Permit ' n p
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00334
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/10/2008
PARCEL: 25101 DB -00801 •
SITE ADDRESS: 13341 SW 72ND AVE J 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: .S-
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
.: .
DEC 0 9 2008
Electrical Permit Application FOR OFFICE USE ONLY
City oe'rigara CITY OFTIGARD , ' '
rI 13125 SW Hall Blvd,. Tigard, O 0VING DIVISIO i . •� '�� - I _ � Y
Phone: 503.639.4171 Fax: 503. ((T O ther Perin .
TIGARD
Inspection line: 503.639.4175 Date Ready/By: ®Sec Page 2 for
Internet: www.Iigard- ur.gov Notified /Method: IIMI Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction 0 Addition /alteration /replacement meare check all that apply (submit 2 sets ofplaniw /hems checked below).
❑ Service or feeder 400 amps or room Ouilding over throe stories.
❑ Demolition ❑ Other
____ -_____ ___ _._. ._ _______.___ __ where (he available laud cumin ❑ Mruinos and boatyards.
• •' .- CATEGORY OF CONSTRUCTION eset ds 10,000 amps at 150 volts or ❑ Fkrating buildings.
less to ground. or exceeds 14.000 ❑ Cunmtcrciabu :c agricultural
❑ 1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building nips for all other inslallu6mts. buildings,
El Multi - family ❑ Master builder ❑ Other: ❑ Fits pmnp. ❑ Inualkuiun of 75 KvA w
JOB SITE INFORMATION AND LOCATION .. ❑ Emergency system. larger separately derived system.
❑ Addition or new motor load of ❑ "A" "G' "I.2•' I •t"
Job no.: Job site address: 13341 SW 72ND AVE. I00HPortitan:. occupancy.
❑Six or MUM residential units. ❑ Rcemariunal vehicle parks.
City /State /GIP: TIGARD, OR 97223 ❑ Health-care 13cililics. ❑ Supply voltage for more than
❑ KIM dints locations. (40 volts nominal.
Suite /bldg. /apt. no.: A -J Project Warne: HAMPTON RIDGE ❑ Service or feeder 600 amps or sore.
FEE SCHEDULE '
Cross street /directions to job site: Description I Qty. ( rev. 1 rvlat J •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. I'3, or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no.:
Limited energy, residential
75.00 2
DESCRIPTION OF WORK (won above sq. n.)
INSTALL FIBER OPTICS FOR VERIZON Limited energy, multi- fa,n »iy 75.00 2
residential (with ;time sq. tl.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER • L ❑ TENANT 7.0 mops ur400 an,ps 306.85 2 •
401 amps to 600 suns 1 60.60 2
Name: I I '
603 amps to 3,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /Stale/7.11?: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I
Owner installation: This installation is being made on property that I own which is not 201 amps Io400 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 - uew, alteration, ur cxtensiuu, per p;utel _
Owner signature:__ _ ^ ________ Date: __ A. Fee for branch circuits with
[] APPLICANT , [Ji CONTACT PERSON above service or fcCJCr fee,
6.65 ?
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC, B. Fee for branch circuits
RYAN ROBE rrhoar s ervi ce o r f f ee,
Contact n am first e:
3irst branch circuit 46.85 2 - Address: 11818 SE MILL PLAIN BLVD STE, 410 Each add'l branch circuit 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 I Fax: : ( )1 -866- 905 -4907 ' Reconnect only 66.85 2
E-mail: mduornnorthskvoomm.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or oullinc lighting 53.40 2
Business name: Signal circuits) or limited -
NORTH SKY COMMUNICATIONS, INC. energy on el. alteration, n, or 1 Page 2 $75.001 2
Address: 11818 SE MILL PLAIN BLVD. STE 410
City/State /ZIP: VANCOUVER, WA 98684 Each additional inspection over allowable in any of the above
Por inspection 62.50
Phone: (360) 254 -6920 Fax: ( ) 1- 866 - 530 -4325 investigation per hour (I hr 041) 62.50
CCs Lic,: 14117 Electrical Lic.17 -154CL Suprv. Lie,: 173LEB rndnstiad plant per hour _ 7:3.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
$75.00 _-
Print name: JACK CAGLE Dow: Plan review (25% of permit fee):
12 -9 -08 Slate surcharge (12% of permit fee):
$9.00
Authorized signature: TOTAL PERMIT FEE: $84.00
This permit application expire if a permit it not obtained within IN
Print name: ETHON A. DOLPH Date: 12 -9 -08
days ,flee II has been accepted as complete.
'• Number of inspections allowed per permit.
la naildingvcm ,i„041.C-P.,•me,\pp.nne 05/.3155 440.401,5T( I WM :OM/WEB
CITY ��nN x ��N- mm����nm��
BUILDING DIVISION PERMIT #: ELR2008'00n1
1312SSVV Hall Bhd.. Tigard, ORA7223 DATE ISSUED: 12/10/2808
Phone: (503) 639-4171
Inspection Requests �4Hmj: (503) 639-4175 .JL@�' � —�
INSPECTION WORKSHEET FOR DATE: 1/12/2OOy TIME: PAGE: 14
SITE ADDRESS: 13J41SW72NQ AVE J CLASS OF WORK:
SUBDIVISION: LOT TYPEOFUSE
� H�NPT8NR|�GEAPA���B� #: USE:
PROJECT NAME: HANpT$NR/DGE
DESCRIPTION: Un(bzA-J. nsLaIiing fiber optic for Verizon.
OWNER: HAMPTON RIDGE APARTMENTS LW, PHONE #:
CONTRACTOR: NORTH SKY COMMUNtCATIONS INC PHONE #: 380-264692O
Inspection Request Scheduled For: Date: 1/1212009 Pour Time:
Code # Inspection Description Confirm # Contact # . Message
109 Electrical final 079590 971 N
Corrections/Comments/Instructions:
•
.)\liki
�� PASS PARTIAL APPROVAL � CANCEL - NO ACCESS
-- -- --
ri FAIL n CALL FOR INSPECTION | | ADDITIONAL FEES ASSESSED
�� Nt33E � �� |Inspector: �~ ^ Date: �J � � Phone#' (SO3\718 . .` (503) 718- 1W6