Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
F
'_ COMMUNITY DEVELOPMENT Permit #: ELR2009-00255
Date Issued: 08/05/2009
TIt',,ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S135CA00800
Jurisdiction: Tigard
Site address: 11255 SW GREENBURG RD 32
Subdivision: Lot: 0
Project: Walnut Tree Apartments
Project Description: Install fiber optics for Verizon.
Owner: FEES
ANDEREGG JOINT LIVING TRUST Description Date Amount
BY ANDEREGG, FRED CHARLES /BEULAH CO, Restricted Energy Permit 07/31/2009 $75.00
17146 SE HWY 212 12% State Surcharge - Electrical 07/31/2009 $9.00
PHONE:
Contractor:
PHONE:
FAX:
Type of Use: COM
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 952 - ( 0011- 0 �XA ,} 1000. You may ob Alli ain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800 332.2344.
Issued By: \ / 1 I C X i .� 1XX Permittee Signature: o
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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Electrical Permit Application '
• City of Tigard Received � ' - A ' O
r 4 i 1125 SW Hall Hall 01vd„ Tigard, OR Plop 97221 Data lil•: y: _ " ! w
t
. ' Phmlc: 503.639.4171 FAX: 503.598.1900 G0 U.ttcr0y: y: 011,cr vc,,, 0
TIGARD inspecuou 1..0tc: 503.639.4175 UalC Ready /By: Jur ® Sec Page 2 for
internee www.ligi1(1 - or.o00 Nmlficamtcrn 'T 1 .. C ......, Supplemenlnl Infnrmntlun
❑ New 40001 lotion l] Ad( Tilton /alteration /repincenloin Please dwck rill that apply(cuhmil 2 :etc nr chili w/hemc checkel!xiMw):
UanOlitiOn ❑ UIhG,: ❑ SClvlce or rSCJcr 407 amps or moo; ❑ nalh6ug over boo atorfc,,
who10110 6v111561c limll cuocol ❑ Marinas and Mmtyards.
• ' ;''..... : ':S . : . :' . .,.::.. CATEGORY OP. CONSTRUC'T'ION ,`- • . . :.,,-:.. usticcdi 10,000 amps :a 150 r.,{61 or ❑tI iony bui1Jiogs.
Ica to y,vmc1, or o.wccdr 14A00 ❑ Cumnrorchd•u,a :victim
❑ I - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building mills lur n11 other 111,101 Micas. buildings,
0Mu hi- 6lrnily ❑ Mosier builder ❑ Other: ❑ rim pomp. ❑InolliSo°nf
.. . y +)•Man,. larger acpamtc,y donned system,
: ..- . JOB SITE, ir9FORYIATION AND LCICATMN ' :', Cmcrgu, • . � .: .. � '. ...:�'. ❑ Ad d itio n ni nnv mnmrlu:u, n( [a "A" "iS" "I.2" "LP
Job no.: Job site address: 11255 SW GREENBURG RD 100xP °rnx >,v. ocsop,mcy.
❑Si.( or 011ge re0,1co(ial vac. 0 Recn ;iinnnl chicle park,.
City /Store/ZIP: TI GARD, OR 97223 [l Hcnhh•cnro CO (hies. ❑ Supply voltage for toorc than
__ 0 HaxMli , ), io cali°nv. 6(10vollcanminol.
Snits /bldg. /opt. no, 32 - 35 Project name: WALNUT TREE APTS ❑scrvtcoof Reuel' 600umpsofmom.
• ..FRE•SCIIEDULfi ' '
Croon street/directions to job site: no<ripdnn i 910. I 1:r. I 'rnhd 1 •
Now reslQentiul single. or nultl•fnnilly dwelling mai.
Inolnilus attached garage.
Subdivision: Lot no.: 1.000 sq. It. or less 145.15 ~ ^ 4
-- 1 Ea. ad0'I 500 sq, It. or portion 33,40 I
Toe ntaplpareci to.t Lioinedcoergy,residential
DESCRII °ION OR WORK 75 2
(with awns xy, uJ -
INSTALL FIBER OPTICS FOR VERIZON t ;mi "`` "' °rsy, "'alai family 75.00 2
rceidcnlild (with utxsvc,q, 0.)
Services or feeders inatallotlon, ulternrinn, alxUnr s•otncutlnn
200 amps or less 80.30 2
'❑ PROPF,R'fY.OWNER .. ' 0 TENANT ' 201 amps 10 100 11up< 106.85 2
Name: 401 amps to 600 amps 160.60 2.
"'"'""" 601 cobs to 1.000 81n05 240.40 2
Address. Over 1,000 amps of volts 454.65 - 2
City /State /ZIP: 'fuurpurnry scrvicea or feeders inxlullatlon, tdlernlion, and /or
- -- _.._.- relocation
Phone: ( ) Foe: ( ) 200 amps or leo< 66 85 1
Owner instnitntion: This instnilntion is being 'undo on property that 1 own which is not 201 amps to 400 amps 100.30 2
intendad for sate, lease, rein, or exeluwge, according to OR3 447, 449, 670, and 701, 401 any:: to 599 ampu 133/5 I 2
Owner signature: -•_ _ - -- _.Date: __
Brnnchch' cults - new.ld tort ion, or extension, er panel
A. rec for broach ciecui0 with
' ' ❑ AMPL_ICA_NT _ 0 - CONTACT PERSON ' above service or feeder Poo, 0.65 2
e;lcit branch circuit
Ruslncssname: NORTH SKY COMMUNICATIONS, INC. B. Foe tor bind circuils - -^ .__ _
Contact name: wiltsour scrviccw f ordo( fen,
ER SCHENCK 46,85 2
--.- .. --..- rim branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each add'i branch circuit 6.65
_ __ _ ivlisccllaneous (aarvice ur fectrxr not included)
City/State/ZIP; VANCOUVER, WA 98684 Earlllnannrrclu(odo(tnndtrmr I
9090 2
Phone: (503 /969-7729
Fax:: (866 > 452 -4853 Mooning. service nor{ / °r (ceder
Reconnect only 66.85 2
Email: mduar 6C�northskycomm.Gom Pump or irrigeci0o circle 53.40 2
CON'i'RACfOR • • Sign or outline 1101ing 53.40 2
Business NORTH SKY COMMUNICATIONS i c ener iNC, i panel, ahcrtdion, or or
Address: 11818 SE MiLL PLAIN BLVD. STE 410 exl°n0ion. Describe: 1 Page 2 $75.00 2
City/st VANCOUVER, WA 98684 Each nd(lltional Inspection over nllo<roblo in any of the above -
Phone: ( 360) 254 -6920 Fro:: ( /1-866-530-4325 investigation s t igati o n 62.50
btvcsti Slttinn l cr ho urp nr mini 62.50
CCB Lin.; 14117 Electrical Li 154CL: Supt-v, Lic.: 173LEB Indusu'inl plant per hour 73.75
"ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subwlol: $75,00
Alleommor -4.. Print name: JACK CAGLE 04 7/29/09 Phut review (25%ofpenult fee):
Sloe snreharge (12Vo or pennil fee): $9.00
Autlun'ined signelurc; $84.00
/D
inTAL r[inh11'f rat::
Print name THAN A. DOLPH Date: 7 /29/09 '1'ht, parnit uppIknlun oxplrve IC;r vomit is not obrnlncd „ilbfu 180
dnyc after It lo, beep, nCCV111e,1 AK complete.
Nmnbcs of Inspcnituns vllowc,I {00 pcnnll.
I:■Oo, s V'ero0c,n:i,C•veraidApp.iin, 0517,006 :40 4615'rn lack:Ohtlwlill