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Permit • • CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permittf: ELR2009 -00149 Date Issued: 06/04/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 parcel: 2S102BD02201 Jurisdiction: Tigard Site address: 9988 SW WALNUT ST 2 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 0 952- 00. 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: Pernittee Signature: t ' x/ j -77 n/ 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. • • i RECEIVED JUN, 01 2009 CITY OF TIG : r Electrical Permit ApplicatioBUILDING DIVISI I City of Tigard �„ � /1_� — / / / rl 13125 SW hall Blvd., Tigurd, OR 97223 !� ' f Mute' 503.639.4171 Isla: 503.593.1960 Fliffirl.111111111111 Ol Perntr, TIGARD Inspection Line: 503.639.4175 Wm Ready /Ilya See Pew 2 for Internet: www.tlgrud- or.gov NuIIfcd(MUhurl: IlliM Supplememollnformation • • TYPE OF WORK • :PLAN REVIEW ': '• ".1"i•• ' ❑ New consuvetion 0 Addition/alteration/replacement Please check ;di that apply (submit 3 acmnt l+Ians whims checked :Klnw): Ut:In011t1011 [J Other: O Service or levier 4111 amps ur mruc O flultd a,g over dove no. is . uiie die available hair emcee! ❑ Mµrlllat and hnetyards. : , r',' "'• CATEGORY Or CONSTRUCTION . •, „` • exceeds 10,000an ISO roic ISO volcc or ❑ Mating builtlince. Ica in groom:. or esvvedx Iy000 ❑ Commerclal•uso :violated ❑ 1- and 2- family dwelling ❑Commercial /industrial ❑ Accessory building amp lord! odrerinsnlhnimrs. buildiegt. In Multifamily ❑ Molitor builder ❑ Other Q ': pimp.. ❑ 6 of 7S ISVA a, ' • IUD SITE. INFORMATION AND LOCATION Cmcrgclay ""i• urger ttpahmelytedved 'yam. . ,-,1:1 / i lton nrircty l+l,xnr ll+ut of ❑ A. "W, "1.2" "I.3" Job no.. fob site address: 9988 SW WALNUT IIWHP or mom occupancy. ❑Sit or noose rcsirlenrial omit. ❑ Recn allonal vehicle hniev. Cily/Snue/ZIP: TIGARD, OR 97223 ❑ Heohh.cwchclihret ❑ Supply,YdWgo firs ,, wrnllrarl ❑ Hanuhnrt locations. 500 vales nominal. State /bldg. /apt. Ito. a ion, too EVEn Project name: CHALET VILLAGE 0 rervh.om fee der 6nonmpl ornx,ro. • • . ' CI FEE . SCHEDULE • Cross sure( /ciircclionx to job site: _ nnemm rOld I • New resIdcntlul single. nr nu ltl•famlly dwellhng mull. Inchrdus enriched garage, Sulxlivision: I Lot no.: 1.000 sq. I). or loss 145.15 -• 4 Too H /,tiro( no.; Ea. ddll'l 500 sq. li. or portion 33.40 1 • I emitcd energy, rcsnlci It I 75.00 2 DESCRIPTION OF WoR(( (witlt AMY cq, n I INSTALL FIBER OPTICS FOR VERIZON WHIM( energy, 111u111•Inh1111y 7500 2 ' rcsidc rill (with imam al. n.) Scrvaees or feeders ins9nlIntlon and/or rclocullo 200 Maps or less I 80.30 2 • •' • ❑ PR(IPI:RTY•'OWNER • • I • • ' - ' Q' TENANT • • ' 201 mope In 400 mops I 106.85 2 • Name: 401 Hops rot 600 mops I 160.60 2 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps ornaiis 454.65 2 City /Slate /ZIP: Tempo wiry her vicex or feeders Installation, alteration, and /or relocation Phone: ( ) I Fox: ( ) 200 mops or less 66.0$ I Owner Instullallon: This installation is being made on properly that I own which is not 201 maps to 400 ar 100 30 2 intended for sale, lease, rein, or exchange, according to ORS 447, 449, 670. and 701. 401 mops to 599 amps 133.75 2 Owner signature; __ _ _ „Date: Manch circuits new, oltcr tlou, ur extension, per panel A. Tee for brooch eircuds with • ' ❑ APPLICANT ' . • . ti ' ' ' © CONTACT PERSON ' .>bovc service or feeder l'co. 6.65 2 Business n:u each Winch circuit no: NORTH SKY COMMUNICATIONS, INC. II. Fee for branch CiiCiiii'i Concoct uamer without service or feeder fee, E RIK SCHENCK limbr.un h circuit 46.85 2 Address: 11818 SE MILL PLAIN BLVD STE. 410 ii.ich add'I broach circuit I G•(s5 — 2. - Miscellaneous (service or feeder not included) City /Slnlc/ZIP: VANCOUVER, WA 98684 Each inunufhcuuedormodular 90.90 2 Phone: (503 )969 7729 I Fax: (866 dwelling, service and /or Redo. • ( ) 452 -4853 Reconnect only 6635 2 E22211: or annort mduhsk m c„o ycomm Pomp or ii ligation dicic 53,40 2 ' • • CONTRACTOR • ' • ' Sign nr outline lIghling 53.40 2 BUSinCS.S NORTH SKY COMMUNICATIONS, INC. Signal pncel energy panel, altor,Jion, or Address: 11818 SE MILL PLAIN BLVD. STE 410 eµient■oix Deccrlbe• 1 kge 2 $75.00 2 City/State/ZIP: VANCOUVER, WA 98684 Cult additional Inspection over allowable In a of the above Phone: ( 360) 254 -6920 I Fax:( ) 1- 866 -530 -4325 _ In v Inspocvcslicntloon 62.50 IurnlncrhourU Ixmim 62.50 cce Lie.; 14117 Electrical Lic•17 -154CL Stiffs.. Lie.: 173LEB Industrial phut) per horn 73.75 •'•CLECTRICAI, PF,R MIT FEES Suprv, lacclricinn signature, required: Subtotal: $75.00 Print lame: JACK CAGLE Date: 6/1/09 Men review (2594 of permit fee): State sunhdrge Orb of scroll feu): $9,00 Authorized signnturc: / „. 0 TOTAL PEO1M E I1ttE;: $84.00 Printhom e: ETHAN A. DOLPH _ I Date: 6/1/09 ' 1' ht+ pornlllal/pllrnlen aspires IF a potmltIs not ohlnh¢d%IVAn100 tiny, after II los bcea ,us.ptpl nv tuu • Number of hnpc Bunt elluwed per penult. iO nvadingU 'cronNI:I,C•r.•rmi,yrp.dnc OV)V06 la0- 461SI5t I/Iu/CUsNV >•11