Permit 114 v CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00330
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/9/2008
PARCEL: 25101 DB - 00800
SITE ADDRESS: 13309 SW 72ND AVE A 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 97104 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 12/9/2008 $75.00
[TAX] 12% State Surch 12/9/2008 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: Nth n Q `t 0/Lb Permittee Signature: j p 5 A Co n
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
.
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° CITY ��m� mum�|�m����
BUILDING DIVISION PERMIT 1
| ~�~~"~~~°""°~° ~�"°"~~"~~"° #: �LR�OO8O($�D
| 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/9/2U00
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) G3Q417G a��- ^��..
$
INSPECTION WORKSHEET FOR DATE: 1/9/2009 TIME: 7�O1�� PAGE: 19
SITE ADDRESS: 13309 SW 72ND AVE A CLASS OF WORK:
SUBDIVISION: HAMPTON RIDGE APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: HAkApT8NR|DGE
DESCRIPTION: Unit& A-.1. Installing fiber optics for Verizon.
OWNER: HAMPTON RIDGE APARTMENTS LLC, PHONE #:
CONTRACTOR: NORTF-1 SKY COMMUNICATIONS INC PHONE #: 360-254G920
1
Inspection Request Scheduled For: Date: 1/F3/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message 1
199 Electrical final 079646,03 971-663-4082 N
Corrections/Comments/Instructions:
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" `/
/ \/
�� PASS �� PARTIAL APPROVAL ����N�EL �� NO ACCESS
'-` �� ^-� _-
D FAIL E CALL FOR INSPECTION [| ADDITIONAL FEES ASSESSED
G' - �^��^y�� ‘ �� 1 | Phone #: (503) 718- .1q4:)_
RECEIVED
Electrical Permit Application DEC 0 9 2008 . FOR oF
` FiUU USE ONLY
City of Tigard 1
' _ • f�t�l •• ,
�'t 13l25SW Hall Dlvd., Tigard, OR OF TIGARD Pl;ulbtcvicw �
ti • Inc: ho 503.639.4171 Fax: S � Da tc /0 : Oi Pcrnlil:
TIGARD Inspection Line: 503.639.4175 I_ Mb DIVJSI 0 putcRcndy /fly; UM 0 See Page 2for
Internet: www.tigard or.gov Noti fied /Method: Supplemental Information
TYPE OF WORK . • PLAN REVIEW
❑ New construction 171 Addition/alteration/replacement Please check all thin apply (suMniI j sett n1•p w/ilema checked helow).
❑ Service or feeder 400 amps or more ❑ Building over time stories.
❑ Demolition ❑ Other: where the available f;mlt current ❑ Ai rime; and Ann yards.
•
• •• • CATEGORY OF CONSTRUCTION • . . exceeds 10.000 amps al 150 volts or ❑ blotting buildings.
less in ground. or exceeds 14,000 ❑ Commercial -use agricuhurd
❑ 1- and 2- fancily dwelling ❑ Commercial /industrial ❑ Accessory building antis for all otherinsIallnlions. buildings.
L7 Multi- family ❑ Master builder ❑ Other: ❑ hire pump. ❑ Installation of 75 KVA of
. ❑ Emergency system. larger scpaf: teiy derived system.
JOB SITE INFORMATION AND LOCATION • . • ❑ Addition of new motor la or ❑ - A" ••G•' "1 •' l • (-
Job no.: Job site address: 13309 SW 72ND AVE. 1000Pormom. occupancy.
❑Six or more residential unit}. ❑ Recreation! vehicle parks.
City /State /ZIP: TIGARD, OR 97223 ❑ Heald, -care facilities. ❑ Sop1)ly voliage for more man
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: A -J Project name: HAMPTON RIDGE , ❑ Service or feeder 600 ampsurnxno.
• • FEE SCHEDULE •
Cross street /directions to job site: nexerlpnw, I Qty. 1 For. t Total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'1500 sq. R. or portion 33.40 I
Tax map/parcel no.: Limited energy, residential
DESCRIPTION OF WORK • (with above sq. 6.) 75.00 2
INSTALL FIBER OPTICS FOR VERIZON Lilc,itraenergy, l»ulbi- 6ln,ily 75.00 2
residential (with above sit. 0.)
Services or feeders installation, alteration, and /or relocation
200 naps or less 80.30 2
❑ PROPERTY OWNER ' J . 0 TENANT 201 maps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps _ 240.60 2
Address: Over 1,000 IIn113S or voles 454.65 1 2
City /State/ZIP: Temporary services or feeders installation, alteration, and /or
_ relocation
Phone: ( ) Fax: ( ) 200 amps or Icsx 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps 10 400 ; 100 3(1 2
intended for sale, least, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
firtuicic circuits — new, alteration, or extension, per panel
Owner signature: A. Fee for branch circuits with
❑ APPLICANT I O CONTACT PERSON above scrv icc or feeder ice, 6.65 2
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. D. Fee for brunch circuits
RY ROBERTS oil /w service or wetter fee
Contact name: 46.85 2
first blench circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each add'I branch circuit 6.65 2
y VANCOUVER W 98684 aneoos (service or der not Included)
City/Stale/ZIP: /Sta1C21P: Each manufactured or modular
90.901 2
dwebline, :nu vice and /or feeder
Phone: (503 ) 519 -5264 Fax: : ( )1- 866 - 905 -4907 Reconnect only 66.85 I 2
E-nlaii: rnduor(Wnorthskvcomm.com pump or irrigation circle 53.40 2
CONTRACTOR • Sign or outline lighting 53.40 2
Business name: NORTH SKY COMMUNICATIONS INC.
Signal
circnil(s) t>rtitnited -
i enerCy 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
Phonc: (360) 254 -6920 FaK: ( ) 1 -866- 530 -4325 inspection 62.50
Gcvcstiu hour phr minl 62.50
CCB Lic.: 14117 Electrical Lie.1 -154CL Suprv. Lic.: 173LEB industrial lantperhour 73.75
ELECTRICAL. PERMIT FEES ..
Suprv. Electrician signature, required:
Subtotal: $75.00
Print name: JACK CAGLE Dale: 12-9-08 Plan review (25 %n of permit fee):
State surcharge (12% of permit fee):
<� � , 84 0
Authorized signature: �� TOTAL PERM FEE: $84.00
This — pe rmit upplicatiun expires if a permit is not obtnincd ii Rhin (80
Print name: ETHON A. DOLPH Date: 12 -9 -08 days lifter 11 has been accepted AS tomptete.
— ' Number of insIKCtio,)s ; per permit.
I: lluildingV 'ermiMnl.C.PenotlApp.Anc 0925/16 .1411•46 151 In /$ /COMAV,in