Permit 'pi ` a CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00058
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/19/2009
PARCEL: 2S 101 AB - 01000
SITE ADDRESS: 12456 SW 72ND AVE 711 ZONING: MUE
SUBDIVISION: HAMPTON PARK APARTMENTS LOT: JURISDICTION: TIG
PROJECT: HAMPTON PARK APARTMENTS
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: 1
Owner: Contractor:
HAMPTON PARK LLC NORTH SKY COMMUNICATIONS INC
BY WEST COAST MORTGAGE 11818 SE MILL PLAIN BLVD
4000 KRUSE WAY PL, BLD 1 STE 2 SUITE 410
LAKE OSWEGO, OR 97035 VANCOUVER, WA 98687
Phone: Contact #: PRI 360- 254 -6920
FAX 1- 866 - 905 -4907
FEES Reg #: ELE 17- 154CLE
LIC 14117
Description Date Amount
[ELPRMT] ELR Permit 2/19/2009 $75.00
[TAX] 12% State Surch 2/19/2009 $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.
f .
Issued By: (� (.,, � k , Permittee Signature: � � QC/11,67)
W i Ls__
INSTALLATION ONLY ��_ "' 111""" ��t""` k
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.
. - . ✓ . . . - ^IV131)
Electrical Permit Application
-i 2009
City f Tigard tteeeived
Y .. _ • Pcnnil N,,.: ►
Date /l1 es 4 �► • • t^.1J0 $
Plan R
131 _5 S W Hall Rlvll., Tigard, OR' 97� �tq/� eview
n o (1 ►V
Phone: 503.ti39.417 Fax: SO.v.5r78. Outer Permit:
n, t Dale /R ya
TIGARD Inspection Line: 503.639.417 DIN DIVISID Date Ready /By: 0 Sce Page 2 for
Internet. www.tig :u'd•or.gov Nolifca /Method: I Cell Supplemental Information
• TYPE OF WORK PLAN REVIEW
❑ New construction 01 Addition /alteration /replacement Please check all that apply (submit 2 sets arplans w /items checked below):
0 Sct vice or reeds, 400 atoms in unite ❑ 0uilding over Ilncc sturius,
❑ Demolition ❑ Other: where ihe available hull current El Marinas and boatyards.
• CATEGORY OF CONSTRUCTION exceeds 10,(x:0 ;tams ,n 150 volts or ❑ Flow ingbuildings.
less 10 ground, or exceeds 14.000 ❑Commcrcial•u;c anticuhur :d
❑ 1- and 2- fnlnily dwelling ❑ Commercial/industrial ❑ Accessory building :om, for all other installations. In
t7 Multi- family ❑ Master builder ❑ Other: ❑ Fire Pump. ❑ Installation of 75 KVA in
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived sy.acm
❑ Addition nl' new motor load of ❑..�.• ..(' .• I _r I -i"
Job no,: Job site address: 12456 SW 72ND AVE. utOHP xettputny.
City /State /ZIP: TIGARD, OR 97223 ❑Sia nwrcresidentialunits. ❑
❑ HcaOh•rtrc (ac•ililics. ❑ Su I volut for more than
❑ Haraidous locations. 600 volts nominal.
Suite /bldg. /apt. no.: BLDG 7 Project lame: HAMPTON PARK ❑Service or feeder 600 amps or more.
FEE SCHEDULE •
Cross street /directions to job site: neacrtpnuo 1 Qlv. I Fee. l 'rued i •
New residential single- or multi - fancily dwelling unit.
Includes attached garage.
Subdivision: Lot 110.: 1,000 sq. It. or less 145.15 4
— — Ea. add'I 500 sq. n. or portion 33.40 I
1 OX map/parcel no.: Limited energy, Icsidcntial
DESCRIPTION Or WORK 7s.00 2
(with alwvc sq. a.)
INSTALL FIBER OPTICS FOR VERIZON Lir
ii o'am'ily
rcsidenlinl (with :lure st n.) 7500 2
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
Name: 401 amps to 600 mops 160.60 2
60! amps to 1.000 amps 240.60 2
Address: Over 1,000 ;amps or volts 454.65 I 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 properly that I own which is not 201 amps to 400 amps 100.3(1 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 imps to 599 amps 133.75 - _ 2
[;ranch circuits - new, alteration, or extension, L1er panel
Owner signature:._..._._._ _.._......_._____Date:.,.. __- A. Fee for branch circuits with
0 APPLICANT I O CONTACT PERSON above service or feeder Ice, 6.65 2
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. B. Foe for branch circuils
Contact name: RYAN ROBERTS _ without service o,' feeder fee, 1 46.85 2
lust branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each add't branch circuit _ I 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: .....--- -- ......._ ... _.._... --
y W 98684 E ac h manufactured or modular 90.90 1 2
dwelling. service and/or feeder
Phone: (503 ) 519 -5264 Fax :: ( )1 -866- 905 -4907 Reconnect Diml I 66.85 j 2
E mduor(U7.northskvcomrn.com Pmmp or rotation ci,clO 53.40 1 2
CONTRACTOR Sign or outline lighting 53.40 2
N ORTH SKY COMMUNICATIONS, INC. e i ne rg yp l"tl`(`)ertit"iled-
Bu siness name: ccr�
,y panel, allcl ;uiun, or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Pogo 2 $75.00 2
City/State/ZIP: VANCOUVER, WA 98684 Each additional inspection over allowable in any of tire above
Per inspection 62.50
Phone: (360) 254 -6920 Fax: ( ) 1 866 - 530 -4325 Investigation per hour (11a min) 62.50
CCB Lie.: 14117 Electrical Lic.17 - 154CL Supra. Lic.: 173LEB industrial plant per hour 73.75
�. / ELECI R[CAL PERMIT FEES
Suprv. Electrician signature, required: J Subtotal: $75.00
J ACK CAGLE D ate: Plan review (25% of permit fee):
Prim name: 2 -18 -09
Slate surcharge (12% of permit fee): $9.00
Authorized signature: 0, TOTAL PE:RNIrr ITidi: $84.00
This permit application expires if 0 permit is not obtained within 180
Print name: ETHON A. DOLPH Date: 2 -18 -09 days after it has been acceplednocomplete.
v Number of inspections allowed per permit.
lanuildinglbcritiMa,C•t' crime Aim (Inc 05/2.1106 441616 I,S'r(I I /I.S /CObt/wl'>n
•
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: FLR2009-00058
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/1912009
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 7J26/2009 TIME: 7:03AM PAGE: 3
SITE ADDRESS: 12456 SW 72ND AVE 711 CLASS OF WORK:
SUBDIVISION: HAMPTON PARK APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: HAMPTON PARK APARTMENTS
DESCRIPTION: Install fiber optics for verizon.
OWNER: HAMPTON PARK LLC, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-254-6920
Inspection Request Scheduled For: Date: 2/26/2009 Pour Time:
Code # Inspection Description Cct)f'r Contact # Message
199 El ectii cal final 80874-01 503-932-6684
Corrections/Comments/ Instructions:
0)\.
■ PASS El PARTIAL APPROVAL CANCEL E NO ACCESS
fl FAIL n CALL FOR INSPECTION E ADDITIONAL FEES ASSESSED
Inspector: G 6 Date: 1115` Phone #: (503) 718- PM