Permit CI TY OF T I GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00332
ITIGARD. 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/9/2008
PARCEL: 25101 DB - 00801
SITE ADDRESS: 13317 SW 72ND AVE 2 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 97140 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: - QAA Permittee Signature: Sitk � n
� 41%0
OWNER INSTALLATION ONLY T
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.
. ,
• - RECEIVED
Electrical Permit Application ' FOROFFICEUSEONLY
DEC 0 9 2008
City of Tigard 1 ' 7 • + : - �,
13125 SW Nall Blvd., Tigard, O ( 3 OF TIGARD
t: - ' Phone: 503,639.4 171 Fax: Otlhe' PCrnrii:
TIGARD Impect !. . 50 LU NG D'VIS polo Randy /ny: ® See Pnge 2 for
Internet: www.lig:,rd- or.gov Notified /Method: Suppteme mot Information
TYPE OF WORK . . . 'PLAN REVIEW ' •
❑ New construction la Addition /alteration /replacement Please check all that apply (submit 2 sets of Plans w /iteols checked below):
❑ Service or feeder 400 amps or more ❑ Building over dove guiles.
❑ Demolition ❑ Other: where the available I tit CtInCnt ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds (0,000 amps at 150 volts or ❑ Floating buildings.
less In ground, or exceeds 14,000 ❑ Commercial - use attriculuu'al
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ,ims tor:ll other ins, :dhaions. buildings.
GI Matti family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger sepal:mtely delved system.
❑ Addition of new motor Toad of ❑ "A" •'((' • "I -
Job no.: Job site address: 13317 SW 72ND AVE. 100HPormom. wch" "y
❑Six ter mute residential units, ❑ Itemational vehicle parks.
City/State/ZIP: TIGARD, OR 97223 ❑ Henith-c,rc facilities. ❑ Supply t•olr,ge, for more than
❑ Hazardo locations. 600 volts nominal.
Suite /bldg. /apt. no.: A - J Project name: HAMPTON RIDGE ❑ Service or feeder 600 moos ormum.
Cross street /directions to job site: FEE SCHEDULE v. 1
1 mnrrtt,un„ 1 Qty. err. 1 rnmd 1 •
New residential single- or multi - fancily dwelling unit.
Includes attached garage.
Subdivision: 1.01 no.: 1.000 sq. 11. or Icss 145.15 4
Ea. ;WWI 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, lcsidcntial _____-
DESCRIPTION OF WORK (with:awe sil. f)J
75.00 2
INSTALL FIBER OPTICS FOR VERIZON
Limited energy, n,ulti- family
75.00 2
I'esidem(ial (with at...,. lit)
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
40! amps to 600 amps 160.60 2
Name: I I '
601 : to 1,000 am 240.60 2
Address: Over 1,000 amps or volts 454.65 I 2
City /State/7..1P: 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 1 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 :amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature:- - _Date: __- — A. Fee for branch circuits with
❑ APPLICANT I Q CONTACT PERSON above service or feeder 1'ce,
•
each branch circuit 6.65 2
Business name: NORTH SKY COMMUNICATIONS, INC. B. Fee for branch circuits
Contact name: RYAN ROBERTS without service or feeder teem 46.85
2
lire, branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each add'l branch circuit 6.65 I 2
Miscellaneous (service or feeder not Included)
' City /State /ZIP: VANCOUVER, WA 98684 Each manufactured or (nodular t
dwelling, service and /or feeder
90.90 2
Phone: (503 ) 519 -5264 Fax: : ( )1- 866 - 905 -4907 Reconnect only 66.85 - 2
Entail: mduor annorthskycomm.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign oroutlinc lighting 53.40 2
Business dance: NORTH SKY COMMUNICATIONS INC. energy circuit(s) alteration, or
.,. _...._._.---- cner;y panel, uhcration, or
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
CCa3 Lic.: 14117 Electrical Lic.1 -154CL Suprv. Lic.: 173LEB Industrial plant per hour 73,75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
$75.00 !.
Plan review (25% of permit fee):
D ate:
Print mune: JACK CAGLE _ 12 -9 -08 State surcharge (12% of $9.00
g permit fee):
Authorized signature:
5 ° 10TAL PER NI rr 1'1:13: $84.00
T his permit app expires +f permit is not obtained within (80
Print name: ETHON A. DOLPH _ Date: 12 -9 -08 da :Ina it has becn accepted as complete,
• Number of inspections allowed per permit.
l)nand ins o'crn,i,.Ua,C- farm :a. \pp.dot 05 /?a/OL 4.111.4D 1 NV( %%ln5 :COslAvcn
CITY OF TIGARD
BUILDING DIVISION PERMIT #: Et.R2008.00332
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1219000t1
Phone: (503) 639 -4171 �A
Inspection Requests (24 Hrs.): (503) 639 -4175 : ' . 1!.
INSPECTION WORKSHEET FOR DATE: 1/9/2009 TIME: 7:01AM PAGE: 21
SITE ADDRESS: 13317 SW 72ND AVE 2 CLASS OF WORK:
SUBDIVISION: HAMPTON RIDGE APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: HAMPTON RIDGE
DESCRIPTION: Units: A -J. Installing fiber optics for Verizon.
OWNER: HAMPTON RIDGE APARTMENTS LLC, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-254 -6920
Inspection Request Scheduled For: Date: 1/W2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 07954G01 971.583 -4082 N
Corrections /Comments/ Instructions:
r
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: F -9. (4 Phone #: (503) 718 - IAA__