Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
`' COMMUNITY DEVELOPMENT Permit #: ELR2009 -00179
• Date Issued: 07/10/2009
I1GARL 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S102CA01300
Jurisdiction: Tigard
Site address: 9915 SW FREWING ST 19
Subdivision: Lot: 0
Project: Orchard Park
Project Description: Install Fiber Optic for Verizon
19 -28
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
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 9 - 1 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246 6699 or 1.800.33.2344.
Issued By: Permittee Signature: 0
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.
,,? , „ , REC
JUL 0 6 2009
Electrical Permit Apt) 01= TIGAR IF04 : ptlr><eHusgi m v
City f Tigard alked
Y G DIVISION �� ,t
03rd° K /-_ v «,n. I- 7409 -°1'� 7S
'r 13125 11 SW Nall Blvd., Tigard, OR 97223 Pion „ IC \V •�- l
t • ' Plwncr 503.639.4171 Rix; 503.5 Other PCnuiu
ns section Line: 503.639.4175 D R
'TIGARD i I U.uc RcadyAiy: lr::: 81 fist Pngc z for
intones: www.tigard- or.5ov Nu lhcd/Malo,s Supplcmoro l foemmtImt
TYN OF \YORK "' .• :
❑ New construction Q Addition /alteration /replacernetn Plac0 check ;Al that apply (suhntil 1Zscn vi'pin w /Acne cIcckal ttcluw):
El OL`IhO11t1011 ❑ Other: Sm vtcc 01 fcedcr 400 rumps 00 (10000 El nullolingnvcrt0100 cs.
where OM ;wail.,hle 1'3411 currmll ❑ Marina; and bolopuris.
-:-.,.•.',''....:....:;:',:, ,' :. CATEGORY .OF . CONSlUICTIUN .. czc■cdi 10,000 amp.; :II 1 50>r,lea or ❑ MAN; 0uildingt.
1401 00 grou nl, or excccde 10110 0 Co nlntcrcl :4.ouo v,rtcululcr■
❑ I- and 2- (,lrndy dwelling ❑ C01»nt0rcinl /ilodtl.Nlrto) ❑ Accessory building cups for nil other i buildings,
I] Multi-family ❑ Master bailder ❑Oilier: CI Fife puny. 0 lOnllntieu of 7.5 K VA ol
JOB SITE • INRURyIATION AND LOCATION QC„>crgeilLy Iergcr°cpalalcly
0 Ad,n6 i „„,,,,,,,„,.1,,„,1,,r d ^A' °r, ..I.1 I •S',
Job no.; Job site address: 9915 SW FREWING ST ItIoHP ucc311M9Cy.
Q SIX or mare rcvklcntiul oak, D Rco:1,11nn1 vehicle ork,.
City /State/ZIP: TIGARD, OR 97223 0 HCahh.cgc frcintier. ❑ Supply voliogo for 0010 nlro
Suilc /bldg. /0(16 100, 1 0 -28 PIU'CCt name: ORCHARD Harardu>u luculiunc. 600 v,>tlo noutinul.
ORCHARD PARK 0Contra or fecdcr4CD o>n p 00r nwrc.
. FEE'SCIIEDULE ...,
Cross street/directions to job site: Oc.cr I pl.. ( No. 1 'I'r11111
Ncw residential single. or nndt•fandly dwelling uull,
Includes winched garage.
Subdivision: j Lot no.: 1,000 sq. IL or less 145.15 4
Tux uuq> /parcW no.:
j - { Ea. or/WI 500 sq. 11. orp>oaion 33.40 I
Limited cuagy, rcaldunhnl 75.00 3
- - - .._. .. ...._._ DESCRIP'f(ON OR WORK ' (with above stl, ii.)
INSTALL FIBER OPTICS FOR VERIZON Limited energy, muhf fnnuly 7500 2 '
wadwili;d (will' uleWe vii, n.)
Services or reotlors ins)a11nllon and/or relacntIon _
200 amps or bees 80.30 2
'0 PROPERTY OWNER ' .. - ❑' TRNANT 201 amps to 100 mops 106.85 2
Nance: 401 ampsw600 180.60 2
-- 601 antp.x to 1 ,000 Wraps 240.00 2
Address; Over 1.000 amps a' vnits 454.65 -- 2
City /Side /ZIP: Temporary services or feeders Installation, alteration, and /or
relocation
Phone: ( ) Fax:( ) 200 sops or !CNN 66.8.5 1
Owner instt►tatIon; This instnlhuion is being made on property (hat 1 own which is not 201 "I's l0 400'1n>1)8 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branchdreulis - new, iera,urexl C r
lllonenslon, e anel
Owner signature: .... Date: ,. - 0
_ A.I'ce for brooch chef iu will,
0 APPLICANT : :j • • ' ° [f] "CONTACT PERSON • above service or feeder l'ce,
' 6.65 2 •
each branch circuit
. Rusinesosanle: NORTH SKY COMMUNICATIONS, INC. B. Fee (or brnnchcircuits
Contact 100100: Ividrnrrr service or feeder foe, 2
ERIK SCHENCK 46.85 first branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each ndd'I branch citcuit L , ---
hlisecbtnneons_(service or feeder not included)
City /Stale /ZIP; VANCOUVER, WA 98684 Each manufactured ormodular I
• 90.90 2
Phone: (503 ) 969 - 7729 Fax: : ( 866) 452 -4853 dtv :fliun„ service nnd(or feeder
Reconnect only 66.85 2
E•ntatl. mOuPro- nQrthskycomm,com Pun>p of ir'rig:tlion circlr; ' 53.40 ' 3
CC)NfRAUTOR
w • ' Sign 61'4)11111n° killing 53.40 2
Busincsy name: NORTH SKY COMMUNICATIONS INC, _ sigma ci n or limited.
COMMUNICATIONS, energy p;tel, altet,diva, ur
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension, 1 Paget $$75.00 2
City /SIate/ZIP: VANCOUVER, WA 98684 Each additional lurpection ovet 0110011010 In nny_of the above
Phone: ( 3601 254 -6920 Fox: Per ) 1- 866 - 530 -4325 Per s 62.50
(uvcstigat(nuporitour(I hr min) 62.50
CCB Lie.: 14117 Electrical Lic. 17- 154CLE Suprv. Lic.: 173LEB Indusirialplant 73.75
', � �--� -. Rf,f C1'RICAL PERMIT FEES ..
Suprv. Electrician sl(,(I��icquirod; i I(I ►I �A it I
Subtotal: $75,00
Print once: JACK CAGLE Date: 7/3/09 Nan review (25% of permit fee):
Sane surcharge (12 of permit fee): $�
Authorlxcd signature: TOTAL PERMIT P195: $84.00
Print name: ETHAN A. DOL P H Date: 7 /3/09 '1010 porno uppltrnllun asphvr If t ourralt 13 not obtnhlcd w6.11111100
Any.; oiler II ling beat nettaied 3x,0101,1,1,,
° Number or Inepc011un, allowed oar pcnnll
tatA i,s\01,C•P¢n>usdpp.clnr 0113300 il■ 4 6 151'U U