866 ) 452 -4853 Rccooiiccl only 66.85 2 Entail; mduor(Onorthskycomm,00m P or itrigntiun 53,40 2 CON't'RA(�IOR w _ Sign or outline lighting 53.40 2 INC. Business Halle: NORTH SKY COMMUNICATIONS e n e rndct101, ;dtcrt s) nrcmilo r • i......, energy pA ;uw1, uiolt or Address! 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Paget $75.00 2 City/SIMC/ZIP: VANCOUVER, WA 98684 Each additional I:apeclioft over altlwuhlo in any of the ubovo • Phone: ( 360) 254 -6920 Foe: ( ) 1- 866 - 530 -4325 Pct inspection 62.50 ' tnveslignllou per hour (Ihrmint 6250 COB Lie,: 14117 1 Electrical Lic 154CL: Suprv. Lie.' 173LEB hldnsuia p11111 Crholn' 73.75 '- ' • . • • CI,ECTRICAI. PE "' PERMIT FEES • . &writ, Electrician s g 7 ari , required: ) / /./ '0 ? // Subtotal; $ 75.00 Print a JACK CAGLE Date: 7 /3/09 P1011 review (25% of permit roc). State surcharge (121/4 of permit fee): $9,00 Authorized signature: TOTAL Pf:ttmnr rots; $84,00 Print n li �AN�QL PH y Dote: 7/3/09 ' tilt, poxndt altpnrnuon uxphvy If A prink Is net ahtnlutd ■t{chio 184 drys offer It two been nccopiml ax cmmplate•, ° Num/cc 0l'lil >pcclluor Of owed per permll. Ina. ihltngu 'cr";tttl:l,C-tt;nn,,ll,p.dnc 001 4111461/1510nVCO5tAV1i1i