Permit ii
- a CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
-n- COMMUNITY DEVELOPMENT Permit #: ELR2009-00246
13 125 SW Hall Blvd., Ti Date Issued: 08/04/2009
;TIGARD. and OR 97223 503.639.4171 9
Parcel: 1S135DD03703
Jurisdiction: Tigard
Site address: 11624 SW LOMITA AVE A -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
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- 0001- 0 You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332..22344.
Issued By: �� " 1 t Jn1 id �1 a h Permittee Signature: ` .k Q_ vp
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.
i Erk I
JUL 2 9 Z00'9'
Electrical Permit Application . EO OFFICE USE ONLY. :.-:..:; °,':,t
City of rl are BUILDING DIVI ,� Ncr � ,
1 13125 SW Hall Blvd., y h:t Nn,; r r t 441.1yf -1
tt „Tigard, OR 97227 •
mg 7 Phone: 503.039.4171 Fix; 503.598.1960 lini I °lbw Pencil:
TIGARD Inspection 1,10e: 503,639.4175 Dm RoaiY /liy: Iris 0 Sec Pngc 2 for
Interact: www.ri -or.goy Noltfied /MCdiva: kit Supplernenlnl lnfm-nmlinn
TYPE nF WORK'., t.,” PI,AN RrV.IQW `;:::'
0 New t:Onsliiletion p Addi lion /alterutionlrepinccenent ('lose check :dl that ;splay (subwil Ifpimu wiiluuscisccked leluw)�
0 DGn01t11Un El Other: 0Scrvtccof feeder CM;imp cif 111 ,e 0 nnilchng 4weelltiVe 510101.
wiiorc dw insniablc Bolt c,rtwut 0 Mamas and boatyards.
CATEGORY :Or 'CONSTRUCTION , exceeds 10000 turps m 150 sr■ts' or 0 51 ling buildings.
lece to grooiaJ, or exeeedc 14.000 0 Coelnlesclsi -uso a5tichIIIo Al
1• and 2- Stonily dwelling 0Comlllel'ciil /intlustrial ❑ Accessory building loops Ibr rill oilier iatlailuliwu. building,
IS Allli•fnrnily 0 Maxtor builder ❑ Outer: 0 rite pungt. 0 tow;dhttionof 75 KVA or
' largo sc911 rOly derived sys tcm,
- ' JOB ' SITE INFORMATION AND LOCATION t t y
Y
• � ❑Adr 0 "A ""f;', "I.2 " "I• 3",
Job no,: Job site address: 11624 SW LOMITA AVE 100Hp ori" "' `ecoo'n`'y
0 Sid or more IC ;110111i:d u 0 Recreational vehicle parkv.
City /Stale/ZIP: TICARD, OR 97223 0 Hcallh•auc raciniics 0 Supply volh'go for' mote than
. - ..._ -- ❑ Ha'1ardnns 1081510ns. 600 win nominal.
Suite /bldg. /apt. no, Al -A14 Project name: PARK PLACE CI Ser ie0 Ill feedcr600 woo or Min°.
Cross steeeVdirections to job silo: _ iloortlouan I ()iv. . ir• i r I 'r'wl I •
New resldentlul ningle- or nil Ill- famlfy dwclling unit.
Iuchldvs nttnelted wage, •
Subdivision; 4 1.000 t. or less 145.15 •'
Lae no.: co Q
— • - 1 1.5o. ;WWI 500 sic. h. or portion 3140 1
Tnx imp/parcel I10.I Limited energy, residcmial
_ DESCRIPTION OF WORK ' (Willi alx,tc>q,'i.) 75.00 2
INSTALL FIBER OPTICS FOR VERIZON Lilnird<! energy, muJel•R ",uly 75,00 2 '
residoniial (mot nl tvear n.)
Services or feeders inslnllntlon, ulceration, l»id/or relocation
200 amps or less I 80.30 2
. •D PROPRR'CY :OWNER •• I :, - • .. '. TENANT 201 amps to 400 snips 1 106.85 2
Nance: 401 nips to 600 lochs 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 maps or volls 454.65 2
City /Sense /ZIP: Temporary services or feeders 'macho ion, :dlern and /et'
. relocation
Phone: ( ) Fax: ( ) 200 amps or km 06.85 I
Owner Instullntton: This insinuation is being made on property that I own which is not 201 snips w 4G° lisps - 10030 2
intended for sate, tense, rent, or exchange, according to ORS 447, 449, 670. tend 701. 401 amps to 599 amps 133.75 2
_- _
(bunch cb•culls - new. ultimate() 1, or extension, per panel
Owner signnlw'e: -Dale:
• A. Fee for branch circui Is with
• 0 APPLICANT • . :.' : :;I . • • a CONTACT PERSON • above 'm 00,, or ICeder Cso, '
6.65 2
each branch check
Business same: NORTH SKY COMMUNICATIONS, INC. B. Fee for brooch circuits
Concoct name: ERIK _ SCHENCK witam service or feeder fcn, 46.85 2
use b ranch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each a1141 branch circuit J _ 6.65
Miscellaneous (service or feeder not included) '
City /Some /ZIP: VANCOUVER, WA 98684 Each lnannl'acolrcel cc modular i
90.90 2
Phone: (503 ) 969 -7729 I Fnx:: 866) Reconnect i /or(codcr
( 4 4853 Rec on ly ' 66.65 2
C•niaiI: P r
mduara�northskycomm.com Pomp 53,40 2
CON'i'RACP(1R Sign or utline lighling 53.150 2
But; name. Signal eircuit0 or limited.
_ NORTH SKY COMMUNICATIONS, INC. energy panel, alteration, vr
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension, Describe: 1 Page 2 $75,00 2
City/State/ZIP: VANCOUVER, WA 98684 Each additional Inspection over allowable In any of the above •
Per inxpccti0li r 62.50
Phone; (360) 254 -6920 Fax: ( ) 1 -866- 530 -4325 63,St)
luvcsligrnion par hour(I hr mill
CCB Lie.: 14117 Electrical Lic..17 -154CL Spry Lic,: 173LEB htmistli phi', 73,75 _
• 'ELECTRICAL. PERMIT FEES •
Suprv. Elcctricinn s'lgnnttu'e, requited; Sabtutul: $75.00
Print 0111110: JACK CAGLE I Date: 7/29/09 l'!au review (25% cicerone fee):
_-�.. State su (12% of permit (co); $9,00
Auth01'i /ed signature; x_ %/ TOTAL PfIRtv)19' I Iili: J $84,00
Print name: ETHAN A. DOLPH Dote: 7/29/09 'lhls poemtt uppllcndou (x51151 parent is not Oinked oiibtn 180
days After II hex Inca nccupf0 rte complete.
• IsIH'n,tio•u'rnngAl;I,G rvnn�,x o Arc Oi /J]leG . +Numlxa of' luspccllon; allowed pc( mom. IP• 1 111. /Il5CObt/wlin
•