Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELR2009 -00130
T I G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/12/2009
Parcel: 1 S134AB00100
Jurisdiction: Tigard
Site address: 10960 SW SPRINGWOOD DR
Subdivision: Lot: 0
Project: Englewood Terrace Apartments
Project Description: Install fiber optics for Verizon.
Owner: FEES
Description Date Amount
Restricted Energy Permit 05/12/2009 $75.00
12% State Surcharge - Restricted Energy 05/12/2009 $9.00
PHONE: •
Contractor:
NORTH SKY COMMUNICATIONS INC
11818 SE MILL PLAIN BLVD, SUITE 410
VANCOUVER, WA 98687
PHONE: 360 - 254 -6920
FAX: 1- 866 - 905 -4907
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
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
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 `n copy of the n rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: e n Q Q n x Permittee Signature:
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 she until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
MAY 08 2009 2:31 AM FR TO 5035981960 P . 04
,
RECEIVED .
Electrical Pgrrnit Application ?.L Y 0 7 2009 roR OFVIC,E 1,:)I.: O1.'
City of Tigard
I :ler 5.7.•ct _ A 122, .1 1Mal
- -. 1 4 13125 SW Hall Blvd., Titaird. OR 9722CITY OF TIG , . • ohet Permit
pit 503.639.4171 Fax: 50159 1311ILDING DIVISI I IV
t . , ,,,, ii 0 Inspection Line: 503.639.4175 Itoady/By: tic ::ZruM..a.
Internet: www.tigard.or.gov Notalodfolonal :
--)
".i: % '''.:. ?::;: : ..": r' ',::!.'!•:.:' ..'.. ' -:: '''.'.! WORK :T;: : •:A : .' '. : : :;.....;:, .:.:'..''''' . ''',' . '' . 1.: -: S::: " : . : ,: .,:::.' • :41,AN REVIEVV■iL:'.' •••• • .; :'. ••••,' .:!.. -
ft:meek* an tan apply (submit Isots of plaits whom chock() botoo*
CI New construction 8 Addition/Aeration/replacement
a som. w Solar 400 amps ur mum 0 flantlisis owe Ono storlm.
CI Demolition 0 Other: taboos rho ovaitchle WA mous CI Martims isol moque,.
'...:;'OATEC()Rir 'OP OOKSTRUCTION Y.•; , ;I:...:..',;: ' ,;,:,:.:,..:`,....:::...• csomds to 10,000 at 150 wen or B0,11411% OJl IVDlIUfOl
,
13 I - and 2-family dwelling 0 Commercial/industrial 0 Accessory bighting amps for sit mbar issuatailoas waiting.
13 Multl-famil El Master builder 13 Other: 0 Filo mom. CI tmulkaloo of 75 KVA or
CI neaugeocy system.
.......::.......'...!.'.':. .... .. : JOB .51TK. INFORMATION 'AND. LOCATION . ':•."C•.''''' •.. ''..: :'' CI add Moo oraow wow woo or 0 - A - . 1: 1r. - 1.7. 12 . - ta sYslein.
toaRP or mom. occopanoy.
Job no.: I Job site address: 10960 SW SPRING WOOD DR.
0 six or MOM resideatial twas a Reovadostal which parks
Oty/StattalP: TIGARD, OR 97223 °Healthcare facistics. CI Supply mow for moro thin
El Huard= toostions. 1100 wags sontbul
Suite/bldg./apt 110.3 oeso 0978 event Projeet naille: ENGLEWOOD TERRACE APARTMENTS P . S4n4 . at rt nu" ..
Cross street/directions to job site: Ilaserlsifin i ON i ikm i T4s1 i •
New residential Angle- or multi-family dwelling unit
Iodides attached garage.
Subdivision: . I Lot no.: 1,000 aq. IL or text I 145.15 ' 4
Ea. arhrl 500 sq. IL or portion 3140 l
Tait map/parcel no.: • Limited cuormr, residential 75.00 2
DESCRIPIION OP WORK . (with Mom sa. n.) -
Limited enorgy, mum-raimiy .
INSTALL FIBER OPTICS FOR VERIZON othid.thial (with .1www ,,,,. 6.1 75.00 -,
Services or (ceders Matatlation, alteration, nod/or relocation
. 200 amps or lees 80.30 2
' : •• ' '' 0 PROPERTY .' '.' '1 c ', ; • ' .. .. '.0' TENANT '' " '' ; . : ' ' 201 amps 1°400 amps I06.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 antes 240.60 2
Address: Over 1.000 amps or volts 1 454.65 2
City/Slate/ZIP: Temporary services OF feeders I,tutlIadout, alteration, andlor
reksesdon
Phone: ( ) I Pax: ( ) 200 tuys or less 66.85 1
Owner installation: This installaiicm is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale. knee. rent. or exchange. according to ORS 447, 449, 670, and 701. 401 amps to 599 omps 133.75 2
ihustch clrotdts- ntwolteradon. or axamslon, pe)onel
Owner signature: Data: A. Foe for branch circuits with
• :' .: . • . CI APPLICANT : . ;::: %. • :' .!'. 1 • '. • : - .IZI - CONTAcy pgmoN ' ' .. • above service or feeder (co.
- each branch circuit
Bininess onilux NORTH SKY COMMUNICATIONS. INC. 13. Fee fat branch circuits
oil/hour service or feeder fce,
Contnet name: RYAN ROBERTS lint branch circuit 4483 2
Address! 11818 SE MILL PLAIN BLVD STE. 410 . Each WI tromoh circuit 6.65 -.- 2
Misedlanoons (service or feeder not Included)
CiWataleaa: VANCOUVER, WA 98684 Each manullsouroil or modular 90.90 2
Phone: (503 ) 519-5264 I Fax: : ( )1-866-905-4907 &mut service anger feeder
Reconnect only 66.85 2
e MdUOITarlgEthSkyllOOMM.COM Pump or inisation circle 5140 2
53.40 2
Signal eircult(s) or limited.
Business name: NORTH SKY COMMUNICATIONS. INC. energy panel. alteration, or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Des 1 cribe: Page 2 $75.00 2
CitY/StateZIPI VANCOUVER, WA 98664 Each oddhlood asspeedoeoverallowable in of the above .
Per hapoction 62.50
flow (360) 254-6920 1 Fax:( ) 1-866-530-4325 bwesigstion per hour 0 br Mb) 62.50
CCB lac 14117 I Mewl"! Lic•17-154CL = SaPrv• Lic.: 173LEB Indult Plant Ply ham' '73,75
Suprv. Electrician sginature, required: - , .....
roomy Subtotal: smoo
Print name: JACK CAGLE Dose: 5 Plan review (7356 of pesmit feat
sate surcharge (1256 of permit reek $9.00
Authorized signature: ,.. ., . ' ' TOTAL PERMIT PEE: $44.00
his w application aspires It a porosh Ss mg cihiatoori wisas o lea
1=Wrrri 1st „ *A • . Dare 5 T days attar It Ims bean aecoottal as complar.
• Nooks of hasp:woos slicosed per push.
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