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Permit r ELECTRICAL RESTRICTED ENERGY PERMIT CITY OF TOGAR® , p g ` COMMUNITY DEVELOPMENT Permit #: ELR2009 -00315 � , ,.Fa ,: ? Date Issued: 10/02/2009 - I G AR 6 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 � Parcel: 1S134BC00403 Jurisdiction: Tigard Site address: 12505 SW NORTH DAKOTA ST 1501 Subdivision: Lot: 0 Project: Meadow Creek Project Description: Install fiber optics for Verizon. FEES Owner: BEL -EQR III LIMITED PARTNERSHIP Description Date Amount BY EQR - REAL ESTATE DEPT, PO BOX 87407 Restricted Energy Permit 10/02/2009 $67.84 CHICAGO, IL 60680 12% State Surcharge - Electrical 10/02/2009 $8.14 PHONE: Contractor: NORTH SKY COMMUNICATIONS INC 11818 SE MILL PLAIN BLVD, SUITE 410 VANCOUVER, WA 98687 PHONE: 360 - 254 -6920 FAX 1- 866 - 530 -4325 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 $75.98 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 a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: Permittee Signature: L,A Q Q Ap 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 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. RECEIVED Electrical Permit Annlicatl6d 01 ?[?C .... s: FOR OFFICE USE ONLY. : + Ci t3 S ri o '! :d i gar d l O lv d., Ti "u,Qt ( fM S7oF TIGARD Recol,ral Gate 2004 O `� Permit Na; /(i : pl, n n vic,v �� Phone: 503.639.4171 O T VI�:D�INEIDIVISION Dawny: 011wrI'crndl TIGARD tnspet:nonLino:503.63 A DaleRcady /liy: 111 Bt See Vow 2for (ntcin0. www,dgord- or.00v Nutifrcd(Mcnuul: l l Supplemcnlni Infmmnnm, ..... '. • :. TYPF. OF WORK ';'::e., ...:. ,.•. • .i: " •, .• ;•••' PLAN litiVlIIW. " : :' : :: > • . : 0 New construction 0Addition /alteration /replacement Plcmo cheek all Ih: n apply ( ubmit 3scu plans or/actin oIecked:xlow): 0 Se,vico or feeder 400 amps or nor ❑ Sollding over thn;o steles. El D00101i00n 0 Other: whom it IOdilah ritmoo ❑ muniui and homy:vas• CATEGORY • or CONS"1'RUCl'1UN ( .....• M. mec,li 10,000 amps: at 150 .11* or ❑ Meeting buiWingi. las to ground. or excccdr 14,0(0 0 Cwnmorcl:d-aso agrtcntiorol ❑ 1 • and 2- infnily dwelling ❑ Comntc•cinl /industrint ❑ Accessory building amps lot all mrkrhl,lmladmis. building*. QMtllti•fsutiiSy 0 Master builder ❑Other: Q61,1 111my'. 0 tor:dlndun of 70 KVAur - ... '• JOB SITE •INF.ORd'IATION AND LOCATION `; [JEmcrgaroysystonn. hrgurnnnIcyacrtvcd � ... .. QAdhim,nfnewmoonrla:nlnf �f "rl "'Y';' "I. 3 "I•t" ucn Jobno.: Job site address: 12505 SW NORTH DAKOTA uxlHP arWO. uecnpancy. ❑ Sin Of lute reside 11 ,4 00110, 0 lice:eulitm ! vehicle p:dxv. City/State /ZIP: TIGARD, OR 97223 0 iknta Q Supply volute for more limo ❑ 1iazardu Inculiu (700 veto; numu,ol. Suite /bldg. /apt. no. 1501 -1516 Project name: MEADOW CREEK 0 Scrvicoorfccdcr600 wain ormore. — FCE SCIiEDULrs Cross stfeel /<(irccli< +its to job site: Oviedo fon v Pa 'I I New residcntlut;Ingle. or multl•family dwelling uultt includes attached garage. Subdivision: Lot no.: 1.000 sq. R. or loss 145.15 ' 4 4 Tax limp/parcel lie.: 1 Ea. add 500 sig. h. or portion 33.40 ( Limited energy, residential 75.00 2 DESCRIPTION OP WORI< • (withuIn c ;q, f1.) INSTALL FIBER OPTICS FOR VERIZON Li,n)ii cIciolgy, °'uhf- I' " 'ily 7 ;00 2 ' rcsidcnlial (wi01 ulxn•,;;s n.) Services or feeders insiollntlon niid/ r tclucndnn 200 mops or Icss 80.30 2 'so PROPER'tY'OWNER .• ..0 TENANT . • ; .''' 201 amp* fo400any* 106.85 2 Name: 40t amps w600amps 160.60 2 601 amps to 1,000 in 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City /Suite /ZIP: Temporary services or feeders Installation, alterailoli, aotti /of relocation Phone: ( ) Fox: ( ) 200 un+pn or icxs 1 I 66.85 I Owner Installation: This instnilation is being made on property that I own which is not 201 romps io 400 min 100.30 2 intended for autc, lease, rent, or exchange, according to ORS 447, 449, (S70, and 701. 401 apps to 599 anipa I 133.75 2 (hunch circuits new, niteratton, or extension, er anel Ownc1• Signature: Date; _ - P P -- — - A. Foe for brooch ciicurls ' ' • © APPLICANT • . : 'rJ - - j] CONTACT PERSON • above service or feeder fro, 6.65 2 each brunch circuit Ruxiness NORTH SKY COMMUNICATIONS, INC. B. Fee for branch circuits vifhout service or feeder fc 4685 Celled ER SCHENCK name: first branch circuit Address: 11818 SE MILL PLAIN BLVD STE. 410 F•achadd'i branch circuit — 765 Misccllaneous (service or feeder ltd i City /State /ZIP: VANCOUVER, WA 98684 Each inunufaculrad ortnndulur 90.90 2 drvellitle„ service and /or fccdc' Phone: (503 ) 969 -7729 Fax:: (866) 452 -4853 Reconnect only 66.85 2 • r•Itlai1: mduorK_northskycomm,com pumPor irrigaaivoeircic 53.40 2 CONY'RA( TOR Sign or outline lighting 53.4 0 2 iNC, Signul p anel , alt limited- Business name: NORTH SKY COMMUNICATIONS ,INC, cucrgy paper, alteration, or Address: 11818 SE MiLL PLAIN BLVD. STE 410 ex(a)sion. Dnncribe: 1 Page 2 $75.00 2 City /State /ZiP: VANCOUVER, WA 98684 Each additional Inspection over allownbto In any of the above • Phone: ( 360) 254 -6920 Fnx: ( ) 1- 866 - 530 -4325 Per i Iuvcs tigrtti iott 62.50 nn per hour (I L•r miul 62.50 CCB Lic.: 14117 Eteclrical Lic.17 -154CL Suprv. Lic.: 173LEB industrial plant per hour 73,75 '• ••ELEC1' tCAL PERMIT FEES •- Suprv, Electrician signature, required: Saban/II: ( EL/ Print 11111110! JACK CAGLE Don:: 10/01/09 1 1 1 review (2591 01 permit fee)! / State surcharge (12% of per ni' Ice): ,'�9,UU c3.1. ' `l Authorized signalurc; / % -, r TOTAL P((Rtvl IT P110: D ate: 10/01 /09 'ilil :r•mlt u , tirnnun ox hvs Ir a permit Is not ohtnlun + ^ Printnnrno: ETHAN A. pOLPH 1 o anysnrtornlaxbeoAoetotO ;ivtonl,rlett, Number of luepceilun; nllowee lkr Ill Ill . l I t, ing"'cree,nnit,01'.11rn,ylp•dnc 05,20104 1.11146101(11/l'o O IAVai