Permit .&
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
11111 COMMUNITY DEVELOPMENT Permit #: ELR2009-00133
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/12/2009
Parcel: 1 S 134AB00100
Jurisdiction: Tigard
Site address: 11022 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 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 AR 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: �(.� �1 V J� 0 V� Permittee Signature: • p Q 0 jp 1 k e 1
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.
MAY 09 2009 2:32 AM FR TO 5035981960 P . 07
.I4. . .,...
REC
Electrical Permit Apalkation I■ . f,,,,oc,10.: ESE ONLY
• City of Tigard " 'town,'
2 0 09 fuel . . - 7 .0
Pw4114°4 2 - dkel — 0th ■
11 . - - 'I 13125 SW Hall 131vd..15gurd. OK 4/ ' •
n EF-4 Mal Pelmn
i
Mom 503.630.4171 Fax 51/C1,•■,1 .1 ..,F
• • Inspection Linv 503.639.4173" • / 1 /N . tutte Waterer:
• IC,A1,1.) W &elves sr*,
Immo: www.tipri•Ot.SOV %4 "IVISION oseetlane '1 1 '
s .r) Supplemental infonnurlen
•,i.r '•,:. F.:: :'::., r!••• .;." 1?.' .".... • . "'• s '.:'''.: ......TYPE :OP ' Nnfmv
WORK '.; , , ,• ' • • • !.• .; . ;,Y ..:. ....".‘ .:„..,' ;: I....! • ::' PLAN REvjgyt: iQ.:...... :..... %. • ' ,.. ....
0 N e w construction 0 Additionialteralionlreplyx.mmit none chase an tofu op* Oatentit I set, oreani wrheins checked wow):
In Simko of Ncdcr OD amp yr imuu Chlulldieu ovor dna gorier&
Ci Demolition 0 Mu: " Mum the avalkdits Rion coat a Rohm, arid boxyurm,
.•'::•.;:•:. . '. •:;CATFA:ORY :OF :CONSTRUCTION,: •.. •••• ; :.....; .•:: ' ..,,.;.,:,..:;,;.., ;,-.:........ exaxds 10,000 amps in ISO .olts or 0 flowing buffslinip_ •
Ion to smack or much 14,000 0 Oraninerclakne noicouvral
El I.- and 2-family dwelling 0 Commercial/industrial 0 Accessory Wilding amps (or all Oar installations. hulling'.
la Multi-family CI *star builder 0 Other: CI Rut puinp. 0 limPalloliuu of IS KVA of
, ' 0 Ilmagency system. lager scPacnclY &Ow MOM
• .":::%:' . ! T. '''' F■ '':, .:JOB.SITE•INFURISiATION 'AND. LOCA'fION ' ''::: :'• • ..• ' : .::...:, ... (3 Amines crow mow mid nr 0 -A-, .6*. -1,r, - i .y.,
Job no.: 1 Job site address: 10980 SW SPRINGWOOD DR. lotninor mom necuponer.
, ant or mare redoemial ue6s. 0 Rev.:venom' wail* p;411.
cityatate/ZIP: TIGARD, OR 97223 CI ilostaveua Acuities. 0 Slimly raw Far Lreve tluul
a natweens locations SOO war wontital.
.
Suite/bldg./apt. no.n i022-110.10 EVENI Project mune:ENGLEWOOD TERRACE APARTMENTS 0 sew" c• ( We' d° "vs '"
.."•'::.;:•7'•:'•'.. •.'■'• ':' :.FEE 'SCHEDULE '.' :..' : " • • .
Cress Nlatfiditt`Cii0115 to job ite: ^ uftertproo I Oft I Ves• I 'Vaal I •
New residential single or multi-family dwelling =O.
Includes attached garapp.
Subdivision: [Lamm.: 1.000 sg. 11._ or less 145.15 ... 4
. -
.. Ea. Ail 500 9:1. It. or portion 33.40 1
Tax mapfparcol no.: ' Limited energy. residential
75,00
•
orsaurnoN OF WORK ' (with 2bn tro sq. fL) 2
ited 75.00 2 •
INSTALL FIBER OPTICS FOR VERIZON Limenorgy, mein-family raidentiflipm, Ann on. 0.)
Services or feeders in ilk rcloadion
200 zunps or less I 80.30 2
:1 PreoPERTy;OWNER .',.. - ....1 :.'. , • . . -.. . 0' TEi4ANT ' ' ..!; ' • ...." ' 20i amp mato umor I 106.8$ 2
-
401 mops to 600 amps _ 1 160.60 2
Name:
601 amps to 1,000 iunps 240.60 2
Addtess: —
. - Over 1,000 amps or volts 454.65 2
City/StatefZIP: Temporary services or Redo% installation, diciiition. and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 I
• Owner Installation: This intallation is being made on properly that I ovm which ii, not 204 4"P" 100-30 _ 2
i ntended for sale, lease. rent, or exchange. according to ORS 447, 449, 67o, and 701. 401 amps to $99 amps 133.75 2
brunch &mats - new alteration, or extenslin, per pawl
Owner signaltutn_ Date:
. A. Fee for branch circuits with
' ..' '• : ... ; . . CI APPLICANT : . .':::, • : • e'. ' ' ! PERSON ' • .. ' above service or feeder too. 045 2
- - each bromt cheat
DUI/111M name NORTH SKY COMMUNICATIONS, INC. B. Fee for brooch eircuas
without scrvics or feeda fee, 46.85 2
Contact Malec RYAN ROBERTS • lissi branch circuit
Adria= 11818 SE MILL PLAIN BLVD STE. 410 Pads add' !branch circuit 6.65 2
. - Mbeellarteons (service et-feeder not iiieluded)
alYiSlakaw: VANCOUVER. WA 98684 Each numufactural ar modular 9R90 2 .
dwelling, service andror feeder
Mom (503 ) 519-5264 I Fax: : ( )1-666-905-4907 Reconact only 6615 ,
2
E mdt.prenorthskycommcom Pomp or inigation circle - ., 33.40 2
55,40 2
Wawa eIrcirids) or lindtcd- — •
Business na/Px NORTH SKY COMMUNICATIONS, INC. energy panel. Amino. or
Address 11818 SE MILL PLAIN BLVD. STE 410 • extension. Describe: I Page 2 $75.00 2
...-
ellY/SudyraP' VANCOUVER. WA %,6,14 Stich odditiongleopectioa ovaingowabis in a of Ute above •
----- Pa inspcairm 6250
Phow ( 360 254 1 Fax:( ) 1-886-530-4325 62,30
Eavatigaion i:es hour (I re nolo —
CCB Lk': 14117 1 elccuical uel 7-15421 suPrv. Lic.; 173LEB inch8"14 P.8111 Pew /miff 73,7S
•
SliptV. acc India signmore, roquirete
...• Subtrash Ink°
Print male: JACK CAGLE Date; 5-7-09 Plan review (25512 of wroth rook
Stole surcharge (12911 of vomit rea): $9.00
Authorized signattent: de olc• .I
den NM e
i'V TOTAL PERMIT Me $84.00
Willi am: ETHAN A. DOLPH — J Date: $-7439 nil permit spaituani sspiew a Wu wadi igutued thlo 10
dup atm It Po ban meow u eimplatv.
• Haggler uf Invective% anwasi pa. wroth.
MeaRlleteren.MALCAMIttANidne minas •40161Y1(IWAV4W138
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