Permit I.
Iii CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
: ..
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 -00348
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/18/2008
PARCEL: 1 S135CD -00900
SITE ADDRESS: 11503 SW 98TH AVE ZONING: R -12
SUBDIVISION: GLACIER LILY APARTMENTS LOT: JURISDICTION: TIG
PROJECT: GLACIER LILLY APARTMENTS
Project Description: Install fiber optics for Verizon. This is for units: 11499, 11501 & 11503.
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:
SHARON DEVELOPMENT CO, LLC NORTH SKY COMMUNICATIONS INC
5795 SW CRANBERRY CT 11818 SE MILL PLAIN BLVD
BEAVERTON, OR 97007 SUITE 410
VANCOUVER, WA 98687
Phone: Contact #: PRI 360 - 254 -6920
FAX 1- 866 -530 -4325
Reg #: ELE 17- 154CLE
FEES LIC 14117
Description Date Amount
[ELPRMT] ELR Permit 12/18/200E $75.00
[TAX] 12% State Surch 12/18/200E $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.
U I
Issued By: ', Onto \ Permittee Signature: ,. / • A tte t _ 0 ,
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.
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EIect>< ical Permit A licati G�
FOR OFFICE USE ONLY
City of Tigard ��C 1 2 � 0 � D� Pennitno.: �, - ...
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' 13125 SW Hall Blvd., Tigard, OR 97223 '� i�
Plume: 503.639.4171 Pax: 501598.1960 F/k 11L 11 Other Permit:
TIGARD
in
TIGARD 503.639.4175 C `�y0 ,�, t7JSei'c2
Internet: www.tigartt- Ur.gov ``,, �,�� � sl i Sttpplcmc o for
• TYPE OF w0 41�� PLAN REVIEW
❑ New construction Ell Additi on /alteration /reptaccmcnt Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder Sell amps or note ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current Q M arinas and boatyards.
. CATEGORY OF CONSTRUCTION . exceeds tom) ;aims at 150 volts or 1� Floating buildings.
•
• less to ground, or exceeds 14.0(10 0Caonncrci:d•uecagticulnird
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building slips for all oilier inxudluiions. buildings.
El Multi -famil y ❑ Master builder ❑ Other: ❑ rite pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency sysrom. largos separately derived sysIem.
• ❑ Addition of new motor load of ❑ "A" ( {" "I - "I .)
Job no.: Job site address: 11511 SW 98THAVE. IOOHPormorn. occupancy.
❑Six or more residential units. ❑ tteecational vehicle parks.
City /State /ZIP: TIGARD, OR 97223 ❑ Health -taro facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Su ite /bldg. /apt, Ile.: 15499.11501.11503 Project name: GLACIER LILY ❑Service or feeder 600 amps or mom.
FEE SCHEDULE
Cross street /directions to job site: Description i Otv, 1 Fee, i Total I •
1" MM 16--63 New residential single- or multi- family dwelling unit.
!ll ,1 C} � I I ] I �`�]� ' Includes attached garage.
Subdivision: 6 Lot no.: 1,000 sq. ft. or less 145.15 4
En, odd' 1 500 sq. ft. or portion 33.40 1
Tax map /parcel n0.: Limited energy, residential W
DESCRiPTION OF WORK (with above iii, ft.)
75.00 2
I NSTALL FIBER OPTICS FOR VERIZON Lintitedcltclgy,lttulti multi-family 7500
residential (with above. so. tn.)
Services or Feeders installation, alteration, and/or relocation
200 amps or Tess 80.30 2
0 PROPERTY OWNER — ❑ TENANT 201 stops 10400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 1 I
601 anips 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 stops of less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 stops 100.30 2
intended for sate, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 sops 133.75 2
Owner signature:. Date:
Branch circuits - new, alteration or extension, per panel
- -•-- ------ A• Fee for branch circuits with
0 APPLICANT 1 n CONTACT PERSON above service or feeder fee,
6.65 2
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC, B. Fee for branch circuits
witllOu( service or feeder tee,
Contact name: RYAN ROBERTS Boast branch circuit 46.85 2
Address: 11818 SE MILL PLAIN BLVD STE, 410 Eachadd'l branch circuit ] 6.65 12
Miscellaneous (.service or feeder not included)_
City/State/ZIP: VANCOUVER, WA 98684 Each manufactured or modular
90,90 2
dwelli iv. service and /or feeder
Phone: (503 ) 519 -5264 Fax: : ( )1 -866- 905 -4907 Reconnect only 66.85 2
E -mail mduorta7.northskvcomm.com Pomp or iiriahiiaic circle 53.40 2
CONTRACTOR Signor outline lighting 53.40 I 2
Business name: NORTH SKY COMMUNICATIONS, INC. energy panel, alteration, or
> energy panel, ahcralian, ur
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Paget $75.00 2
City /State /ZiP: VANCOUVER, WA 98684 Each additional inspection over allowable in any of the above '
Per inspection 62.50
Phone: ( 360) 254 -6920 Fax: ( ) 1- 866 -530 -4325 Investigation per hour (I hr min) 62.50
CCI3 i,ic.: 14117 Electrical Lic. -154CL Suprv. Lie.: 173LEB Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES '
Suprv. Electrician signature, required:
Subtotal: $75,00
Print name: JACK EAGLE Date: Plan review (25% or permit fee):
12-16 -08 Slate surcharge (12% of permit fee): $9 00
Authorized signature: f�� _ TOTAL PERMIT FM:: $84.00
This p ermit a expires if a permit is not obtained within 180
Print name: ETHON A. DOLPH
Date: 12 -16 -08 dayxAfterilNutbeennetopledascomplete,
r Number of inspections allowed per pencil.
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PERMIT ~°~°"~~~°""�~= ~°"°"~~"~~"° #: ELR2008-00348
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/1G$2OU8
Phone: (503) 639-4171
Inspection Requests (24Hroj:(503)630'4175
INSPECTION WORKSHEET FOR DATE: 1/6/2009 TIME: 7:O0AKA PAGE: 20
SITE ADDRESS: 1 16O3SyV98THAVE CLASS OF WORK:
SUBDIVISION: GLACIER LILY APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: GLACIER ULLY APARTMENTS
DESCRIPTION: |n»ioU fiber optics for Verizon. This is for unby: W9
OWNER: SHARON QEVEL0Pk4EMT CO, LL(|. PHONE #:
CONTRACTOR: N0Rl`MSNYC[)KAk4UN|C�[|{)NS!N{�
PHONE #: 360-254-6920
Inspection Request Scheduled For: Date: 1/6'2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
136 Low voltage 079407 603- 5t'3-4O82 M �
Corrections/Comments/Instructions:
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•
PARTIAL APPROVAL 11] CANCEL ri NO ACCESS
E FAIL CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
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Inspector: ��' � 0������� Date: � phona#� (5O3\718' ���=���