Permit IN . CITY OF T I GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00337
TI GARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/10/2008
PARCEL: 25101 DB - 00801
SITE ADDRESS: 13375 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: LANDSCAPEIIRRIGAT:
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 12/10/200E $75.00
[TAX] 12% State Surch 12/10/200E $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.
Issued By: Permittee Signature: 7 /9/r,�,15
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.
RECEIVEP
Electrical Permit Application FOR OFFICE USE;
City of Tigard DEC 0 9 2008 i
'c x: 13125 SW Hall Blvd„ Tigard. OR '4 ' 7
Phone: 503.639.4171 Pax: 503 - 0, Inn Permit: OFTI
TIGARD Inspection tine: 503.6)9.4175 O I Y �SI 0.ue Ready /Uy; ® Si c Page 2 for
Internet: wa'w.tigard- ur.,ov 'Vi Notified /Method: Supplemental Information
TYPE OF WORK PLAN REVIEW • '
❑ New construction I51I Addition /alteration /replacement Pleacc check .4l that apply (submit 2 set: of pla w idens ctu•cked he IOW):
❑ Service or (ceder 400 amps or more ❑ Building over Ihicc Stories.
❑ Deinoliti on ❑ Other: where the available hudt current ❑ 04urinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Hooting buildings.
less to ground. or exceeds 14.090 ❑ Commerci al•IISe agrtcolluoil
❑ I - and 2- family dwelling ❑ Commercialfindustrial ❑ Accessory building maps for;ili other installations. buildings.
Multi-ball' y n Master builder ❑ Oilier: ❑ hire pimp. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately del ived system.
. JOB SITE, INFORMATION AND LOCATION ❑ Addition of new nmtnr load nl'
• Job no.: Job site address: 13375 SW 72ND AVE. WOHPor;nom occupancy.
❑ r
Si Six or me residential units. ❑ Rceicalional vehicle !silks.
City /State /ZIP: TIGARD, OR 97223 ❑ Health -care facilities. ❑ Simply voltage for more titan
❑ H;v.ardaus locations. 600 volts lumina),
Suite /bldg. /apt. no.: A -J Project name: HAMPTON RIDGE ❑Scrvicem feeder 000 ;imps ur lmon:.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Foe. 1 Total I •
New residential single. or multi - fancily dwelling unit,
Includes attached garage.
Subdivision: Lot no.: 1,000 so. ft. or less 145.15 4
Ea. ;WWI 500 sq. ft. or portion 33.40 I
Tax map /parcel no.; Limited energy, residential -_.. —
2
DESCRIPTION OF WORK ' (with above sq. Il.) 75.00
INSTALL FIBER OPTICS FOR VERIZON Limitcde ( multi-family
y 75.00 2 •
residential (winlnlwvcsq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ' . ❑ TENANT 201 amps to 400 amps r 106.85 2
'--...._ _____. I
I
401 amps to 600 afn s 160.60 2
Name:
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 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 :unps 100.30 2
intended for Sale, least, rent, or exchange, according to ORS 447, 449, 670. and 701. 401 amps to 599 amps 133.75 7
Branch circuits - new, alteration, or extension, per panel
Owner signature: - - -___
A. Fee for branch circuits with
❑ APPLICANT .1 O CONTACT PERSON above service or feeder rec., i 6.65
1 each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. B. Fee for branch circuits 1
C
Contact name: RYAN ROBERTS ru m bi., 111C service or feeder fee, 46.85 2
rum bl'iI7 circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each :opt branch circuit 6.65 2
Misceilaneous (.service or feeder not included)
City /State/ZIP: VANCOUVER, WA 98684 Each manufactured or modular 9090 r 2
-.- dwelling. service and/or feeder
Phone: (503 ) 519 -5264 Fax: : ( )1- 866 - 905 -4907 Reconnect only 66.85 2
E - mail: mduoranorthskvcomm.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: NORTH SKY COMMUNICATIONS, INC, Signal citel al or limited-
energy pannel, , ;dlcr:lliun, 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
Phonc: (360) 254 -6920 Fax: ( ) 1- 866- 530 -4325 Investigation per hour 0 hr min, 62.50
CCB 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
J ACK CAGLE Plan review (7S %of permit fee):
Print name: Dale: 1 -9 -08
State surcharge (12% of permit fee): $9.00
Authorized signature: `e h TOTAL PERMIT PEE: $84,00
This peralit application expires if a permit 10 not ohlained within 189
Print name: ETHON A. DOLPH Date: 12 -9 -08 clays after 11 has been accepted as complete.
' Number or inspections allowed per permit.
Tam,it,1;nbv4oni \I7.C•Ponna.vpp, 08 83416 •14(J }'1)111414 /COOUWIi13
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2008-00337
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1i 21/0/2008
Phone: (503) 639 - 4171µ444p , ulll+
Inspection Requests (24 Hrs.): (503) 639 -4175 ■ ,ft,... _ 1
INSPECTION WORKSHEET FOR DATE: 1/14/2009 TIME: 7 :01AM PAGE: 23
SITE ADDRESS: 13376 SW 72ND AVE A 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 -€i920
Inspection Request Scheduled For: Date: 1/14/ 2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final • 07868G -02 971- 6E;3.4082 N
Corrections /Comments /Instructions:
191
[PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
Li FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector:` N\
v Date: Phone #: (503) 718- 246_