Permit - 4 CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00338
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/10/2008
PARCEL: 2S 101 DB -00801
SITE ADDRESS: 13383 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 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 503.246.669• = X0.332.2344.
Issued By: Permittee Signature: ' -.cTS m._
//J i .
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.
. • • RECEIVED
Electrical Permit ApplicatiojEC 0 92008 FORO>"FICE USE ONLY
clty Of T►gard
4 3125 S W Wa41 131vc1 Tiga F TIGARD _ = � VIW: •
• Phone: 503 .639.4171 pa � ( Other Pcnnit:
TIGARD Inspection Line: 503.639.4 1�u L DMG DIVISION Dote Ready /By: ® See rage 2 for
Internet: www.tigard.or.gov Nulificd /Mcthad: FIR MI Supplemental Information
TYPE OF WORK ' PLAN REVIEW
❑ New construction 01 Addition / alteration /replacement Please check all that apply (submit b sets M plans w /item, chrrked belowp.
❑ Service or !ceder 400 amps or more ❑ Ouilding over Ilium stories.
❑ Demolition ❑ other
wit= the Availa l u dt coistot ❑ ,4lnrinas mut boat
• - CATEGORY OF CONSTRUCTION . exceeds 10,000 amps at 150 walls or ❑ Bloating buildings.
kiss to ground. or exceeds 14.0(10 ❑ Commercial agricalwral
❑ 1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps rornal ether installations. buildings.
o Mufti - family ❑ Master builder El other: ❑ Pitepump. ❑ Installation of75KVAot
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION
• ❑ Addition nl new motor load of ❑ •. A" "G • ' �'• "I C'
Job no.: Job site address: 13383 SW 72ND AVE. IOUHPurmom. occupancy.
❑ Six or more residential units. ❑ Recreational vchic le parks.
City /Slate /ZIP: TIGARD, OR 97223 ❑ Health -taro laciliiics. ❑ Supply volmgc fm more than
❑ Hazardous locations. (,00 volts nominal.
Suite /bldg. /apt. no.: A-J Project name: HAMPTON RIDGE ❑ Service or feeder 600 amps or mom.
FEE SCHEDULE '
Cross street /directions to job site: ncncrtpneu, 1 Qty. 1 Fee. 1 Tow 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no. 1.000 sq. II. or less 145.15 4
Ea. add'I 500 sq. fl. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OP WORK (witltalwveaq.
INSTALL FIBER OPTICS FOR VERIZON Limited energy, m°)`i'lsn ly 75.00 2
I'CSIdCltllnl (win, alx,ve s IL)
Services or feeders installation, alteration, and /or Nlucatinn
200 amps or Icss 80.30 _......._ -._ 2
•
• ❑ PROPERTY OWNER I - . 0 TENANT - 201 amps to 400 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 amps or less 66.85 1
Owner installation: This installation is being tnadc on property that 1 own which is nut 201 amps in 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 . 2
— Drandi circuits - new, alteration, ur extension, er panel
Owner signature: _._ --. _____._._Date: ___...._. A. Fcc for brunch circuits with
0 APPLICANT - I Q+ CONTACT PERSON above service or fccdcr fcc,
6.65 2
each hr;uteh circuit
Business name: NORTH SKY COMMUNICATIONS, INC. 13. Fcc for branch circuits
RY AN ROBE f i rdr m u s c h c i co • lctxl cr fe c,
Contact 2
coct name: 46.85 lira brunch circuit _
Address: 118 SE MILL PLAIN BLVD STE. 410 Each add'l branch circuit 6.65 2
Miscellaneous (service or fccdcr not included)
City /Stale/ZIP: VANCOUVER, WA 98684 Gach manuflchncd or modular
90.90 2
Phone: (503 ) 519 -5264 Fax:: ( )1 866 - 905 -4907 Rcco Ittec o t 111y c and/or fccdcr 66.85 2
E -mail: mduar(&.northskvcomm.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign Or outline lighting 53.40 2
Signal cireuit(s) or li mitcd-
Businessname: NORTH SKY COMMUNICATIONS, INC. energy 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 inspection 62.50
Phone: (360) 254 -6920 Fax: ( ) 1- 866 - 530 -4325 Investigation per hoot (1 hr min) 62.50
CCB Lic.: 14117 Elcccrical Lic.17 -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):
Date: Print mane: JACK CAGLE 12 -9 -08
Slate surcharge (12* of permit ice): $9.00
Authorized signature: /"� 1'h} TOTAL PERMIT FEE: $84.00
Print name: Date: 12 -9 -08 Is p ermit application expires if a permit is not obtained within 1110
ETHON A. DOLPH allyS diet' il has been accepted ascomplete.
" Number of IIUpeclions allowed lx:r permit.
1: nluadinsObnutdla.C•permsApp.dne 05/!3106 441-4013r(t In15MCOMAVn1I
CITY OF TIGARD
BUILDING DIVISION PERMIT #: I LR2008
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/10/2008
Phone: (503) 639 -4171 I
Inspection Requests (24 Hrs.): (503) 639 -4175 .. F__..
INSPECTION WORKSHEET FOR DATE: 1/14/2009 TIME: 7:0l AM1 PAGE: 22
SITE ADDRESS: 13383 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- 54-6920
Inspection Request Scheduled For: Date: 1/14/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 079686 -03 971 -563 -4082 N
Corrections /Comments /Instructions:
v
N ___
■
[\ PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
" ❑FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED C)I Inspector: G--■ ," te Date: I " 1 L i,' Phone #: (503) 718- 1144