Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/5/2009
PARCEL: 2S 102AC - 00201
SITE ADDRESS: 09271 SW MAPLEWOOD DR S 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.
Issued By: VQ1� .UL4 110AZI Permittee Signature: &) Q 'ANA I () (',,' k VI
OWNER INSTALLATION ONLY F� �'�!► V
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.
RECEIVED
Electrical Permit Application • FOROFFICEUSEONLY
' • I M Q 5 2009 ... '-
City of Tigard It eeelter] E I l ..
y � r Permit No. •
, 13125 SW lull Dlvd„ Tigard, OR TIGARD Da le o9 _.._. � •.
�F
Plait Revie v
PP Phone: 503.639.4171 tax; 503. 101111 G Other Permit:
Date/I3
TIGARD Inspection Line: 503.639.1175 3�II DING DIVISIO l )aw Ready /Dy: ® Sec Page Z for
Internet: www.tigard or.gov Nutifted /Nict NM: Supplemental Information
. • TYPE OF WORK - .: '. PLAN REVIEW ...
❑ New constriction 01 Addition /alter utiun /replacement Pto:rso chock all that apply (strhntit z sots or plans w/itonvl checked below):
❑ Service or (ceder 400 amps or more ❑ Building over dart stories.
0 Detnolition ❑ Other: when: Ilm nvailahle Soil Bantu c ❑ Mirrors and boatyards.
• CATEGORY OF CONSTRUCTION . ' • exceeds 10,000 amp at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14.000 ❑ Commercial - use ay,iculmral
❑ 1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building mops for all other installations. buildings.
GI Multi - family ❑ Master builder 0 Other: ❑ Fire pump. ❑ Installation of 75 KVA 0
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately deliver] system.
__ ❑ Adr]itinu anew motor load of ❑ "A" "ls' "I.2 "I ",
Job no.: Job site address: 9271 SW MAPLEWOOD DR. IBOHPorra:orc. occupancy.
❑Six or more residential units. ❑ Recreational vehicle parks:.
City /State /ZIP: TIGARD, OR 97223 ❑ Hcnllh•care facitiiies. ❑ Supply voltage fur nacre Wan
❑ H:uatt!ons locations. 600 volts nominal.
Suite /bldg. /apt. no.: S 198 -205 Project name: MAIN STREET VILLAGE ❑ Service or feeder 600 amps or nrorc.
FEE SCHEDULE '
Cross street /directions to job site; Descrlpttrm I Qty. I Pee. I •1;; 1 - '" ..-
New residential single- or multi- family dwelling old!.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq_ ft. or less 145.15 [ 4
Ca. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
75.00
DESCRIPTION OF WORK ' (with above so. it.)
INSTALL FIBER OPTICS FOR VERIZON ut»itedlelaergy , tnulli- falniiy 75.00 2
residential (with ;dam so. 0.)
Services or feeders installation,_alteration, and/or relocation
200 amps or less 80.30 2
0 PROPERTY `OWNER ' ' I . ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name:
I • I '
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 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 l own which is not 201
amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 snips 133.75 _ 2
Branch circuits - pew, alteration, or extension, per panel
Owner signature: ._. __
A. Fce for branch circuits with
❑ APPLICANT ..I O CONTACT PERSON above service or fccdcr fee, 6.65 2 •
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. B. Fee for branch circuits
fi brunch uiruuit iir service or fccdcr fee,
Contact name: RYAN ROBERTS 46.85 2
first
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each am! branch circuit 6.65 2
Miscellaneous (service 01' feeder not included)
City /State/ZIP: VANCOUVER, WA 98684 Bach t»anufactured or modular
90.90 2
dwell ine, service and /or feeder
Phone: (503 ) 519 -5264 Fax: : ( )1- 866 - 905 -4907 Reconnect 0n1y 66.85 2
E -mail: mduorc n v
orthsk comm.com Pul »p or irrigation61ICIC • •..Y , -_. _._ 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: NORTH SKY COMMUNICATIONS INC. energteilrel,alterlimited-
COMMUNICATIONS, energy patrol, alteration, ur
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
Perinspcction 62.50
Phone: (360) 254 -6920 Fax: ( ) 1- 866 - 530 -4325 Investigation per hour (1 hr min) 62.50
CCB Lie.: 14117 I Electrical Lic.17 -154CL Suprv. Lie.: 1 73LEB Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: $75.00 _
Plan review (25% of permit fee):
Print name: JACK CAGLE Date: 1 -5 -09 Slate surcharge (12% of permit fee): $9.00
Authorized signature: 0, TOTAL PERMIT FEE: $84.00
This permit application expires if nermtl is not obtnised within ISO
Print name: ETHON A. DOLPH Date: 1 -5 -09 days after it has been accepted ns complete.
Number or ingxctiooS :Moored per permit.
Fin n krtng'J ermil tit.C-1'ernra,tpp.dnc 05.(25106 .I4(146l I uosicOMJWcl)