Permit ,,,
IN 4 CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00336
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/10/2008
PARCEL: 2S 101 DB -00801
SITE ADDRESS: 13367 SW 72ND AVE A ZONING: R -25
SUBDIVISION: HAMPTON RIDGE APARTMENTS LOT: JURISDICTION: TIG
PROJECT: HAMPTON RIDGE
Project Description: Units: A - J. Installing 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 RIDGE APARTMENTS LLC NORTH SKY COMMUNICATIONS INC
15952 SW PARRISH LN 11818 SE MILL PLAIN BLVD
SHERWOOD, OR 97140 SUITE 410
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 12/10/200E $75.00
[TAX] 12% State Surch 12/10/200E $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:
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.
,.._ ,. .
RECEIVED
Electrical Permit Application FOR OFFICE USE ONLY. :
DEC 0 91008 Received
City of Tigard � � .
't 1 hone S 0 Nall .4171 TFax , OR ` fil(OF TIG�ARD R e e111 •
Phone: 503.639.4171 Fax 503.5 Other Permit:
TICiAN U Inspection Lin.; SU3.639.4175 BUILDING DJVISIO , inr Su ® ppl Sec cmc Pange lnll 2 for nfarmntion
Internet: www.ligard- ur.gov
TYPE OF WORK - ' PLAN REVIEW
❑ New construction GI Addition /alteration /replacement Plc check :di win ;a,ply (submit 2 sets 01Itns rwhcmc cboekcd below):
❑ Sc rvicc or (ceder 400 apps or more ❑ Building °vet chive stories.
❑ Demolition ❑ Other: where the twailablc fault Ca \TC,II ❑ Marinas and Mrnyards.
• CATEGORY OF CONSTRUCTION . cxeceds 10,000 amps al 150 voles or ❑ Floating bt iildings.
El less to ground. or exceeds 14,000 ❑ Conmicrci:ii -uxc aeticuhural
I- and 2- family dwelling 0 Co nmercial /industrial ❑ Accessory building amps for all other installations, buildings.
Q Multi-famil y ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA ut
JOB SITE INFORMATION AND LOCATION ❑ entapticy system. larger separately d.rived system. • ❑ Addition or new motor load of ❑ "A" - 11" •'1.2" "1.3"
Job no.: I Job site address: 13367 SW 72ND AVE. 100HPormore. occupancy.
❑$ix in more residential ousts. ❑ Rccicaliunnl vchicfe perks.
City /Statc/ZIP: TIGARD, OR 97223 ❑ HeaImt•carc racihucs. ❑ Supply voltage for afore than
❑ Hazardous locations. (00 Valli 11011141M.
Suitc/bidg. /apt. n0.: A -J Project name: HAMPTON RIDGE ❑Scrviccur feeder 600 amps ormore.
FEE SCHEDULE
Cross street /directions to job site: uescdpdou 1 Qty. 1 Fe. 1 Total 1 •
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. or Its, 145.15 4
Ea. K I W I 500 sq. ft. or portion 33.40 1
Tax trap /parcel n0.: Limited energy, residential - -
DESCRIPTION OF WORK (with above sq. 8.)
75.00 2
INSTALL FIBER OPTICS FOR VERIZON Linlitc <lellclgy,ll,ulti•I'al,lilj' 7500
residential (with above gq. no) _
Services or feeders installation,_alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ' • I .. ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: amps I
601 :I nps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /St'ue/ZlP: 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 20) maps 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 ell - new, alteration, or extension, pper panel
Owner signature:__ _____ Date: •_ A. Fce for branch circuits with
0 APPLICANT -I 1:0 CONTACT PERSON above service or feeder I've,
each branch circuit 6.65 2
Rosiness name: NORTH SKY COMMUNICATIONS, INC. B. Fec for branch circuits '
fi r st brunch circuit rr service or feeder fee, Contact name: RYAN ROBERTS 46.85 2
lint b
Address: 11 SE MILL PLAIN BLVD STE. 410 Each:rdd'I branch circuit 6.65 2
tvliscellaneous (service or feeder not included)
City/State/ZIP: VANCOUVER, WA 98684 Each ,nanufacnnedormodular
90.90 2
dwelling, service indium feeder
Phone: (503 ) 519 -5264 Fax: : ( )1- 866 - 905 -4907 Reconnect only 66.85 , 2
E -mail: mduor(&northskvcomm.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2 '
Business n ame: NORTH SKY COMMUNICATIONS INC. energy circus, alteration. or
COMMUNICATIONS, energy p:,cl, :dlcr :uiun, or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Page 2 $75.00 2
City /State /ZIP: VANCOUVER, WA 98684 Each additional inspection over allowable in any of the above
Perinspectiou 62.50
Phone: (360) 254 -6920 Fax: ( ) 1- 866 - 530 -4325 Investigation per hour (I hr min) -. 62.50
CCB Lie.: 14117 Electrical Lic.17 -154CL Suprv. Lie.: 173LEB Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: $75,00
Print nalne: JACK CAGLE Date: Plan review (25% of permit fee):
12 -9 -08 State surcharge (12% of permit fee):
$9.00
Autholizcd signatte: TOTAL PERMff FEE: $84.00 4;;;gem,..__,____Ogg__, ibis permit application expires if a permit i5 not ohlnined wilbin 180
Print name: ETHON A. DOLPH Date: 12 -9 -08 days niter a has been accepted as complete.
" Number of inspections allowed per permit.
1:1Duad in4V'cnnitAt :i,C.1'unta App.am 05123/177 .1411-461.. 1(11I..VCOJIAVI?It
CITY OF TIGARD
BUILDING DIVISION PERMIT #: E! R X008.003.37
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 12/10 /2008
Phone: (503) 639 -4171 Vit Inspection Requests (24 Hrs.): (503) 639 -4175 .-
INSPECTION WORKSHEET FOR DATE: 1/14/2008 TIME: 7 :01AM PAGE: 24
SITE ADDRESS: 13367 SW 72ND AVE A CLASS OF WORK:
SUBDIVISION: HAMPTON ON RIDGE APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: 11AMPTON RIDGE
DESCRIPTION: Units: A -J. Installing fiber optics for Verizon.
OWNER: HAMPTON RIDGE APARTMENTS LLC, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 36g-2566
Inspection Request Scheduled For: Date: 1/14/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 0796B6 -01 971-563-4082 Y
Corrections /Comments /Instructions:
N
\ .
' \ M\
PASS I f PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: cS . N 4 e Date: I 1 "' 1 Phone #: (503) 718- 1— t