Permit •
Rj CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• ° ' COMMUNITY DEVELOPMENT Permit#: ELR2009 -00150
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/04/2009
Parcel: 2S102BD02201
Jurisdiction: Tigard
Site address: 9986 SW WALNUT ST 3
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: . 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- 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: Permittee Signature: Q e9-P/�L i C�¢—T /ON
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' Date:
LICENSE NO.
Call 603.639.4176 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.
f
RECEIVED
JUN 01 2009
CITY OF TIGARD
Electrical Permit A p p DIVISION •FUirori�ICE USE ONL .; „.. :7.; :•. •'': `,;i
City of 'Tigard Ilcee L
't 13125 SW Hall Olvd., Tigard, OR 97221
Mall : i a(' 4 f v Permit No.: ,, ..- c.749 � it � r; 0
1 * � I >huue: 503.630.4171 lc,lx: 503.598.1960 cawPCmdl:
TIGARD Inspection Line: 503.630.4175 UelcReady /ny: la See l'ogeIfor
Internet: www.dgard -oegnv Nwlliicd(MuNw, liF Supplemental Information
TYPE, fits WORK' " PLAN RIWJCW'i
❑ New consuuclion In Addition /altcrolion /replacemcut Plcac check all ilia upply (submit 2seud ,roc.,,,dam50 shn\ctitIChMv)
❑ Service or feeder 40a amps or mom (] nulltht Weer thn:e dm:es.
❑ Dcmohron ❑ Oilier: s
whole the available ltuh mein ❑ Muniuf and Qnntyanls.
• • •_ •t. CATEGORY OT CONSTIWC'TION , . .. merits 10,(INI amps atIs0 mil, tor 0 P015100 buildings. •
ID I -And 2.1'nlnil dwClhn tae togruuttd, ur exescdt 14,0110 0 Couauotclal•mo agdcuhunl
y G ❑ Commercial /industrial ❑ Accessory b u i lding nrnpn lentil olftct hiisdbnitun. buildings.
10 Multi- fiunily []Mastul•builder ❑Other. C Pitomoon. QIn,udlarunof"tKVAor
JOB SITE INCURIIATION AND LOCATION ❑emergencytyumn larger icy, iclynmloed>y>ten,,
O maim al'ncwmoms 0 ''A " "It ".'1• ?••, "I.1"
_
Job no.; I Job site address: 9986 SW WALNUT n10HP or mom m.tnp.mc
City/Stine/ZIP: TIGARD, OR ❑Sir or mere rerhfennol unite ❑ Recreational vehicle parkc.
s 97223 0 llcalm.cxte faehitct. 0 Saltily tntw.sc r,s utust loss
❑ Ho.aalun, locutions. 600 veils twminol.
Suite /bldg. /apt. [W.11011 open f ono' Pmjectname: CHALET VILLAGE ❑Screkonr feeder dno nabu or MM.
FEE •SCIIEDULB • '
Cross Wed/directions to job silt: 00er nun IR>TINIMP})• MIMI r
New residential single. or nm111•fa,mlly devenlug cull.
Include, Witched garage. _
Subdivision: Lot no.: 1.000 sq. ft. or less 145.15 4
Tos neap /passel no.: L''a. dill 501) +q. It. or poninn 33 .40 I
Limited cnagy, resulcnlial 75.00 2
DESCRIP CON OF WORK (win(.dx,re sq. it.)
INSTALL FIBER OPTICS FOR VERIZON Lindtel I dungy, i l l i I v Al mold-Nog 75.00 2 ,
refidcutial (who above ep
Services or feeders lneisllntIon, ullcrn and/or telnudlon
200 amps or less 80.30 2 • ' ❑ PROPERTY 'OWNER •. ' 0' TENANT • • • • ' 201 amps to 400 amps 106.85 2
Nano: 401 amps to 600 amps 160.60 2
Address:
"'— 601 amps to 1,000 limps 240.60 2
Over 1,000 amps or volts 454.65 r 2
City /St,i(e/7.IP: Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( ) Fox: ( ) 200 amps or less 66.85 I
Owner installation: This installation is being made on properly that I own which is not 201 amps to 400 mans 10030 2
intended for sale, tense, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 5111p5 to 599 amps ^ 133.75 2
Ownersignnturc: __. Dale, Branch ch• calls — new. tiller:nlol /er per
Fee for broach circuits nab
❑ APPLICANT • • • ' •' • • ' •• Q CONTACT PERSON • above service or feeder fee.
6.65 2 •
Rux(ncaa Hume: each branch circuit
NORTH SKY COMMUNICATIONS, INC. If, Fee for branch elicit
Conine name: ERIK SCHENCK without service or feeder fee. 46,85 2
lint branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each add'I branch citcuit I 6765 • - -- 1
hlisecllaicous (service or feeder not included)
City /State /ZIP; VANCOUVER, WA 98684 Each muntitachued or modular
dwilinq, aervice and /or feeder 90.90 2
P110110: (503 ) 969 -7729 I Fax: : ( 866 ) 452 -4853 Recoi111cct only 66.85 2
c •ntall: mduor(anorthskvcomm,com Pump or is ligation cit 53.40 2
' • CONTRACTOR • ' • • • • • Sign or outline Raining 53.40 2
Business 110510: NORTH SKY COMMUNICATIONS, INC. Sigim' citcuit(s)torlimited.
t energy pa altcrntion, or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Deterlbe: 1 Page 2 $75.00 2
City /State/ZIP: VANCOUVER, WA 98684 Each uddlllonal Inspection over allownblo In an of the abovo
Phone: (360) 254 -6920 I Fax: ( ) 1- 866 - 530 -4325 Per inspecrr 62.50
I uvcs1lgmio per hour(' It mint 62.50
CCB Lic,: 14117 1 Electrical Lic.17 -154CL Snprv. Lic.: 173LEB !oduwial plant per hour 7333
• • C L f CTRIC PERMIT FEES • • '•
Suprv. Electric' nn slgnmure, requited: Subtotal:
$75.00
Print name: JACK CAGLE Date: 6/1 /09 Phut review (2544, of permit fee):
Slate surcharge (1258 of permit fee): $9.00
Authnriycd sign inure: 0,
TOTAL PERMIT PER: _
Print tome: ETHAN A. DOLPH I Duce: ' 'Tbhttor fu permit 1e not otain(' Ofilu180
dnys after II bow Into notuplc,t ow tvuy,lelt,
t Number of i allowed per pennll.
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