Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1 "
- COMMUNITY DEVELOPMENT Permit #: ELR2009 -00148
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/04/2009
Parcel: 2S102BD02201
Jurisdiction: Tigard
Site address: 9982 SW WALNUT ST 19
Subdivision: Lot: 0
• Project: Chalet Village
Project Description: Install fiber optics for Verizon.
FEES
Owner:
CHALET VILLAGE LLC Description - Date Amount
TWO CENTERPOINTE DR STE 210 Restricted Energy Permit 06/04/2009 $75.00
LAKE OSWEGO, OR 97035 12% State Surcharge - Restricted Energy 06/04/2009 $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 R 9 - 01 -0 00 You may obtain a copy of the rules or direct questions to OUNC by calling 503.246 6699 or 1.800.332.2344. w /
Issued By: Permittee Signature: f ? /9-1 C/9-7
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 603.639.4175 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
JUN 01 2009
Electrical Permit ADPlicaanY . , -: FOR:OFxiICEliSEONLY`
BUILDING 7,1 City of Ti G DIVISION lain 42 7A P"."' N'''. X1/1,200 C d /
ismirdimm i ° 1 3125 S W Hall ONO., Tlgnrd. OR 97227
r g Phone: 503.639.4171 Etc 503 598 1 960 Olhcr pcnuu:
TIGARD Inspection Line: 503 639.4175 URIC Ready/ny: I' gc oe
Inte
Inter www.tlgmd -or soy Nulifnd /Meduvl: IM SupSec ptcmer4nl S r ((formative
, TYPE OF WORK , .. •• ' .' PLAN REVIEW .: : .
❑ New eons uuotion 0 Addition /nlierulimJropincernem More ahcd.Al Apply ( oI0 e.,= ser ntpinor y /,IC,n cheated lIClo,v)
❑ Demolition ❑ Other:
f] ic,vle0 or (ceder 10 :010,1 or now: ❑ nnumn owr,n „k nos
mime rho ava,Ilhlc fault cumin ❑ Mnnnu, And hnlny.ords,
• CATEGORY OF CONSTRUCTION , : cac Ir 10,000 amp, m l So oats or ❑ Idnnnn5 building,
lot lu ground, orexcccda 14,0(10 ❑ Con,nrcrcl:4.05o :volume
❑ I • and 2-family dwelling ❑ Commercial /industrial ❑ Accessory building (sups turnuodls, iminluniwn, buildlnxr.
['Multi-family ❑ M,ole, builder ❑ OIhci . Prim ln 0 lnn:dtnnun of >5 KVA of •
•• JOB SITE INFORMATION AND LOCATION ❑enkrgcn ysyFrmn. larger ,epau;nclyncsived low,
• ❑ A d rliunnnf new motor load of ❑ "A" •'I^ • • 1.1” "I.1••,
Job no.: — I Job me addtcis: 9982 SW WALNUT Ilx)HP or luu0 ueagl. ncy.
❑ Sit nr (lure rank,al.d wlnr, ❑ Recr0ananal vehicle a vkv.
City/Stnte/ZIP: TIGARD, OR 97223 ❑ Heallh•cale raelllllcr CI SApply voh,:pe for( more than
I ❑ Hasa„ tuna luroliam. 600 Min nominal.
Suite /bldg /Apt. Ito, 022.,,0 EVhul Project name: CHALET VILLAGE ❑ Acrvico or feeder 6110 Am more. ps or ore.
11 BEE SCIIEDULE • '
Cross sheet/directions 10 job site: _ — ^ nnerlpu I OM I err, I Tool I .
New resldenllul single• or nwltl•fnmlly dwelling uull.
Includes nitric lied garage.
Subdivision: Lot no.: 1.000 so 0. or less 145 15 . . _ 4
Tax mop /parcel Ito.: Ea. ,,dd'I 500 so It or poSinn 33.40 - ~ t
linthed energy, Icsnlenunl 75.00 2
DESCRIPTION OF WORK to ith .done so, hI
INSTALL FIBER OPTICS FOR VERIZON
Limited enoqy, multi•Intotly 7500
resi,iminl (worn nlvlv,: 21.113
Services or feeders instollotIon and/or relucutlnn '
200 amps or tc+.s 80,30 2
❑ PROPERTY 'OWNER 0' TENANT • . " 201 empa to 400 nmps 106.85 2
Name: 401 nmps to 600 nngas 1 160.60 2
--- – 401 mop, to 1,000 Jams 240,00 2
Address: — –
Over 1,00D amps or volt 454.65 2
City/Stale/ZIP: 'routpnrary services or feeders Installation, alteration, and/or
relocation
Phone: ( ) Fos. ( ) 200 amps m Ices 66,85 1
Owner Installation: This installation is being made on prop that I own wh i s not 201 nn1110 to 400a111ls 10030 2
intended for sale, (case, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 , to 599 amps 133.75 Z
Owner signature: „ Date:
Branch circuits - JIM, uhur, or exlenslmr, per panel
- -- A. Fee for brooch cileu,U aith
.' 0 APPLICANT 1 • (] CONTACT PERSON ' above service or feeder feu, 6.65 2 •
Rosiness (n each henuch oil alit
te:
NORTH SKY COMMUNICATIONS, INC, n Fee for bunion minis
Contact name mahout service or feeder fee,
E RIK SCHENCK lintbrnmhcircuit 46.85 2
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each :Writ branch citcuit 1 6.65 — 1 2
Ivbseellaneous (service or feeder nut included)
City /Statc/ZIP: VANCOUVER, WA 98684 C•aclt munutilcturcdor nodular 1 90.90
Phone: (503 ) 969 -7729 I Fax:: ( 866 ) 452 -4853 dwell((;, .ce,vicc nod/or feeder
Recmntcel only 66.85 2
e•nta;l: mduorla'�northskycomm.com Puny Osi ligation ciµle 53,40 ?
CONTRACTOR Sign or iitIlrmn lighting 53.40 2
Business manic: NORTH SKY COMMUNICATIONS, INC. energy rateel, alteration. or
cucrgypond, altordion. ur
Address: 11818 SE MILL PLAIN BLVD. STE 410 clrlention.Deserlbe: 1 Pagel $75.00 2
City /Slate/ZIP: VANCOUVER, WA 98684 Each additional Inspection over allowubloIn any oftheabove
Phone: (360) 254 -6920 nix; ( ) 1 -866- 530.4325 luvcsligndon Per 1n+o t 62.50
per boor ( l hrroun 62.50
CC8 Lie.. 14117 Electrical Lic.:17 -154CL sttpty. Lie.: 173LEB Indll.,hial plant per hoar 73.75
'ELECTRICAL PERMIT FEES .
Spry. Elcetricinn signature, required:
Subtotal:
$2.5.00
Print mime: JACK CAGLE Date: 6/1/09 Mini review (25et, of permit fob):
Sim surcharge (12% of permit fee): $9.00
Authorised signature' / 1- - "1
TOTAL Kama era:: $84.00
\--
9 71t, 1 pp p permit a
Printnnrn °: ETHAN A. DOLPH I Dote: /1 /09 locndtu, s us ,b el fu unnhl
doss dui' 11 11.1, been ncaplc,l .1. congdc<,
laa nose •wa,nu,at 1•c•p:nu.,, , me nvs o6 • Numhu•r ul Inaflcedoaf allowed inr ponnll.
+ 1p 440 461S