Permit ' CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I ~ N
COMMUNITY DEVELOPMENT Permit #: ELR2009-00242
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/04/2009
Parcel: 1 S 135 DD03300
Jurisdiction: Tigard
Site address: 11555 SW 88TH AVE 17
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 throigh OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
l
Issued By: 0 �L 1 1 Q J \QjJj l J Permittee Signature: 0 D
P-
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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REC
Electrical Permit Application JUL 2 9 2009 aornd, IISEONLY
City of Tigard CITY OF TIG t ,•.• YMI
11
'' 11125 SW Wall Blvd., Tibard. OR 9722 � 3 ��p D �� C Y � ' ��� 1
Ihoner 503.639.4171 Pax: so3.59R.lvbtBIj L iNG DatMOy: OihcrPermit:
TIGARD impel/on Line: 503.639.4115 Uate Ready /ny: i ric l 1 0 SaoPagc2
w
Internet: ww,tignld -or. ;Iry NunneorMethwL Su l damrnlul larormntltru
;'' ' . TYPE OP WORK ".., --- , .. I PLAN REVIEW.' . ". .. . •
❑ New conshuGion - 11 AdditIO11 /nlleralio JrepinccmGiI Nleascchock: dtlhatRN tly (Subntit2sectnl ' plus wfitemscixrkedtxiluw):
I SGrvhro or feeder 450 now or ante 0 OulltlinI owe ilu ostoics,
❑ Uptlt011t11)It L1 Other:
r whore IIio:naitahlc Wilt cancan ❑ Manors and t un yams,
•: , CATR(:ORY•OF:CONS"I'ItUC'I'ION •, mcvds10,(100 amps I ISO volts or ❑FlnaHnybuiWinps,
CI - and 2-family dwelling COmntClCiAI /ihdUSlrinl • Ic +t to yrwnd. oroucucdv 14,000 ❑ Cuuunordalawe agdcuhnral
❑ 0 mops tin tll other Installations. buildings,
o Multi-family 0 Master builder Q Other: 0 Pirc pump. ❑ In>ranutiun aP KVAar
;�;`. ?? SOD s1TR INFORMATION AND LOCATION : ,r' :' [ICnrctgetaysystonL brgar separately durivedviler%
i7A,Wtti„,7,. t n tanor fiadol C7"A".,1 ..,.3 ",•`t•3.•,
Jobno,: I Job due address: 11555 SW 88TH AVE 1001.1P or moo, ko.vT'err`y.
° Six or uwre residential amts, 0 Rlomulions1 velklo parts.
City /State/ZIP: TIGARD, OR 97223 CI Hcallh•caroracititics. 0 Supplyveaagcforwowthat
• L I NaxarJmn InuatiOnl. 400 vans nominal.
Suite/bldg, /apt. no, 17 -26 I Project name: PARK PLACE 0Servuoor ono ormore.
Crops xttect/direclitnnsrojobsite: �.._.,. ' :.1.:.,. '" ` '� "• •'Far•SCIIEDULE •
t)v u wr,a I 919. I sae. I ' idol
Now residential single- or multi - fancily dwelling null
Includes attached garage.
Sululi vision: • I Lot no.: 1.001) CO. 11. or Is 145.15 4
Tax nntp /parcel uo.; ' la. Mir! 500 uq. n. or portion 33,40 I
• 1,tmitcd cnerSy, lcndmuini 75,00 2
DESCRIPTION Or WORK ' (with inane eq. It.)
INSTALL FIBER OPTICS FOR VERIZON Liutircd cltorsy,mohi- hua;ty 75 2 .
revidcntial (woohmu� n,)
Services or feeders inalalintlon,alteratlon, and/or roloca tlen
200 amps or less 80.30 2
'•0 PROP) RTY'OWNER ...1 :,. .. '13 TENANT 201 amps to400antps 106.85 2
Name: 401 maps to 600 amps ..._ .._ 160.60 2.
-- 601 amps to 1, maps 240.60 2
Address: Over 1,009 limps or volts 454.65 _ 2
City /State/ZIP: Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( ) Pax: ( ) 200 amps or less 66.85 I
Owner Installation: This installation is being made on property that I own which is not 201 amiss to 400 amps 100.30 2
intended for sate, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 nom . 13175 2
fitvnch ch' cults - new, tdteration, or macitsion, per panel
Owner signature: c: __ pate:
A.Ice for branch circuits Writ
• • : : ' "• • ' ❑ APPLICANT ' ': • •' : :,.I ' • ,r(", CONTACT PERSON ' above Service or lecder Teo. 645 2 •
Business name: each branch circuit
NORTH SKY COMMUNICATIONS, INC. n. Fee for branch circuits
Contact name: ERIK SCHENCK wood scrviccorfccdcrfee. 46.85 2
..— •-. .__
first branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Iinchadd'I 3
Minch 6.65 ��—
Miseellanecus (terrier, or feeder list it
City /Statc/ZIP; VANCOUVER, WA 98684 such munufactu or modular
f dwdli smoke and /or feeder 90,90 2
PhOnut (503) 969 -7729 1 sax:: (866 1 452 -4863 Acconncct only 66.85 2
G•mail: dui aC7.nar#hsk Pump or irrigation circle 53.40 _ 2
• - CONTRACTOR • ' • - ' • Sign or outline lighting 53.40 2
Business name: NORTH SKY COMMUNICATIONS, INC. Signal c;rcuit(s) or limited-
, energy panel, alteration, or
Address: 11818 SE MILL PLAIN STE 410 extension. Describe: 1 Page 2 $75.00 2
City /State/ZIP: VANCOUVER, WA 98684 Erich additional Inspection over allowable In any of the above '
( 360)
Phone: I Fax: ( ) 1 -866- 53 0.4325 Per inspection 62.50
254 -6920 Iltvcsligminn per hour (I nrmho 6350
CCB Lic.: 14117 I Electrical L -154CL : Suprv, Lie.: 173LEB Industrial plant palms. 73,73 '
/ •• •:' • .• • ' '' •• •'ELECTRICAL PERMIT PEPS ... :..... .
Suprv. Electrician signature, requited: , Subtotal: $75.OQ
Print dalrn:: JACK CAGLE Datc: 7/29/09 Plan review (25% of permit foe):
State snreIIa (12 of pennit fee): $9.00
Authorheod signature: SI' ,e /f ~ . TOTAL PERMIT P108; $$4.00
Print name: ETHAN A. DQLPH Date: 7 /29/09 This peradt uppticntluu osplres If a moth is not obtained WithIII ig0
dnyc after it t a u brim nctcitted tor wutpteto,
• number of tnspc IIuns oilmen (or Peril/,
Inanenguor mitM1,0P,rnr4,tpp.,rur 440 46I'IY1'rwCOstA in