Permit 'PI CITY O F T I GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00059
T I G A R DD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/19/2009
PARCEL: 2S 101 AB -01000
SITE ADDRESS: 12478 SW 72ND AVE 811 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.
Issued By: 1 JtJLflJ Permittee Signature: p J(� l 1,05-MO A OWNER INSTALLATION ONLY ` 11
The installation is being made on property 1 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.
. v RECEIVED
Electrical Permit Application FEB 18 2009
City of Tigard / � OF Re ived `� V rr m,it No. • _ to •'c
4 13125 SW Flail Blvd„ Tigard, OR 91,2 i 1 > n t c 11 / ' d ( ,d 9 • Q • IFIILDING DIVISION
Plan Review :
Ph one: 503.639.4171 Fax: 503 G DarO /n : Other Permit;
T I GRAD Inspection Line: 503.639.4175 Date Ready/By: Sec l'ngc 2 for
Internet: www.ligard or.gov Nutifed(Mcthud: Supplerrre,ttnIInfor•mation
• TYPE (W WORK PLAN REVIEW
❑ New construction lil1 Addition/ alteration /replacement Please check all that apply (subunit 2 sets of plans w /itcuu checked below):
❑ Service or Iccdcr 400 amps or more ❑ Building over duce stories.
❑ Demolition ❑ Other: where the available fault CILTTCIU ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts nr Q Floating buildings.
toss to ground, or c tweeds 14,010 0 Commercial -roc ngticulmr :l
❑ 1 - and 2- family dwelling ❑Commercial /industrial ❑ Accessory building amps for all uthctinstallations. buildings.
Q Multi - family ❑ Master builder ❑ Other: ❑Piro pump. ❑ Installation 01'75 Kvn 01
❑ Emergency system. larger separately tlerivcd system.
' - • JOB SITE INFORMATION AND LOCATION Q nrIJ uo of new ,nolor load or i
Job no.: Job site address: 12478 SW 72ND AVE. 100HP orImre. occupancy. ❑ $is or more residential u ❑ [tee :Mount vehicle p:alcx.
City /State/ZIP: TIGARD, OR 97223 Q Henhh -care facilities. 0 Supply vohuge for more than
❑ H:vnalour locations. (,00 von nominal.
Suite /bldg. /apt. no.: BLDG 8 Project name: HAMPTON PARK DScrvicc feeder 600 amps urnore.
Cross street /directions to job site: PEE SCHEDULE
Description 1 Qtv. 1 Pee. 1 mud ) •
Now residential single- or nwlti• family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. rt. orless 145.15 4
—�— Ea. ackt'I 500 sq. A. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with algae sq. itJ 75'00
INSTALL FIBER OPTICS FOR VERIZON LHrisidentersy,n)nhive.sq . y 75.00 residential (old, alo,w sq. t1.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.10 2
❑ PROPERTY OWNER ' I 0 TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2 I
601 amps to 1,000 amps 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 400amps 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, Der panel _
' Owner signature: Date: __ _, - - A. Fee for branch circuits with
❑ APPLICANT r CONTACT PERSON above service or feeder I'ce,
each branch circuit 6.65 2
Business name: NORTH SKY COMMUNICATIONS, INC. B. Fee for briuch CiECtliIS
Contact name: RYAN ROBERTS wirlu,ra ncrviceorfcedcrI'ec, 46.85
2
First branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 '( ': drcu(l 6.65 2
Miscellaneous (service or feeder not included)
City /Siaie /ZIP: VANCOUVER, WA 98684 each mam,Gtetured or modular
dwelling, service and /or feeder 90.90 3
Phone: (503 ) 519 -5264 Fax: : ( )1 866 905 - 4907 Rccnnce,.nl 66.85 2
E -mail: mduorc northskvcomm.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited-
Business name: NORTH SKY COMMUNICATIONS, INC, energy panel, alteration, 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
Per (360) 254 -6920 ( ) 1 - 866 530 -4325 Investigation __ 1 62.50
Phone: ( Fax: Iovcsligalion per hour (1 hr min) 62.50
CCB Lie.: 14117 Electrical Lic.17- 154CL Suprv. Lic.: 173LEB Industrial plant per hour L 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: -- a Subtotal: $75.00 ,
Print name: JACK EAGLE Date: 2 -18 -09 Plain review (25% of permit fee):
State surcharge (12% 01-Permit fee): $9.00
Authorized signature: � 0 TOTAL PERMIT 11E: $84.00
-..
This permit opplicaliou CSpires if a permit i5 not obtained within 180
Print "MC: ETHON A. DOLPH Dale: 2 -18 -09 days after it has been accepted n5 complete.
Number u( inspections :dlwve,l per permit.
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BUILDING DIVISION
PERMIT #: ELR2009'00M9
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/19/2003
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 2/20f2009 T|K4E: 7:03AkJ PAGE: 2
SITE ADDRESS: 1]470SVV72WDAVE 1311 CLASS OF WORK:
SUBDIVISION: HAh8pT$NPARKApARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: IIAMPT�N PARK APARTMENTS
DESCRIPTION: Install fiber mp4ixo for Yerizmn.
OWNER: HAMPTON PARK LLC, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-264G920
Inspection Request Scheduled For: Date: Jy26J2009 Pour Time:
Code # Inspection Description )C Contact # Message
199 E]wokimal final 080 583-932-6681 N
Corrections/Comments/Instructions: ``------
1 ;:g . PASS 0 PARTIAL APPROVAL El CANCEL 0 NO ACCESS
n FAIL CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: G--^ �\ ' ~ ~� C)ata: 2- 16~ 9 Phone #: (503) 718- DM)