Permit �+--- •v
III a CITY O F TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00010
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/5/2009
PARCEL: 2S 102AC -00201
SITE ADDRESS: 09322 SW MAPLEWOOD DR V ZONING: CBD
SUBDIVISION: MAIN STREET VILLAGE APARTMENTS LOT: JURISDICTION: TIG
PROJECT: MAIN STREET VILLAGE
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:
Owner: Contractor:
CASA LA VETA ASSOCIATES + NORTH SKY COMMUNICATIONS INC
HIGHLANDS ASSOCIATES ET AL 11818 SE MILL PLAIN BLVD
BY GUARDIAN MGMT ATTN: BARRY B SUITE 410
PORTLAND, OR 97228 VANCOUVER, WA 98687
Phone: Contact #: PRI 360- 254 -6920
FAX 1- 866 -530 -4325
Reg #: ELE 17- 154CLE
FEES LIC 14117
Description Date Amount
[ELPRMT] ELR Permit 1/5/2009 $75.00
[TAX] 12% State Surch 1/5/2009 $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: 3t ('I �� 51 Permittee Signature: �9_Q pp
- I 't i QO l c
,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.
RECEIVE
Electrical Permit Application FOR OFFICE USE ONLY
,
JAN 0 5 2009
City of Tigard It caned 1 , .
Er 13125 SW Hall Blvd., Tigard, OR 97223 D :ltel0 : O � t(♦
5 8 arY OF TI�iAR P' " " Review
Date/By: Phone: 503. 639.4171 Fax: 503.9 Date/By: Omer Perini!:
T IGARD fns,ection Line: 503.639.4175 ` , � ` ' Q ft . u Rand /0 l ock: 0 See rage 2 for
Internet: www.tignrd•Or.gov gU'LDI�G DIM ei ificd!Mcih e ► ei Supplemental Information
. TYPE OF WORK • •• . . . .. . ' 'PLAN REVIEW .
❑ New construction 1:41 Addition /alteration /replacement Please check all Mai apply (submit 2 sets or plans wfitems checked helnw):
❑ Service or (ceder 400 amps or more ❑ Duilding over throe stories.
0 Demolition ❑ other _ wk. the available fault current ❑ Marinas and boatyards.
• . CATF,coRY OF CONSTRUCTION exceeds (0,000 snips at ISO volts or ❑ floating buildings.
less to ground. or exceeds 14,0110 ❑ Cun -toe agricultural
Ei I - and 2- family dwelling ❑ Commercial /industrial 0 Accessory building amps for all other btctatlations. buildings.
o Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION DEtmergency sysiem. larger separacly derived system. • ❑ Addition of new motor load of ❑ "A ", "(s ' 1.2" "1.3",
Job no.: Job site address: 9322 SW MAPL EWOOD DR. IIIOHP or mere. occupancy. ❑ Six or nitre residential snits, ❑ Recreational vehicle parks.
City/State/ZIP: TIGARD, OR 97223 ❑ Health -care ravititics. a Supply voltage ror more than
❑ H:vardu■s loculim,s, N10141111; nnntinal.
Suite/bldg. /apt. no.: V 222 -229 Project name: MAIN STREET VILLAGE ❑ setvicaor feeder 600 amps ormore.
FEE SCHEDULE
Cross street /directions to job site: lesertptwn I Qtv. I iM. I r,n:n 1 •
New residential single - or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. or less 145.15 4
Ea, WW1 500 sq. ft. or portion 33.40 I
Tax map /parcel n0.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with stove sq. Ii.)
Limited energy, multi - tinily 75.00 2
INSTALL FIBER OPTICS FOR VERIZON residential (with above sq. n.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2 .
' 0 PROPERTY OWNER ' J ❑ TENANT 201 amps to 400 amps 106.85 2
40Lam sto600am,s 160.60 2
Name: P amps
601 amps to 1,000 amps 240.60 . 2
Address: Over 1,000 amps or volts 454.65 2
City /Slale/71P: Temporary services or 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 amps to 400 snips 100.3(1 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
!!ranch circuits- flew, alteration, or extension. per panel
Owner signature:_ ________ - .Date: ______
A. Fce for branch circuits with
❑ APPLICANT p CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2 branch
Business name: NORTH SKY COMMUNICATIONS, INC. B. Fee for branch circuitS
C wiUrau scrsiccorfccdcrfce,
Contact name: RYAN ROBERTS 46.85 2
lust branch citatit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not Included)
City/State/ZIP: VANCOUVER, WA 98684 Each manufactured or modular
dwelling, service and/or feeder
Phone: (503 ) 519 -5264 90.90 2
Fax: ( )1- 866 - 905 -4907 Reconnect only 66.85 2
E -mail: mduornnorthskvcomm.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign nr outline lighting 53.40 2
Business name: NORTH SKY COMMUNICATIONS, INC. energy cilCe alte limited-
t cuergy panel, alteration. or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Paget $75.00 2
City /Staten_IP: VANCOUVER, WA 98684 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (360) 254 -6920 Fax: ( ) 1- 866- 530 -4325 Investigation per hour (t hr min) -~- 62.50
CCB Lie.: 14117 t Electrical Lic.17 -154CL S uprv. Lie.: 173LEB rndnstri :d plan per hour 73.75
�./ ELECTRICAL PERMIT FEES
Suprv. Electrician signtuuse, required: J �ri Subtotal: $75.00 .
Print name: JACK CAGLE Date: Plain review (25% of permit fee):
1 -5 -09 State surcharge (12% of permit fee): $9.00
Authorized signature: 70 � EE: TOTAL PERMIT 1 $84.00
-
t This permit application expires if a permit is not obtained within ISO
Print name: ETHON A. DOLPH Date: 1 -5 -09 days after It has been accepted as complete.
• Number of inspections allowed per permit.
1 Annihnng y,p.dne av:3/06 4411461AT(I ImvCOMnvi;o
.. „
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: FLR2009-00010
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/r1/2009
Phone: (503) 639-4171 .6011t
Inspection Requests (24 Hrs.): (503) 639-4175 — ---
INSPECTION WORKSHEET FOR DATE: 1/12/2009 TIME: 7 PAGE: 19
SITE ADDRESS: 09322 SW MAPLEWOOD DR V . CLASS OF WORK:
SUBDIVISION: MAIN STREET VILLAGE APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: MAIN STREET VILLAGE
DESCRIPTION: Install fiber optics for Verizon.
OWNER: CASA LA VETA ASSOCIATES +, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 3E4264-5920
Inspection Request Scheduled For: Date: 1/12J2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 079579-03 503-1349-2026 N
Corrections/Comments/Instructions:
. N.
1 .
PASS 0 PARTIAL APPROVAL El CANCEL El NO ACCESS
pi FAIL D CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: (3 '• NCA\--E Date: I" -1 1', Phone #: (503) 718- 2-114