Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
P
2 , COMMUNITY DEVELOPMENT Permit #: ELR2009 -00244
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/04/2009
Parcel: 1 S 135DD03300
Jurisdiction: Tigard
Site address: 11555 SW 88TH AVE 37
Subdivision: PARK PLACE GARDEN APARTMENTS Lot: 0
Project: Park Place
Project Description: Install fiber optics for Verizon.
Owner: FEES
1616 SHORELINE LLC & Description Date Amount
LOMITA WEST LP, PO BOX 15516 Restricted Energy Permit 07/31/2009 $75.00
FREMONT, CA 94539 12% State Surcharge - Electrical 07/31/2009 $9.00
PHONE:
Contractor:
PHONE:
FAX:
Type of Use: MF
Class of Work: ALT
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 coJ of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Q C A (IQ ' Perm ittee Signature: '
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' 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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Electrical PermitAuuiictxfior{ �� - (19 -: FOR0141CM USE ONLY : •'` < ;
City of 'I't and \ � QF V \ S c L
�,`
' 13125 SW nail Blvd., Tigard, OR 97221 1.-1 tit rt`t Q \ ate/ ily: PC(
Review 2C ( '
g Flume: 503.639.417t Fox; 503.59R.196V p °mar Pm*:
7.1GARD Inspection Limn $03 630.4175 Vv Data Ready/ny: e Jade R1 Sec Fop Zfor
(Mental: www.tigard -orgov Nwinetunied rxl: 4/_r ( Supplemental Inrnrmatiws
■.. • TYPE 01 WORK'",.. '-•";'! 1 ; : PLAN REVIEW. ''∎::';::. ... . . •
D New I7 Addition/alteration/replacement • Nenec Inch ; dI tint lbtply( sulutdt 2 sort M'Idae% Wheats cheatel tcluw):
0 UCm011dO11 ()tiler: rA Semite or feeder 400 amps or mom CI aalhtittg over eueo A1040%. ...,r• Dt it O l wood: tie available nosh currant 0 ,V1nrw.:unl bums Ws.
• %w • i •r. , •:•,:: , CATEGORY •Or :CONS'1'KU( 11ON mews 10,000:mrps at on wilts or a (dialing bulldiogs•
I - - and 2 - falnil dwelih) loss to mood or exceeds 14.000 O Coanvacrd•uso acilcuhural
d y g ❑ Commercial /industrial 0 Accessory building amps Wall other Instnihnio f. buildings.
ri Multi- fancily 0 Master builder p Other: O Pite mom. 0 (nctiletiuu of 75 KVA or
•
SOD SITE • INFORMATION AND LOCATION `a :' ❑ Emergency system. lancer sepetutely derived syn em. • O Additieh,nr new moor lexd d "A ", ° l's ",' ", "1.3
Job no.: slob site address: 11555 SW 88TH AVE IINNe Of naro. uceupancy.
Q Sis or more tcshkntkd unim 0 Reon:miotal vehicle pads.
City/Stale/ZIP: TIGARD, OR 97223 ❑Heaah•carc radiates. 0 Supply voltage far more titan
Ito, 37 - 48 ❑ Ha<a dons locations, GOO wits nominal.
Suite/bldg./apt. j Project name PARK PLACE ❑ Service of feeder 600 taps or more
Cress street /directions to job Nile: " FEE 'SCHEDULE
Onerbnl s, I ¢te. I Pow I '15nnt 1 r
Now residential Angle- or nndtt•fnntify dwelling troll,
Inciudes attached garage.
Subdivision: Lot no.: 1,000 sq. R. or Iota 145.15 4
Tax clap /parcel uo.: En. adrl'( 500 sq. lt. or portion 33.4(3 I
W - Limited ouorgy, rroldontini 75.00 2
DE'tL.RIP'fION OF WORK ' (whit slave xq• li.)
INSTALL FIBER OPTICS FOR VERIZON Liu litcdctloryy,meld•I'nnrily
residential (withnewesq.ft.) 7S ' � t 2
Services or feeders inniallnt(on and/or reinc4104n
200 amps or less 80.30 2
: :: 'In PROPERTY:OWNER .:.I :. ' -.. la TENANT . 201 amps to 400 amps _ 106.85 2
Name: 401 Amps to 600 amps 160.60 2
601 mops to 1,000 turps 240.60 2
Address: Over 1,000 amps or volts 4$4.65 2
City /Scale/ZIP: Temporary services or feeders Installation, alteration, and /or
relocation
Phone: ( ) Fox: ( ) 200 amps or lest Eli 66.85 MIN 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 2
intended for sate, lease, rent, or exchange. according to ORS 447, 449, 670. and 701. 401 tmtps to 599 amps 133.75 2
Ownersigaature: Date: 8rnach circuits - new extension, par panel
' 0 AP NIACANT ' A. ire for branch r fe f • ; ' : •' . .:.'j . ` (7 'CONTACT PERSON ' above service or feeder teen 645 2 •
each brooch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. D.Fce for branch cheviot '
COntnctname: ERIK SCHENCK witbout service or feeder fee, 4685 2
lint branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each WW1 brunch circuit 6,65 — I 2
MiseNlanaous (service or feeder not included)
City/Statc/ZiP: VANCOUVER, WA 98684 Each murutRtccurad or modeler
dwelling, service and/or fecdcr 90.90 ?
Phone: (603 ) 969 - 7729 I Pax:: ( 452 4853 Recamcct only 66.85 2
E-mail: in L491 Pump or initiation circle 53.40 2
CONTRACTOR � ' Sign oar outline lighting 53.40 2
Business name: Signal cireulc(x)or!baited•
NORTH SKY COMMUNICATIONS, INC. energy pond alteration. ur
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension, Describe: 1 ra 2 $75.00 2
/Stele/ZIP: l
City/Stele/ZIP: y VANCOUVER, W A 98684 Each additional Inspection over allowable in any of the above
Phone: (360) 254 -6920 ( Fax: ( ) 1-866-530-4325 Yen inspection 62.50
IuvasligOdrnl per hoop n u min) r 62.S0
CCB Lit:,: 14117 I Electrical Lic.17 -154CL Suprv, Lie.: 173LEB Industrial ptrmt per hour 73,95
•••• • • . ...ELECTRICAL PERMIT FEES '•••" •• •
Suprv. Electrician signature, requited: Subwlxir $75.00
Print name: JACK CAGLE Date: 7/29/09 Phut review (23% of permit fao):
State surcharge (1256 of permit fee): $9,00
Authorized signature: , / $84,00
TOTAL PERMIT PEE:
Print mime: ETHAN A. DOL PH Date: 7/29/09 'Ills locndt application oxplres if is swath Is not obtained within WO
days after n hex been nominal as cumptek.
Nwnlxlr or lnspecllwrs allowed perpcnnll.
l: tan.anfnutJ'rltu5451.C•Pamtltapr .tae ovawd 4111 J61S1Yt 1 /10.CYk..V,y(n