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Permit C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00028 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/5/2009 PARCEL: 2S 102AC - 00201 SITE ADDRESS: 09492 SW MAPLEWOOD DR D ZONING: CBD SUBDIVISION: MAIN STREET VILLAGE APARTMENTS LOT: JURISDICTION: TIG PROJECT: MAIN STREET VILLAGE Project Description: Install fiber optics for Verizon. A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATA/TELE COMM: X NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: : HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: Owner: Contractor: CASA LA VETA ASSOCIATES + NORTH SKY COMMUNICATIONS INC HIGHLANDS ASSOCIATES ET AL 11818 SE MILL PLAIN BLVD BY GUARDIAN MGMT ATTN: BARRY B SUITE 410 PORTLAND, OR 97228 VANCOUVER, WA 98687 Phone: Contact #: PRI 360 - 254 -6920 FAX 1- 866 -530 -4325 FEES • Reg #: ELE 17- 154CLE LIC 14117 • Description Date Amount [ELPRMT] ELR Permit 1/5/2009 $75.00 [TAX] 12% State Surch 1/5/2009 $9.00 REQUIRED ITEMS AND REPORTS Total $84.00 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344. ` Permittee Signature: By: � � �Q ���e� � g Q Appvt �� i Issued B ►� � 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'N: 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. , _ , . RECEIVE Electrical Permit Application FOR OFFICE USE ONLY JAN 0 5 2009 City of Tigard _ , ��_ , 1117,5 SW Fall Blvd.. Tigard. OR 9712.1,„„,,, /1 Review Phone: 503.639.4171 Fax: 503.598 M 8 ill ©F TIGAR Plnuaten /ICy: Other Permit: TIQAAD Inspection Line: 503.639.4175 �Q� tc Re ady /ny: link: ® Sao Pnge 1 for Internet: W1V \V.11gilyd- Uf.oUV BUILDING DIM it tilled/Method: R 1"1 Supplemental Inrermalion TYPE OF WORK • :' PLAN REVIEW ❑ New Construction 0I Addition /alteration /replacement Plcuse OVA iii that apply (submit 2 sets or PL•ms w /items checked bcluw): ❑ Service or feeder 400 amps or more ❑ Building over duce stories. ❑ Demolition ❑ Other: -_ _ where the available fault current CI Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑Floating buildings. less to ground, or exceeds 14,000 ❑ Cummcrciat• use agricultural ❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building all for all oilier installations. buildings. L7 Multi- fancily ❑ Master builder ❑ Other: Once pomp. O Installation of 75 KVA or ❑ Emergency system. larger separately derived system. JOB SITE. INFORMATION AND LOCATION ❑ Addi or new minor load of ❑ °A ••fs" ••1.2" ••1.3' • Job no.: Job site address: 9492 SW MAPLEWOOD DR. 10DHA eoptiney_ ❑ Si x or more residential units. ❑ Rcereanional vehicle pcks. City /State/ZIP: TIGARD, OR 97223 ❑ Iloalda -cone facilities. ❑ Supply votingo for more than ❑ Haraidons location.. 600 volts nominal. Su ite /blclgJapt. no.: D 39-46 Project name: MAIN STREET VILLAGE 0 Scrviee or feeder 600 auaps or Intro. • ' FEE SCHEDULE - Crass street /direct to job site: »r.,.. +,.w,,, 1 Qty. 1 r•.r. I •rn,:a J • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1.000 sq. ft. or less 145.15 4 En. add'I 500 sq. R. or portion 33.40 1 Tax map/parcel n0.: , Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with :above sq. 11.) Limited energy, multi - family 75.00 2 INSTALL FIBER OPTICS FOR VERIZON residential (with above stt. 01 Services or feeders installation, alteration, auct/or relocation I 200 amps or less 80.30 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 snips 106.85 2 Name: 401 amps to 600 amps 160.60 2 -- °- - --- 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 I 2 City / State/ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) Fax: ( ) 200 amps or less 66.85 _ I Owner installation: This installation is being made on property that I own which is not 201 amps l0 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 : to 599 amps 133.75 2 Brunch circuits - new, alteration, or extension, per panel Owner signature: _.._ -„ . - „_ --_Date: ---- A. Fce for branch circuits with ❑ APPLICANT I ❑i CONTACT PERSON above service or (coder (cc, (a.GS 2 • each branch circuit Business name: NORTH SKY COMMUNICATIONS, INC. B. Fee for br.tttch circuits RY ROBERTS u'irhoue sctviccorfcedcrfee, Contact name: lint branch branch circuit 46.85 2 Address: 11818 SE MILL PLAIN BLVD STE. 410 Each add'I branch circuit 6.65 2 Miscellaneous (service or feeder not included) City/State/ZIP: VANCOUVER, WA 98684 Each manufactured or modular 90.90 2 dwelling, service and /or feeder Phone: (503 ) 519 -5264 Fax:: ( )1- 866 - 905 -4907 Reconnect only 66.85 2 E-mail: mduorenorthskvcomm.cam Pump or irrigation eh de 53.40 2 CON•PRACTOR • • Sign or outline lighting 53.40 2 Signal circuit(,) or limited - Busi name: NORTH SKY COMMUNICATIONS, INC. energy ______ Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Paget $75.00 2 City/State/ZIP: VANCOUVER, WA 98684 Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: ( 360) 254 -6920 Fax: ( ) 1- 866 - 530 -4325 lnvesligalion per hour (I hr min/ 62.50 CCB Lie.: 14117 Electrical Lic.1 -154CL Suprv. Lie.: 173LEB lndusteial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: $75.00 - Print Hume: JACK EAGLE Dr 1-5-09 review (25% of permit fee): 1 -5 -09 State surcharge (12% of permit fee): $9.00 Authorized signature: 7_) TOTAL PERbArr Ft : $84.00 This permit application expires if n permit ie not obtained within 180 Print name: ETHON A. DOLPH Date: 1 -5 -09 days otter It has been accepted ns complete. Number of inspections allowed per permit. t :ttluindin5V'o. mi,.ttit.C.lkm,edpp.doe 05!13105 440.4e 15 tn1. /CO,t4AY1•n