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Permit '- r' CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT � .. -`_ COMMUNITY DEVELOPMENT 14 Permit #: ELR2009 00254 TI 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/05/2009 ARD _ Parcel: 1S 135CA00800 Jurisdiction: Tigard Site address: 11255 SW GREENBURG RD 22 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 OAR 952 - 001 -0100. You may obtain a coy of the rules or direct questions to OUNC by calling 50 246.6699 or 1.800 332.2344. 1n V n IL � l � 1 Issued By: �0I . V`�Q, Permittee Signature: > 1 k 00 ' 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. • / ; - Ct 2 ,. Electrical Permit At plzcatian FOR OFFICE use nlvLlr ,.. City of Tigard Receiver � n�1� t !'n G � ... e t 11135 SW (fall Dlvd., Tigard, OR 97223 Dan ill ' r r � / r AND 11t �• 1 71 • 5 r tt PM Rcv,c u • "��, • Interact: www. I holes: 503.639.4171 Far: 503.59A.19Gp Od er t conic A t)mc10y; y inspection Li 503.639 4175 ea se Read /1i -1 ® See Poe Z (or 'FTIGARD Y r� I 1i � 5 Z ugmd- or.gnv NullfiedIMC111oll: 61 Supplemental information TYPE ot< WORK ':`..; .....; :',.. : `:. • :` P „ Rrv(t?w , ', .: '' . . S IN ❑ New cow:ntction (]Addition /alteration /replacement r rleaee check :II ileaxpply(SxOoick > e1s01 '1111nsw/ircwsehccOeillelow): ❑ PCmoIUIOn 0 Ober; 0 Scwlce or Roder 400 amps or more ❑ fiulklurg 41001' wroc xto trtlol0 do aalitahle (:roar cumin CI Mo4t t and homy:44s, ' CATEGORY •OF' CONS'1.'RUC'I (ON ': " :: •' - •:.:,• C.accds 10(070 amps al 150 volt' or ❑ Ignalint Iuild110. Iva to grvmrd, or exceeds 14,0100 Q Crnumorcialmse ngdcrhural ❑ 1- and 2- 11alnily dwelling ❑ Commercial/industrial ❑ Accessory building a op, tbr other :inslnnmious. braidings. 0 Multi - family 0 Master builder ❑ Other: Qpile 11014,. 0 innotluriouorIS KVAor 300 SITE iNb ORN1A "f10N AND LOCATION Q @merency syFr III larger >cpammlyd.rivtd t yseal . -" -- .. © Addilnn nl aces mnmrin:ul nr ❑ "A " "f' "I.2 " Job no.: 1 Job site address: 11255 SW GREENBURG RD MOHR oimipxny. Q Six or ime re'idemiul mils. 0 Itecreuliaral ,chicle park," City/State/ZIP: TIGARD, OR 97223 0 Reath cme rn1iitiea, 0 0'1pt7 eolrpge for mart limo --""'- ❑ Na<mduw locumuns. (A0 vollz nonri,rol. Suite /bIdg.apt, no. 22 - 31 Project name: WALNUT TREE APTS 0 SCIViCt. r r feeder6(10 twins in neCra FEE'SCI( DUJ,E Cross s(fceU(Iireelinnti job site: 1)NeelleM nv. Pm, 95 ■ Ow roaldontlu Sing e• or mu ti- fanny dwelling matt, Includes attached garage. Subdivision: Lot no.! 1.000 0 9. It. or Ins - 145.15 ._� 4 Tax am / trcol no.: Da. dd<I'I 500 sq. li. or po ti n 33.40 P P• Limited enavgy, resi0e»Csal DESCRIPTION OF WORK 75.00 2 • INSTALL FIBER OPTICS FOR VERIZON L ;n,h «lenorgy,tnmhl- rr,nity 75.00 r 2 esidcnti:d (wah ulwea nl. 0.) Services or feeders ino1allntlon lterutlnn. airi/or rnlocntlnn 200 ranps nr less 80.30 _ 2 • PROPERTY , 'OWNER •' . • • . .• ' O'TENA NT ' ` 201 moo to 400 amps 106.85 1 Na MC: 4 01 amps to 600 amps 160.60 2 - 601 mope to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City /Sutte/Z,IP: 'fumpornry services ur feeders Inatnllal Ion, :alert Ono, and /or relocation Phone: ( ) Fox: ( ) 200 amps or lees 66.85 1 Owner installation: This inslnilntivn is being made on property that C own which is not 201 amps 10 400 amps 100 30 2 intended for 3n1e, !caw, real, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Owner signaturCL....�._�„ -,,.., ___ -_ , _, Drench circuits new. nl(eraIIou, ur extension, per punel .,_Dale: A. Pee for branch Circui IV WW1 • 0 APPLICANT ' :: ` i• n CONTACT PERSON ' above 0010(00 or feeder fee, 6.65 2 each brunch circuit Business name; NORTH SKY COMMUNICATIONS, INC, B. Fee for brancheirouils mm � ` Conmctname: ERIK SCHENCK t1 /101n ureicca fe devise, 4695 2 ..... first branch circuit Address: 11818 SE MILL PLAIN BLVD STE. 410 E;ae) ned'I brim chcilcuit 6.65 ........ _._ _.__.__ -_. hlisecllaaoous {service or feeder not lucluded) City /Siaie /ZIP: VANCOUVER, WA 98684 Eeelrinnnmfacltred i 90.90 ? ' dweling, A!rvicC mad /or (ceder P11o11V4 (503 3 969 -7729 Fax: ; (866 ) 452 -4853 Recotmect only 66,05 2 Emai): mduorenorthskycomm,corn Pump or irrigationcirclu 53.40 2 CON'T'RACTOR • ' Sign or outline lighting 53,40 2 Busines male: NORTH SKY COMMUNICATIONS ne , INC, sigma, pn it(s) or ihnhcd energy p;wh ;dlcrdion, ur Address 11818 SE MiLL PLAIN BLVD, STE 410 extension. Describe: 1 Page 2 $75.00 2 City /Slae/ZiP: VANCOUVER, WA 98684 Deli additional Inspection over allewnhlein any o f liteabove Phone: ( 360) 254 -6920 Fax: ( ) 1- 866 - 5304325 Pet inspection 62,50 hn'csl(gluirnl lxr hour (l hr maul 62.50 CCRLie.; 14117 ElcetricalLie.47.154CL Su1Iv.Lie.: 173LEB blduclrini plant per hour 73.75 • • PERMIT FF,ES ' -- Suprv, Electrician 818001110e, requited; Smbmlrlt • 875,00 Pr)rlt nnrne: JACK CAGLE Date: 7/29/09 911111 rcvicw permit fee): - Stan surcharge (12% of prrnit fee): $9,00 Authorised signature: /., d' /, TOTAL PERM arc: $84.00 Printmune: ETHAN A. DOLPH Date: 7/29/09 'rilhpocndtullplirntlunuspin4ihtpormillsnotebtnhtcdMI111ol0o dnyc of(ce 11 ha. bee. nccovied Av cvo4da1e. I:'O.J4,fo •u'crodnmil,6 PcnnB,a 1 ,dnc n5,3traG ' Nu,nbcr orlu>pccilu0i rllwvcd Kr perudl. 6 I P 41 . IfI1,VCOI)AV Till