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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT ," COMMUNITY DEVELOPMENT Permit #: ELR2009 -00253 Date Issued: 08/05/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S135CA00800 Jurisdiction: Tigard Site address: 11255 SW GREENBURG RD 14 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 thrflugh 'AR 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: (1) USt i� pY Permittee Signature: 0—Q OWNER INSTALLATION ONLY iii 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 2 9 2 009 B C ��'�F II G A • r Electrical Permit Application ` ' FUIi QIItICI; USE QNLY .. . . : Ci t of'i'i and nttthc � ' o s�L �13 ( 13125 SW ball 031+00., Tigard, OR 97223 ty : In ' phone: 503.639.4171 pax: 503.548,1960 man Rev,av p;acl0y: Other PCnnic (nspeclion Liuc: 503.639, 175 Dalo Rcadyln r1GARD Y: @ Sec e ni M I for (n10 v1 ci: lvww.dgnixt- or.�ov Nudficd /Mcmerd C ; � Supplt•meni Informntlmt • .'. TYPE Cl ■ `WORK 7t:r :,. -.. . PLAN IIRVIEW ' :..:,.'::: ' ' • :. . ❑ New conxtnlction El Addition /allerution /repincenent Pl ‹beCb all that , apply( suh sou o fplims 'Alms arcked bo1wv): ❑ Servlcc or freticr 400 amps or more ❑ 911114100 aver throe stoics. 0 DG1tOliti011 © Other where the availahlc 6o1i cumin [] )l ,inn >. n d bnuty:ud0. ., . • . CATEGORY .OF• CONSTRUCTION C • .. .. eacecds 10,(x10 ;Imps m 150 voila or 0 Hominy buildings. ---' Icxs as ywvia, or txcccds 14,000 CI Cuuanc' tlabu>u ap(ICUhara3 0 I - and 2- family dwelling 0 Coinn(ct'ctnl /industrinl ❑ Accessory building mops Ibr; all other hrclul(utiuns. building(, L7 Multi•farnity 0 Master builder 0 Other: 0 rue I ml 0 h0gx lull aa of KVA ur ' :) •••• .J013 'SITE I NEOR N NATION AND LOCATION ' A,', Ct s lar0er,cNotcty delved sy,ten,. ' ._: �' �.• .,..:� �' []AAdilinn of new momr load of 0 "A" „ f , , ,, , "1.2 ", "1.1 ", Job no.: Job one address: 11255 SW GREENBURG RD 11101-1P °r mn'u. ocsolu OR ❑ Si.i or 111010 rexldenu:d (Mile, 0 Itccn;arional vehicle p::rkr, MO City /SI/ZIP: TIGARD, OR 97223 0 Hcnllh.r:no rncilitice. ❑ Sulply voli,iee for uwrc there _.-_ 0 Hanel,tmo igcnlioni, (00 Vo twmi,vd. Snits /bldg. /a 14 - 21 Project name: WALNUT TREE APTS O Scrvico orfec der 000 (0,p.+ormum Cross street/directions to job site: nPaC 1511. 1 ree. 1 '1.1111 L ' New residentlut single. or uniltl•femlfy 110011111g mull, Inclndus attached gaenge. Snbdl ViO,OIl: LOt 110.: 1. so, I). or less 145.15 • ' — 4 ( ) (. ado l 500 sq. li. or portion 33,40 - Tax uulp /pnrcct no.: Limited energy. Icsldeulin1 DRSCRIPT[ON OF' WORK ' (Mill iiixi xq. n.) 75.00 2 - INSTALL FIBER OPTICS FOR VERIZON L "n,itt<Itltcryy,malti.l; ° nits 7.00 2 residcaliai (vein/ uh,,w xx 0.) Services or feeders inslallnitan, alteration, anlUnr rolrcullo 200 amps or ICS( 80.30 2. '''0 PROPKRTY.OWNI R _' . .. •.• ' - TRNAN'r " 201 amps to 400 limps 106.85 2 Name; - 401 amps to 600 snips 160.60 2 --' 601 mops to 1,000 mops 240.60 2 Address: Over 1,000anynsorvans 454,55 2 City /Stifle /ZIP: Teinpavgry services or feeders lnslallat :Men (Ion, and /or - ,..._ relocation Phone: ( ) Fan: ( ) 200 amps or Zees 66 85 1 Owner Instullallon: This insnlinlion is being made On properly that I own which is not 201 0111)1( to 400 ;imps 100,30 2 intended for sate, Tense, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 10.599 amps 133.75 2 Owner signatmro: Date: _ (;ranch circuits - new, niteraulon or extension, par panel _ A. Pee for brooch CWCttitc with 0 APPLICANT ' ' ' ' I' CONTACT PERSON ' ubovc service or feeder Coo, 6.65 2 cacti branch ciroait Rosiness m NORTH SKY COMMUNICATIONS, INC, i3. Fee for branch cilemits Contnct nalnet 0041 b r s'crvtec or feeder fee, ERIK SCHENCK 0rs1branchcircuit 46'85 2 Address: 11818 SE MILL PLAIN BLVD STE. 410 Each ndd'1 branch circuit 6.65 — `2 "" -"' miscellaneous (service or fender not included) City /Slate /ZIP: VANCOUVER, WA 98684 f ash lnunbiacurrcd or nnodutur ' P110110: dlvelling, .ecrvicc coal /or feeder 90'90 3 (503 3 969 - 7129 h' a.r:: (8 66) 45 4853 Reconnect only 66.05 2 6.111511: Indoor north$kycomm,com Puny or irti9ntiol circle 53.40 2 CON'fRA4fOR - - Sign orolullmclighlIng 53.40 2 Bto inc"(lanle: NORTH SKY COMMUNICATIONS, INC, i itrait(.z) nrrn,ltea. alrgy otitis/, attaratimn. ur Addreon: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Paso 2 $75.00 2 City /State/ZIP: VANCOUVER, WA 98684 Each nddltionalInspect ion over altotrnhlohr any ofthe ' Phon (360) Fox: Per inspeclion 62.50 P 360 25 - 6920 ( ) 1- 866 - 530 - 4325 plvcsli hour (( h 62s0 CCB Lit:.: 14117 Electrical Lic..17- 154CLE Snpro, Lic.: 173LEB Inditsiri a plant per hour _ 73,75 CI 11 I PERMIT FEhs '.. :..' Suprv. Ctcclricinn signnutrc, required: — i snbtuhrlt $75,00 Milt 11111110: JACK CAGLE Dale: 7 /29/09 Plan review (25% of permit fee): Store surcharge (12% of permit [ce): $9.00 Authorized signature TOTAL PUIRtvn'r 0105: $84.00 %�✓/ r '1 •his v owed( uppllrnllun uzphtf If a ponnll Is not obinhlcd 10111)11 1(0 PrintllmnC:. ETHANA, DOLPH . Dote: 7/29/09 tiny.; after nbasbcit'templed axcuagITER, 0 Number el'Iuspec110 o u1lwvem 1x:r penaa. I:hat.lhrobu crmiIdl(I,C•Pom 05r2ua iOi461 1'(l unuCOatnlGm