Permit ,- r
..r ,,,,,A,
Y -- CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
. , "' ` - COMMUNITY DEVELOPMENT Permit #: ELR2009 -00252
Date Issued: 08/05/2009
TIGAA.D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S135CA00800
Jurisdiction: Tigard
Site address: 11255 SW GREENBURG RD 5
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,€AR 952- 001 - 0100. You may obtain a copy of the rules or direct questions to OUNC by calling 53.246.6699 or 1.800.332.2344.
Issued By: \ RCik � V � 1 Permittee Signature: cV 9 ,1_, AV
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.
1.1
i I ,,
JUL 2 9 2009
CITY OF TIGARD
Ri iii 1 n .
Ciectricai Permit Application - FOROULCE11SEOONNLLY -.1: City of "Tigar �■ ∎4 a� r , rM.r�1j►
' i 13125 SW Hall I OM! Ti gard, OR 9722] pion RvWO,v
• Pliouc: 503,639.417! Pax: 503.599.19 Oalc/ny: Other Permit:
TIGARD lnspeciien Line; 503.639.4175 Dm Ready /Ily: lri &I See Page 2 for
rnternoc swvw,+io:ntl or.gnv >000 lficd7Mei n rl: A no Supplements( information
0 Nzw e0n0buelion 0 Addition /alteration /replacemetll Pia se check ail Ilan apply (submit 3 acts nrpinns w /itcon' cbeckcd below):
0 Smvlce ee fccdcr 400 wraps of nwru 0 INIlding ovE• woe cto, lc,.
❑ Dc:moli(lon 0 OMIicri cc -lie,¢ the available fault edam* Cl Mnriaas nod hnmy.nts. • CATEGOR or:CONSTRUC't'ION a oa¢°n1r 10,000emus in SO I* rc 0 1 +1uann0 byIldingi_
fes. ar yromn), or eneccdo b OIx) 0 Cauunerclia -uco aynculmeU
❑ I - and 2- I'nmily dwelling ❑ Commercial/industrial ❑ Accessory building , yours for all miler insudl■;ens. holdings,
In Muhi•fnu,ily El Master builder ❑ Oilier: 0 rim p,my, O ina;dtmlum er >S rvA e,
Eatergemy symom. larger sera woly derived .ysrun,
' 1013 SITE INfURNIATION AND LOCATION
'I', - Q Addilinn anti moor load of [f °,k" "Ii', "1.3 ", "IJ
Job no.: Job site address: 11255 SW GREENBURG RD li,vHPorw "e. l Ivnimney.
0 Six or MOM raxtcntiul unite, 0 Rccrcalional vehicle p:,rkv,
City/Slate./ZIP; TIGARD, OR 97223 0 Hcabh.cwo raciliticv, ❑ Supply i'cdli c re.. store than
014V'rn0011i luc,niuni. 600 val0 caatinul.
Snits; /bldg./tot. no. 5 - 13 Project Itoe; WALNUT TREE APTS ❑ Scrviw nrfceder610untpxormom,
.!.::....... ... ; „ FCE'SCIiEDULE -:
Cross s(l'ee1/dircci3Ons 10 job site: ur,cniulon 19 /. i p I q• „ „d 1 ,
'"-` Ness residential single. or uuittl•fomlfy dwelling unit,
luciudus attached garage.
Subdivision: Lot no„ 1,000 so. II. or less -- — 1 45.15 4
TAX nntp /parcv uo.: - 1 lin, ,,de!'! 500 a% 3. or portion 33.40 l
1,Ilttilcd energy,l•csl(lenliol 75,00 2
DESCRIPTION OF WORK • (wiN:dwee iy. lt.)
INSTALL FIBER OPTICS FOR VERIZON
Limited cnorgy, muh6liuni 7500 2 ,
residential (with aNive,•q, n.)
Services or feeders insinflntlon, utternllun, Allan rehieutiO
200 amps or less 80.30 2
'''❑ PROPERTY'(WNER -' ..” .... Q 201 mops to 400 awe 106.85 2
Name: 401 Arnim lu600tulips 160.60 2
” 601 ramps to 1,01X) amps 240.60 v 2
Address. Over 1,030 ram €is or voh> 454.65 2
City /Suite /ZIP: Tuulpornry nervices or feeders Instullallun, alter; (Ion, and/ ,v
relocation
Phone: ( ) Fox: ( ) 200 amps or lees I 66.0$ I
Owner installation: This instnllntion is being made on property that I own which is not 201 amps to 400 amps I ( 100.:;0 2
intended for Sate, lease, rem, or excluu,ge, according to ORS 447, 449, 670, and 701. 40! mails to 599 amps 133.75 2
Owner signnhl rC:...____ -_ - _.•._ -._ ___ _ Date:
Itranch circuits - new. nileratIOn, or c xlaulon, ) panel
- -- - - A. Poo for broach circuity with
❑ APPLICANT ' ::. • : f "Q" CONTACT PERSON ' above service or feeder fco,
•
each branch circuit 6.65 2
Rusineasname' NORTH SKY COMMUNICATIONS, INC, fi. Fccror branch circuits
Confect name: ERIK SCHENCK c feeder fee, 4685 2
pars( branch circuit
Address: 11818 SE MILL PLAIN BLVD STE, 410 Each add•l branch circuit 6.65
— Miscellaneous iservice or feet)er not Included)
City /Stale /ZIP■ VANCOUVER, WA 98684 Each inunufactured or 'nodular
d we( G n 90.90 2
p, service and /or feeder
PbOnc: (503 ) 969 -7729 Fo x; : (866 ) 452 4853 Rcco only 66.85 2
E- +„ail: rnduarPnor lasal omm corn Pump orirsigationcirch: ' 53,40
CI)N'1'RA(TOR • • _, _ Sign or outline lighting • 5140 2
15usinoss NORTH SKY COMMUNICATIONS INC, Sign°'cire! al txlimnlod-
energy p:u(el, totuticn, or
Address: 11818 SE MiLL PLAIN BLVD. STE 410 extension, Describe: 1 Page 2 $75.00 2
City /Stnlc/ZIP: VANCOUVER, WA 98684 Each otjditionmil Icicpc1ion Ovec' uulocecolllo In tiny of time above •
Per inspection 62.50
Phone: ( 360) 254 -6920 Fax: ( ) 1- 866 -530 -4325
invesligadnn per hour (I hrn,iiq 62,50
CCB Lie,: 14117 Electrical Lic•17 -154CL suprv. Lie.: 173LEB ►ndwat i pralli peri10w' 73.76
" ELEC'1'RICA1, PERMIT FEES •
Suprv, L•lectricinn signature, required: Suhtolni: $75.00
Print inure: JACK CAGLE Date: 7/29/09 fins review (251 of permit fee):
Stile surciprrge (1241n of pencil fee): $9.00
Authorized signature; , _ .... / TOTAL POO mil. 1 $84.00
Print 'Ionic: ETHAN A. DOLPH / Mac: 7/29/09 •'ht, pocmlt upphcotIoi ospirve if i pormli is not obinincd nithio 180
days Alps,• II how beau ncyWptc 1 NV oun,piete,
e Nu 'Am of luspecilons ullowcu per pcnuh,
1:10olhlin.U'crudc55I,C•l' <ac' .51p,dne 0U1.0NG 410.4,I,C10 1 /n.UWSIAVIM