Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2009 -00178
• 131 25 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/10/2009
T1tCIIS. Parcel: 2S102CA01300
Jurisdiction: Tigard
Site address: 9915 SW FREWING ST 1
Subdivision: Lot: 0
Project: Orchard Park
Project Description: Install Fiber Optic for Verizon
1 -18, office
FEES
Owner:
SUSNJARA, MARKO A/BETTY M Description Date Amount
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
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 OA 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: Permittee Signature:
�- j0- -
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.
R E C EIVE D
JUL 0 6 2 009
Electrical Permit A CI � w , �FTIG ARD FoxoCXt`ICE1JSEONl.Y ._ " O 78
Cit of DIV ISION •, . •
,., .'f 13125 SW Nall Blvd., Tival, OR 9722 rs- -
€ , 8 , . Pin .,lteticw
Phone: 503.639.4171 Ibex; 503.598.1960 °ma : OdterFcrnlitt
TI GARD Iosl> Use: 503.639.4175
® xe
Internet: www.tignrd- <tr,gnv Sopple m 2 In fmmntlon
- TYPE, OF WORK "::. .:. ,-.. .. _.•.
;.'.\ PLAN ttRVlt?W •, .,, . ,:
❑ New cons(nrotion 0Addition /alterative /replacement rime cluck:41 that apply (sahri> t /atm oc slam's wtit '
[� Demolition 0 Uthcr, 0SeivIfcorfccjcr405 ;mpg ur nx>re a (Waling over lure0tevios.
- -_ are 4 a,waduhlc I, - 1 am ul cul �1un to u
nor bn. y. ds.
:. CATEGORY or CONS I' RUC' I' ;
ION '..:: •.. ... e io,cx>O mtgtc:n trite or [] Planing builtliogs.
E. 1 - and 2 -iimil dwCllin la+ to gruun4. or cxeccdr 14,01q Q Cau n4rlcuhurnl
Y g 0 Commercial /industrial ❑ Accessory building nt„ ps ror ell omerlottuilnlions, boildioet.
CI Multi-family ❑ Master budder U Oilier: 0Piro >n,t
I 4' 0 L1q:JIntWa of 75 KVA or
JUB SITE • INFORMATION AND LOCATION 0 6tocrgettcyzyatom. largencpanuclyncrivedsy>tori
. (� Addition nl new molar 11):1,i of [} ,,,�„ ^(' :!
1.• ,. )•'
�.,
Job no.: Job site address:
9915 SW FREWING ST InOHPumom. tnat1 tn4y.
City /Slale/ZI P; TIGARO OR ❑ Six or awe re5itteeti 0111 C ci 0>0 e r 01 ,rkv,
97223 o NcAtth... r.ic
uhr. Supply v 0nug ter utorc thAn
_ -. C Narat /oux locutiurn. 600 volts nuntioul.
Suite /bldg. /apt. no, 1-18; OFFICE Project name: ORCHARD PARK � ❑ Sorvicoor feeder 600 mop ormore. _
Cross street/directions to job silo:
FI B . SCHEDULE o i F
- - urstdntr„rt LQIy. I rm , I_'r��h�l__
New restdontIrrl single. or nniitl- family dwelling unit,
Included Attached garage,
Subdivision: Lot no, 1.000 sq, 9, or loss 145.15 4
Tax nip /parcel no.; L'a, add'I 500 sq. ti. or pon irnm 33.40 1
1 „maned cncrgy, resilleiiial
75,00 2
DESCRIPTION OP WOTKI< ' (wids:io.vo < n.)
INSTALL FIBER OPTICS FOR VERIZON
Limited cony, mold-family 75,00 2
--- ratid4mial (anal ulsnc a1. (17
Services or feeders installation, alteration. Audio r releentlon '
200 amps or less 80.30
• 'D PROPER'I'V'OWNER • ' :•I ..',la•TENAN'T 201mui>sto400loops 106.85 2
Nance: 401 amps to 600 amps _ 1 160.60 2
601 amps to 1,000 maps 240.40 2
Add ress: Over 1,000 amps or volts 454.65 --- 2
City /State /ZIP: 'Tompottary secviees or feeders InalullatIon titerdioit, audfor
relocation
Phone: ( ) Fax: ( 5 200 amps or leis I 66.85 I 1
Owner inshllintton: This instailnuon is being utade on property that I own which is not 201 romps to 400 (naps 100 30 2
intended for sate, leose, rein, or exe:htingo, according to ORS 447, 449, 670, and 701. 401 ii11123 to 599 omits 133.75 2
Owner 0>909010's: _ 01•anch circuits: new, alteration, or extension, 9Im panel
Dale; A. Ike for branch circuila aria!+
❑ APPLICANT ( 'CONTACT PERSON shove s et vice or feeder fco,
• each brunch °kook 6.65 2
Bmainess NORTH SKY COMMUNICATIONS, INC, f3. Fee for branch circuits
Contnet name: ERIK SCHENCK ndthavrscrvicc 46.85 2
rust branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each add' I broach ciwuit 6,65
Miscellaneous (service or ( not included)
City /State /ZIP: VANCOUVER, WA 98684 Each Inunufactured or modular
00.90 2
( 503) 96 7729 Fax; 866 R sot vice and /or feeder
Phone: : ( ) 452 -4853
R econnect t only 66.85 2
c -wail: rnduornQrt Jycomm,co€r1 .�.._ Pimp orii ligation circle 53,40 2
CUN'1'RACfOR Sign oreudhrolighting 53.40 2
Busincss NORTH SKY COMMUNICATIONS INC. energy panel,(a)urlituhcd•
> cncrgy panel, alteration. Or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe; 1 05 $75.00 2
city /S(a`'crZIP_ VANCOUVER WA 98684 80011 aelolltionuf petion over ulIowIlbIc lot Joy of tic uttow
Phone; ( 360) 254 -6920 Fax: ( ) 1 -866- 530 -4325 Pet
iflspcclion 62.50
lttuy csligntton per hour (I hr anal 62.50
CCB Lie.: 14117 J Electrical Lic.: - 154CL Snprv. Lie.: 173LEB hmdushini plot per hour 73.75
I )I I / I ) 7 / / /�/ :•' K€,F-CTRICAI. PERMIT FEES -
Su I t� >rv, Clcctricinn si lty i ln(ulled. Snbletnl: $75.00
Print mime,: JACK CAG L E Dana 7/3/09 ('fun review (25% of permit fee):
State surcharge (1296 or permit fee): $9,00
Authorized signature:
01. TOTAL PERMIT rat!: $84,00
Print nowt: ETHAN A. DOLP H Date: 7 /3/09 'iltIs porntlt upplirnituit uxphvy lr a penult Is not ohtnhmd ehnto 180
day, offer 11 bay been nettptMi ar cun ltlr,
Ia( k, n, nny��cn, d,ara.c.t >,r,tunpp.aooncli.ver, . wtnlwral'Inapectlaa 11110 /04p:r pooh,
44 0 -4 61.Sf(I Il(1.1,'C0Si0Ylill