Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
°1 r COMMUNITY DEVELOPMENT Permit #: ELR2010 -00213
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/12/2010
Parcel: 2S101 BC00900
Jurisdiction: Tigard
Site address: 12291 SW KNOLL DR
Subdivision: Lot: 0
Project: The Knoll at Tigard
Project Description: (1) limited energy to install fiber optics for Verizon
FEES
Owner:
THE KNOLL AT TIGARD Description Date Amount
PO BOX 23206 Restricted Energy Permit 10/12/2010 $75.00
TIGARD, OR 97281 -3206 12% State Surcharge - Electrical 10/12/2010 $9.00
PHONE: 503 - 293 -4038
Contractor:
NORTH SKY COMMUNICATIONS INC.
11818 SE MILL PLAIN BLVD SUITE 410
VANCOUVER, WA 98684
PHONE: 36 4 — Sy— G Sao
FAX: 1— cf'4 6 - s3Q - y3 a s
Type of Use: MF
Class of Work: NEW
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: Y Fire Alarm: N
HVAC: N Instrumentation: N Total $84.00
Intercom/Paging: N Landscape /Irrigation: N Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the 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 a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: , � �
C Permittee Signature: 0 ,97°/4 /(.9-77e A/
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNERS SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 603.639.4176 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.
OCT 11 2010 11 : 46 PM FR TO 5035981960 P.03
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Electrical Permit Aonlication OCT 1 22010 .... . -,..F0B..0Fyiet2, 1;SE ONLY . .. . • .‘ . . .
- ' City of Tfprd active,' ,
pecni : /0A31P ,. .I Nit EL4 .2041—ao ,.
,
.7 13125 SW Nati Blvd...NW. OR 9 ' - - 1, - ,
Mull*: 501659.4171 Fax: 503.59
! C jr. , !-. :. ta 1 . : 1 1 ' -'1 r . " ; iggiallIN=.1 Oduc . ,,L ,2/i y, - ,evay
insfeceoil Uile: 503.630.4173 !.1 .LiJI t N i ■ ' 0:441104140n 142111AEERE!!!II
Internet: www.dgard.orry Nelliadtrolothoth
::••;;;••,.' • ',':•':* .' '.. : :::- . -• ;-:. : • • :..-;.:, .:.:. • • --:: i'• '-'i.;,-;-,••:-;.2 , .--,' KAN Timm %•:.:.::: •,. =. -- :‘.•:. :. , .
'Now constniction a Addiiioanonkac,ineni Piorm olio& WI that oprAy Ismail Iscootplus %Witco ;AL-awl Wow):
0 SOrdoo or feeder deo amps or mese 0 Balloiat over muss ittadiu.
El (30010D11011 0 other: weere4,0eveierge Iv:home D Madan and enowards.
' '•''. :: ••••••• •:. CATEGORY -or:coNsrmuclioN:,:..-..;,:'-::-',:: ",;:,..:,-..:,.:-;.:- cY lox° —1—d 15° n41 " 014443 b
las to aroma or execcds R050 0 Cinunirrebt•teis assiodutral
fa 1- and 2-1anclwelling 0 Commereiallindustrial Ei Accessory building MITA Ibr ail other Instaltmitins. tuiMingf.
I51 Multi-family 0 Master builder 0 other: a Pk pump. 0 (andhdidd at 75 KVA or
.:....:' .„ • ..: F; •:.;Jon srrs• INFORMATION • AND- LOCATION ''.: '-',' .:'• • '. '':::,, '::::.:-:••• •i E a Ad me a c t r o :r sPlaul. tow o t 0 . 1.32 1,A*, "am.
Job no.: I ' 1°b Idt nd4M3: 12291 SwiENSINEEI 1/4.10L.L. 1°C11/5 Qr fix"' uccufsdcY.
1:3Sis or mute addenda gaits. 0 tiewesliseal whisks parks-
C.ity/StaterZ1P: TIGARD, OR 97223 0 Noatdvexia facilities. CI Supply teem 111• Mate tit=
0 Ruud= locations, 603volti mama.
Suite/bldg./apt. no. 601-616 1 Frei= namc: THE KNOLL 0 Sarvica as &War MD =pa a:mom
.• - • • ' *.':' • ' SCREDIJLE *.• ?.: • ' • •
Crow streelidireeliells 10 ieb site: HUNZIKER AND HALL , . M.M
— 1■111.1■NiaM =MI= INIZMIIIII .
----" New r - ■ - , ., :angle- or mulli•flunily dwelling mitt.
incladas attached garage. ._ ...
Subdivision: Lot no.: 1.000 sq. il. or lees 145.15 4
- --- En. add'i 5110 sq. ti. or podia: 33.40 t
Tax amp/parml :to.: • —
Uniited energy. residential
7100
DESCRIPTION OP WORK • WM AtWO YO. R 2 .)
75,00 2 •
INSTALL FIBER OPTICS FOR VERIZON Limited enery. multmily rettthinam (w:di abovo oq. 04
, Sersiges Or re91 aud/or adocation
200 awns es less 80.30 ' 2
: i •••• i•-• - 13 PROPP.RTY.'OWNER -• ' . .,.. ' • . . •-• •-la TENANT • ' •.: ', ' .'-':': 201 ammo to 400 soups 10635 2
Name: 401 areps to 600 amps 160.60 2
601 amps to 1.000 mums 240.60 2
Adell'estil
Over 1,000 MOIR OF volo 454.65 2
City/Sole/11P: Temporary service-4ot feeders lattattatint, alterallon,ataVer
Macedon
Pliant: ( ) I Pox:( ) 200 amps o -. r ios NUS I
Owner installation: This instaHation is being made on property that 1 ain which is n ot 2 0 1 illePs 14 4 00 amps 100.20 2
intended for sale, tease, rem. or exchange. according to ORS 447, 449, 670, and 701. 401 4011 o 92a_mps ... ___ * Ma2
Branch circuits new.adloradou. or exteasion nand
Owner sivlItUret Wet A.R.; fOr biench cimuits with
• ••••• • • a APPUC.ANT • ' •'-'• • • • s' ':, • • :121"CONTACT PERSON " ; ' shows service or c few -
• 665
each broach circuit 2
Re- name: NORTH SKY COMMUNICATIONS, INC. 0. Fee for branch circuits
—
without •ersies.or feeder fee. 46,95
C°° name: JASON SKELLENGER 2 Ilat bnutch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Euch add', breech circuit 6.65 1 2
Miseellatteonsiservi co or feedainot hietadem
alYiSieleinP: VANCOUVER, WA 98684 Each manufactured or modular 90.90 ' 2
thydilinB, =vice .
Phone! (503 ) 519-7466 Fax: : ( 866 ) 452-4853 Recomloot only andior feeder 6195 : 2
E-mail: • J Sa/ka-grvt..Ort- 4 mc 4771 lx)f Poi AI .40,-i - Pump or imitation circlet 5140 2
' - • ' • - --• '.. ' , • " ' ' •• • ' '• • CONTRACTOR ' '• ' • ' ••• -- • ' • " ' `" - ' • Sign or aniline kilning S3A0 2
Signal eiscoiks) or limited-
Basimlu nline: NORTH SKY COMMUNICATIONS. INC. mercy panel 4110Kili0P. or 1 '
AddfCSS: 11818 SE MILL. PLAIN BLVD. STE 410 extension, Describe: Pase 2 $75.00 2
Ci VANCOUVER WA '8684 sadiciatiltaid ,,.. r.. , over allowable la it , of ate above ' •
..- ins - ion - III 62 30 Mill
Rollo: ( 360) 254-6920 Fax: ( -866-530-4325 luemnigation per hour f 1 Iv met> MI 6230 IN=
iktC Li" 14117 . 4 'IM/25115tvItsa= SoPry. Lie-: 173LEB Ind:Led , a) plant per hone 111111111110E11•111111 .
Suprv. Electrician sign ,.0 fund: :'':-.7...4": ,. .-..-. • ELECTRICAL PIMMIT PEES , o • --- -
Subigtok $75,au
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Print 0 o 01 0: JACK CAGLE Doc! 10/11/10 Plan review (25%ot fe(mi! foe):
State surcharge (12% of tomtit reek $93)0 1. / -
AuthorMed signature: TOTAL PP.RMIT r4lF„ 384,00
Print Mlle ETHAN A. )IPLPH Oda 1 0/11 /1 0 Mb smolt appitroden =Ora if I Damn h net &Ward Wade 010
dose Aar K boo Deo nereakil as wandcw.
• ?fainbur of Impactions allowed Pcf MIMI-
lOtk adiV.PenAisaliIILNAtraslApp. 44114,1$7114VCO?VW/ill
** TOTAL PAGE.03 **