Permit v CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00055
.i_ i c A R 1) 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/19/2009
PARCEL: 25101 AB - 00800
SITE ADDRESS: 12400 SW 72ND AVE 411 ZONING: MUE
SUBDIVISION: HAMPTON PARK APARTMENTS LOT: JURISDICTION: TIG
PROJECT: HAMPTON PARK APARTMENTS
Project Description: Install fiber optics for verizon.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
HAMPTON PARK LLC NORTH SKY COMMUNICATIONS INC
BY WEST COAST MORTGAGE 11818 SE MILL PLAIN BLVD
4000 KRUSE WAY PL, BLD 1 STE 2 SUITE 410
LAKE OSWEGO, OR 97035 VANCOUVER, WA 98687
Phone: Contact #: PRI 360- 254 -6920
FAX 1- 866 - 905 -4907
Reg #: ELE 17- 154CLE
FEES LIC 14117
Description Date Amount
[ELPRMT] ELR Permit 2/19/2009 $75.00
[TAX] 12% State Surch 2/19/2009 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: Warr t o p � Permiftee Signature: ` JQ„ It �b
v im _ 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:
CaII 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 ` ., --
RECEIVE
Electrical Permit Application F ol z oF b'I CE USE O NLY ,
C Of Tigard I- f -:� It ac ived • o - _ Perm ti E t F
N. t y � 18 2 009 Date,(► : a • t � :_. Q., OAP o.I.
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
2 • • Phone: 503.639.4171 tax: 503.598.19Ep� p� o UmclOy: Odic( Per,nic
Ins section Line: 503.639.4175 l i 1 S OF TIG
TIGARD 1 Date Runty / Oy: luck El Sec Page 2 for
Internet: www.tignrd or.gov sUILDING DIVISI 0 1Nlifred /Mcdnt: T I (21 Supply/mini information
TYPE OF WORK • ' 'PLAN REVIEW ..
❑ New construction 0l Addition /alteration /replacement Please check al) that apply (submit 2 sets or In w /heat checked teknv):
❑ Service or feeder 400 amps nr mare ❑ Building over nucc 3turic .
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
• CATEGORY • OF CONSTRUCTION exceeds 10.000 amps at ISO robs or ❑ Floatingbrittdins,•. •
•
less ur ground, or exceeds 14,0(10 ❑ Couuncrcial.use agricultural
❑ 1 - and 2- family dwelling 0 Commercial /industrial ❑ Accessory building mops far nil other iustnlhrtions. buildings.
GI Multi - family ❑ Master builder ❑ Other: ❑ Fite puny. ❑ histadlation '1' 75 KVA in
JOB SITE INFORMATION AND LOCATION • ' CI Emergency system. larger separately cIerived system. • ❑ Addition of new motor load or
❑ .. ..(., .. t ..
Job no.: Job site address: 12400 SW 72ND AVE. 100HP ormore. nccnpnney.
❑ Six or more residential unity. ❑ Recreational vehicle p;uk..
City /State /ZIP: TIGARD, OR 97223 ❑ Health -ca laeilii cs. ❑ Supply voltage for inure than
❑ Hazardous locations. (410 volts nominal.
Suite /bldg. /apt.no.: BLDG 4 Project nam HAMPTON PARK ❑ Service or feeder 600 amps ormore.
FEE SCHEDULE •
Cross street /directions to job site: nosrrlpnm, 1 •
1 Qty 1 err. 1 rural
—__ New residential single- or multi- family dwelling nail.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. rt. or less 145.15 4
Ea. ndd'I 500 sq. II. or portion 33.40 1
Tax map /parcel 110.:
• Limited energy, residential
DESCRIPTION OF WORK ' (with ,ve sq. 11.) 75.00 2
alx
INSTALL FIBER OPTICS FOR VERIZON
Limited energy, (with above 7500
residential (withalxxe:sr li.)
Services or feeders installation, alteration, andlor relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ' • ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 :taps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over (,000 amps or volts 454.65 2
City/State/ZIP: Tempnrary Services fir feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 turps to 400 amps 100.30 2
intended for sate, lease, rent, or exchange, according to ORS 447, 449, 670, and 701, 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: _ _._.. A ___._,Date: _• ..___, A. Fce for branch circuits n'i1/
0 APPLICANT .1 FA CONTACT PERSON above service or feeder fee, 6.65 2 •
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. B. Fce for branch circuits
Contact name: RYAN ROBERTS formate service or feeder fee, 46.85 2
first brunch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each ;WWI branch circuit 6.65 2
Miscellaneous (service of feeder not included)
City /Slate/ZIP: VANCOUVER, WA 98684 Each tnamtfactured or modular
dwelling, service and /or feeder 90.90 3
Phone: (503) 519 -5264 Fax: : ( ) 1- 866 - 905 -4907 Reconnect only 66.85 2
E -mail: mduarOnorthskvcomm.com Pimp or irrigation cilcic 53.40 2
CONTRACTOR Sign or outline lightiog 53.40 2
Business name: NORTH SKY COMMUNICATIONS INC, energy eii 1 a) litnired
arergy patch altcralion, or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Paget $75.00 2
City/State/ZIP: VANCOUVER, WA 98684 Each additional inspection over allowable in any_of the above
Per inspection 62.50
Phone: (860) 254-6920 .. Fax: ( ) 1- 866 -530 -4325 Investigation per (tour (1 lir min/ 62.50
CCB Lic.: 14117 Electrical Lic.1 154CL: Suprv. Lic.: 173LEB Induonal plant Per how 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: i Subtotal: $75.00 _-
Plan review (25% of permit fee):
Print name: JACK CAGLE Date: 2 -18 -09
Stale surcharge (12% of permit fee): $9,00
Authorized signature: 0 le TOTAL PERM FEE: : $84,00
This permil application expires if a permit is not obtained within 180
Print Hama: ETHON A. DOLPH Da(e: 2 -18 -09 days idler a has been accepted as complete.
• FSomlx:i of inspections allowed per permil.
Mond .dne 0521IoC 440.4015 trot /COMAVhn
CITY OF TIGARD
BUILDING DIVISION PERMIT #: EL.R2009- 00065
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/19/2009
Phone: (503) 639 -4171 • I�I+�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 2/27/2009 TIME: 7:01AM PAGE: 6
SITE ADDRESS: 12400 SW 72ND AVE 4U CLASS OF WORK:
SUBDIVISION: HAMPTON PARK APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: HAMPTON PARK APARTMENTS
DESCRIPTION: Install fiber optics for verizon.
OWNER: HAMPTON PARK LLC, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360 -251 -6920
Inspection Request Scheduled For: Date: 2/27/2009 Pour Time:
Code # Inspection Description e no firm# Contact # Message
199 Electrical final '\0130907-02 503 -932 -6684 N
Corrections /Comments/ Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
--SS
Inspector: � 'v%R) L Date: 2-2.1' Phone #: (503) 718- 247