Permit • ill 4 CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
°' COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00011
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/5/2009
PARCEL: 2S102AC -00201
SITE ADDRESS: 09323 SW MAPLEWOOD DR Q 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: Permittee Signature: C . f)p . , Q 0V\
OWNER INSTALLATION ONLY Y -lam
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.
RECEIVED
Electrical Permit Application FOR:OFFICEUSE : ONLY
Tigard JAN N 0 5 2009 Received
...:
City
y of Re c ive °(-1 Permit No. :�l 12z°°1 • � 1
Pril J
' 13125 SW Hall Blvd., Tigard, OR 972
Phone: 503.639.4171 Fax: 503.5 OF TIGAR Plan R
c Other Permit:
UaldBy.
Read
Inspection tine: 503.639.4175 to /U Pub: BI See 1'a e 2 for
TIGARD S g IUILDING DIVISION�� y y t
Internet: www.ti nrd -w. ov aihcJl (i Supplemental Information
. . TYPE OF WORK • : • .'PLAN REVIEW
❑ New construction Gil Addition /alteration /replacement Please check all that apply (submit 2 sots of plena w /items checked below):
❑ Service or (ceder 400 slops or more ❑ Building over three stories.
❑ Demolition ❑ Other:
oheim the available fault current 0 Marinas and boatyards.
- CATEGORY OF CONSTRUCTION - . exceeds I 0,000amps at ISO volts or ❑ Floating buildings.
less to ground. orczceeds 14.000 ❑ Conunerci :d•use agricultural
❑ I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building stops for all other imoallalions. buildings.
0 Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation or 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separ rely dot ived system.
❑ Addition of new motor load ni ❑ "A" "E", "1 •Y ' I.3 - ,
Job no.: Job site address: 9323 SW MAPLEWOOD DR. 100HPormum ree,lp,lney.
❑ Siz IV MOM resiticmial units. ❑ Rem:4 sun d vehicle parks.
City /State /ZIP: TIGARD, OR 97223 ❑ Health•carc facilities. ❑ Supply voltage for inure than
❑ Hazardous locations. 6011 volts nominal.
Suite/bldg. /apt. no.: Q 182 -1891 Project name: MAIN STREET VILLAGE ❑ Scrviccorrcedcr6011 amps ormore.
' FEE SCHEDULE
Cross street /directions to job site: Thcseramen -- I Qw. I Fee. 1 Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: I.imiletl energy, residential
75.00 2
DESCRIPTION OF WORK — . (with above ul. ft.)
Limited energy, multi - family
INSTALL FIBER OPTICS FOR VERIZON residential (with ;time se. n.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2 •
❑ PROPERTY OWNER ' J ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps )s to 600 amps 160.60 2
Name: I • I ' -
601 amps to 1,000 snips 240,60 2
Address: Over 1,000 amps or volts 454.65 2
City /State /ZIP: 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 amps 100.31) 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 soups 133.75 2
Brunch circuits- new. alteration, or extension, per panel
Owner signature : - -. .___.Date: , - -
A. Fce for branch circuits u'irh
❑ APPLICANT • I GI CONTACT PERSON about service or feeder Ice,
6.65 2 •
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. B. Fee for brunch circuits
RY AN ROBERTS
without service or feeder Ice
Contact name: first 6.85 2
st branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each add'I branch cit cuit 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP: VANCOUVER, WA 98684 Each manufactured or modular -
90.90 2
dwelling, service and /or feeder
Phone: (503 ) 519 -5264 Fax: : ( )1- 866 - 905 -4907 Recoltnect only 66.85 2
E-mail: mduor ccr-northskvcomm.com Pump or inigatioti circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: NORTH SKY COMMUNICATIONS INC. e i e r'ttI`il n ei ,a lerti o n. o -
, energy Feuer, alteration. r
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: (360) 254 -6920 Fax: ( ) 1- 866- 530 -4325 Investigation per hour (I hr nil») 62.50
CCD Lie.: 14117 Electrical Lic.17 -154CL Suprv. Lic.: 173LEB Industrial plant per hou 73.75
' ELECTRICAL PERMIT FEES • . •
Suprv. Electrician signature, required: Subtotal: $75.00
J ACK CAGLE p ale; Plan review (25% of permit fee):
Print name: 1 -5 -09
State surcharge (12% of permit fee): $9.00
Authorized signature: ��� TOTAL PERMIT lute:: $84.00
'flits permit application expires if n permit is not of :tined within Igo
Print ":nce ETHON A. DOLPH Date: 1 -5 -09 days after II has been accepted as complete.
Y i4u mber of inspections allowed per permit.
l:\lluitdingu'crrnihWt.0 ?ram :a.Cpp.dna 05 /3.ves .J0646 1.4p'( I I famcoSNYIii)
CITY OF ��no m m�'w� nu����m��� •
BUILDING DIVISION PERMIT #: FLA200%00011
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/6/20O9
Phone: (503) 639-4171
Inspection Requo��a4Hmj:(6O3)63Q'4175 .��m~ «��
INSPECTION WORKSHEET FOR DATE: 1/13/2O09 TIME: 7:00AhA PAGE: 10
SITE ADDRESS CLASS 09323 WORK:
SUBDIVISION: MAIN STREET VILLAGE APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: MAIN STREEF VILLAGE
DESCRIPTION: - Install fiber optics for Verizon.
OWNER: CASALAyETA ASSOCIATES +, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360'254'8920
Inspection Request Scheduled For: Date: 1/13/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 E|mthium|fine| 079639-01 505849-2025 N
Corrections/Comments/Instructions:
tti PASS PARTIAL APPROVAL E] CANCEL El NO ACCESS
n FAIL ri CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
� / m~-~ 1 � 1 .
Inspector: U�K�Q����' Date: o � �� �-�
~K Phone (503) ib
,