Permit a CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2009 -00023
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/5/2009
PARCEL: 2S 102AC -00201
SITE ADDRESS: 09451 SW MAPLEWOOD DR C 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
FEES Reg #: ELE 17- 154CLE
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 • u- stions to OUNC at 503.246.6699 or 1.800.332.2344.
•
Issued By: `lb �\ �\\ Permittee Signature: k � 1 � A
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.
Electrical Permit Appli ECEI ED FO R OFTICE U E O N LY
=• S
AN 0 5 2 009 R eceived
City of ')i'igard
- •
oaten) • O .. "� - . i
- h 13125 S W Hall Blvd., Tigard, OR 97 23 plan Review
Phonc: 503.639.4171 I °Ix: 5 t Other Permit:
TIGARD l)ate,Ry:
TIGARD tuspectiou Line: 503.619 1175 Date Ready /Dy: la See Page 2 for
Internet: www_tignrtl-ur "lUIL ING DIVISION Nutifted /Mcthntl: let) Supplemental Information
-
TYPO OF WORK . 'PLAN REVIEW .,....
❑ New construction 01 Addition /alteration /replacement Please check all that apply (submit 2 sets nl' plans w /hems chucked below):
❑ Service or feeder 400 amps or more ❑ Building nvcr dime stories.
❑ Demolition ❑ Other: %'bete the available Ihult cturent ❑ Marinas and boatyards.
CATEGORY - CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
Less to ground. or exceeds 14,000 ❑ Commercial -use apticulntral
❑ I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other imaall lions. buildings.
I7 Multi - family ❑ Master builder ❑ Oilier: 0 Fire pimp. ❑ installat of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately del system. • ❑ Addinnnof new minor Mail of ❑"A" "I" "1.2" "1.3 ",
Job no.: Job site address: 9451 SW MAPLEWOOD DR. lo or n rc x eapaney.
Q Six nr more rcsidemial units. ❑ Rcncaltonal vehicle padtx.
City/State /ZIP: TIGARD, OR 97223 ❑ Hc.alth•ca c facilitrcs. ❑ Supply voltage for more than '
❑ Hazardous locations. (4)0 volts nominal.
Suite/bldg./apt. nu.: C 24 -38 I Project name: MAIN STREET VILLAGE ❑Survive or feeder 300 amps or mnrc.
FEE SCHEDULE
Cross street /directions to job site: ur•.crtpunn I Qty. I Fre. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached gmage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
— Ea. udd'I 500 sq. h. or portion 33.40 I
Tax neap /parcel n0.: Limited energy, l siticnlial
75.00 2
DESCRIPTION OF WORK " (with above sal. Ii.)
INSTALL FIBER OPTICS FOR VERIZON Lilnirtxlenergy, multi- fitn, ily 7500
rcsidcnlinl (with Am: m. IiJ
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY. OWNER . I - ❑ TENANT 201 amps to 400 maps 106.85 2
401amxw s 160.60 2
Name: 1; amps
601 amps to 1,000 amps 240.60 2
Address: __ Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary cervices 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 100.30 2
intended for sale, 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 pa
Owner siggnature: _...-.".--- "(J
- ate: _,
' A. Fee for hrnnch circuits with
' ❑ APPLICANT O' CONTACT PERSON above service or feeder fee, 6.65 2 •
each branch circu
Business name: NORTH SKY COMMUNICATIONS, INC. B. Fee for bowel, valhs
fi
without service tli foxier fee,
Contact name: RYAN ROBERTS
list brunch cir 46.85 2
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each :tdd'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZlP: VANCOUVER, WA 98684 Each manufactured or modular
dwelling, service and/or feeder 90.90T 3
Phone: (503) 519 -5264 Fax: : ( )1 -866- 905 -4907 Reconnect only 66.85 f 2
E-mail: mduor @..northskvcomm,com Pump or inigatioll circle 53.40 2
CONTRACTOR ' Sign or outline lighting 53.40 2
Business name: NORTH SKY COMMUNICATIONS, INC. eiergypnei.
, energy Panel. alteration. or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Page $75.00 2
City /State/ZIP: VANCOUVER, WA 98684 Each additional inspection over allowable in any of the above
Per Phone: (360) 254 -692.0 Fax: ( ) 1- 866 - 530 -4325 Itvesl per ltour (Ver milli - -� 62.50
Cal Lic.: 14117 Electrical Lic.17 -154CL Suprv. Lic.: 173LEB industrial plant per hour 73.75
ELECTRICAL. PERMIT FEES
Suprv. Electrician signature, required: Subtotal: $75.0Q,
plan review (259 of permit fee):
Prim name: JACK CAGLE Date: 1 -5 -09
, �' Slate surcharge (12% of permit fee): $9.00
Authorized signature; 0 TOTAL PERIN FEE: $84.00
This permit application expires if a permit is not obtained within 110
Print name: ETHON A. DOLPH Date: 1 -5 -09 elsyn after ii has been accepted no ca,,ug,leir.
• Number of inspections :glowed tier permit.
ho llu itiin5o 'c,miMEI,C•Pennii, \pp.dnc 06r23r06 44t1.11i131'(I VgS/t• "OSmAVIali
CITYOGA
ISIO
PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1i512009
Phone: (503) 639-4171 ,,,
Inspection Requests (24 Hrs.): (503) 639-4175 AA,
_,,,ErlAili FLR2009.,0002.3
INSPECTION WORKSHEET FOR DATE: 1/2612009 TIME: 7 PAGE: 1
SITE ADDRESS: 09 SW MAPLE DR (...s. CLASS OF WORK:
SUBDIVISION: MAIN STREET VILLAGE APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: MAIN STREET VILLAGE
DESCRIPTION: Install fiber optics tor Vetizon.
OWNER: CASA LA VETA ASSOCIATES +, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-254-6920
Inspection Request Scheduled For: Date: 1/2612009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 00001404 fi0J-1349- 20.2Ea N
Corrections/Comments/Instructions:
l b
PASS 0 PARTIAL APPROVAL 0 CANCEL n NO ACCESS
fl FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: CY N 6 t-i Date: 1 -1. Phone #: (503) 718- A6_
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