Loading...
Permit i•. CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT 1.: COMMUNITY DEVELOPMENT Permit #: ELR2009 -00249 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/04/2009 ;TIGARD Parcel: 1 S135DD03703 Jurisdiction: Tigard Site address: 11624 SW LOMITA AVE D -1 Subdivision: Lot: 0 Project: Park Place Project Description: Install fiber optics for Verizon. Owner: FEES 1616 SHORELINE LLC & Description Date Amount LOMITA WEST LP, PO BOX 15516 Restricted Energy Permit 07/31/2009 $75.00 FREMONT, CA 94539 12% State Surcharge - Electrical 07/31/2009 $9.00 PHONE: Contractor: PHONE' FAX: 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 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 lie 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 •• R 952- 0 -0100 You may obtain a cop of the rules or direct questions to OUNC by calling 503.246.6699 or 1 800.332.2344. Issued By: % £ nu X Q l I 1 Permittee Signature: Q__ n - ��'� � I 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. tI JUL 2 9 2009 Electrical Permit Application CITY OF TIGA BUILDING DIA'. ..: FOR' •••• OFFICE - . ' Y •• City f Tigard o a tN ll i>, Pcrnr,l Nn,: I' flt;"� 00 2_Z{ Q • II i't 13125 SW Halt Blvd., Tigard, OR 97223 Plan Review w II a Phone: 503.639.4171 i'ax: 503.590.1960 Datrl(i : 0dw, I'cuail: TIGARD Inspection Line: 507,639.4175 0310 Ready /lly: In t: i RI Sec Page 210r Werner: www.ti;;nul- or.9av NalirtcdrMclhad. Supplemcntnl Inrm•matlmt ❑ Now eonsemotion 0 Addition /alteration /replacement Moto clock : dl that apply (submit 2 sots of plAtowOictmcheckedbelow ): ❑ Demolition 0 Utter: CJ Servlee or Rater 400 :cope at note ❑ ridding over d on, lea. tt•Itere tact auailabie IitOh carton 0 Mun and Imia p, tut. • - `! CATEGORY .OF CONSTRUCTION , - . : •...',: '::;:'. •':,. racoon i0,900 :toys nr t 50 wits to- ❑ Ut 110g ltuildiugs. 1 loss to prownl. or cxcecdv I4,0tt0 0 CoNnicrcl:d-u:o ngdcl ❑ I - and 2- !.'tinily dwelling ❑ COiOillerCial /industrial ❑ Accessory building I amp) for all tutoriii0ollurions. buildings. 01 Multi - t 0 Master builder ❑ Other: 0 Fite potal. lyl Ina Mullen of 75 KVrt to JOB SITE INFORMATION AND LOCATION ❑ Cmcrgcncy rystom. ht•Vf acpmaaly dsrivcd system, • --.-- • Q Addition ill new at to nt 0 "A" "1i" "i• ?" "1 •] Job no.: Job site address: 11624 SW LOMITA AVE steMPor ocov,naw. 0 Si'c or mote re unite, 0 Rcurealional vehicle parkv. City /State/ZIP: TIGARD, OR 97223 17Hcahh•c,ucr, -eue icr. 0 Ripply volrbge far atorc Oran 0 Hualiluut leculi0nn. GOO vdlh nnminnl. Snits /bldg./apt. no, D1 - D11 Project 'mine: PARK PLACE O servicoar Redo' f+aa maps orroom FEE - SCITEDULE Cross street /directions to job cite: T _ oronlatnn I ON. I tar, I 'l,hd [ New realdcntlul .tingle• or nndtl•fnruity dwelling unit, Includes Attached garage. S ubdivision: Lot no.: 1.000sq. 0. or loss 145.15 4 --- Ut. All 500 sq. ti. or portion 33.40 1 Tax neap /parcel uo.l Limited cuergy, ro.iidcntiel DGsertirftON OF WORK (with 2 (aitir alwec sq, li.) INSTALL FIBER OPTICS FOR VERIZON Limited ° °algy.iiiuIr !:utty 75.00 2 ' ... residential (with above gig a,) I Services or feeders inatagotion, Otero lion, and/or retncutln ���` 200 atops or less 80,30 2 ''❑ PROPF,R•I'Y•'OWNER 21 .. 'P❑' TENANT • ' . 201 natps 10 amps 106.85 2 Nanle: 401 amps to 600 units C 160.60 2 "_ - 601 amps to 1.000 amps 240.60 2 Address: Over 1.0001mps m veils M 454.65 Mx 2 City /Stale /ZIP: 'Ccutpo rn ry services or feeders Installation, :thermion, atlrllor relocation _ Phone: ( ) Fax: ( ) 200 oittps or less 66.05 1 • Owner installation; This installation is being Made on property that I own which is not 201 amps 10400 amps 100 30 2 intended for sale, lensa, rent. or exchange, according to ORS 447, 449, 670, and 701, 401 amps to 509 naps 133.75 2 Owner signature: _ —____. _ Date: _ Brunch circuits - new, niter_ttlon, or cxtooslon, per pine! — A. ' Or hronS 410001)0 tx/ ' .' '. - ' ❑ APPLICANT • • : : ; ' I , ' • `- © CONTACT PERSON above service or lccdcr tree, 6.65 2 • each branch circuit flintiness name: NORTH SKY COMMUNICATIONS, INC, 0.Fec for brand) circuits ---.- . Contact name: ERIK SCHENCK Wilk)!!! ervicc orfccdcrfCo. 46.85 2 not brunch circuit Addre 11818 SE MILL PLAIN BLVD STE. 410 Each add'i brunch citesit _� 6.65 Miceellaneoas (service or (ceder not included) .. City /State /ZIP; VANCOUVER, WA 98684 finch lnunufacturcd or modular 90.90 2 Phony: (503 ) 969-7729 Fox; : ( 866 ) 452 -4853 w dweitinr, sc+vicc nnd/or Reconnect only _... -...__ 66.85 2 E-mail: 1Tmi91 ncgt�tsliyComm cum Pomp or itligatiUlcirt:lt5 - 53.40 2 . CON'I'RAUTUR Sign(roman° alibiing 53.40 2 Business name: Signl circuits) or limited• NORTH SKY COMMUNICATIONS INC, energy panel, ahormlioa. Address: 11818 SE MILL PLAIN BLVD. STE 410 extension, Describe: 1 Page 2 $75.00 2 City /State/ZIP: VANCOUVER, VA 98684 Each additional Inspection 0nes' al lowablein any oftlteabave Phonc: ( 360) 254 -6920 Fax: ( ) 1- 866 - 530 -4325 l snspecnmt 62.50 htvcsligatipn per hour (I ur 0,110 62.50 CCB Lie.: 14117 Electrical Lie :17 - 154C L Snpty. Lie.: 173LEB hldtlstlial plant perbour 73.75 •"CLEC'I'RICAI. PERMIT FEES Soprv. Electrician signature, requii'ede Sabath: $75.00 Print come: JACK CAGLE Datc: 7/29/09 Phut reviow(25%ofpermit fee): � Stale sarehnrge (120b of permit foe): $9 Audu yrircd,rignalura / i ` /� TOTAL PERMIT $84.00 CO-- Print Home: ETHAN A. DOL PH Date: 7/29/09 'fists parrots upphcnnun ospkoa Ira permit Is not obtained Ohio dn niter R I. broil ncecuted ar cuulpIcle. ° Numla;r of loopedIona allowed or M AI, I: la. Oamg 11 0517,VoG 440 451 3 1'(1Ini.000A1AVP11