Permit •
ill - q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00347
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/18/2008
PARCEL: 1 S135CD -00900
SITE ADDRESS: 11493 SW 98TH AVE ZONING: R -
SUBDIVISION: GLACIER LILY APARTMENTS LOT: JURISDICTION: TIG
PROJECT: GLACIER LILLY APARTMENTS
Project Description: Install fiber optics for Verizon. This is for units: 11493, 11495 & 11467.
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:
SHARON DEVELOPMENT CO, LLC NORTH SKY COMMUNICATIONS INC
5795 SW CRANBERRY CT 11818 SE MILL PLAIN BLVD
BEAVERTON, OR 97007 SUITE 410
VANCOUVER, WA 98687
Phone: Contact #: PRI 360 -254 -6920
FAX 1- 866 -530 -4325
Reg #: ELE 17- 154CLE
FEES LIC 14117
Description Date Amount
[ELPRMT] ELR Permit 12/18/2001 $75.00
[TAX] 12% State Surch 12/18/200E $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: h Q� ( ►! V � � Permittee Signat _ f 0 _ , 0 . ■ (1 0 All
\ \v��'' at
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application 1l'OR OFFICE USE ONLY
City of Tigard " "`i'ed : 8 /A �� o DID
Penne N .;
Date /ny f�2� �
r' 13125 SW Hall Blvd.,Tigard,
Pica arvicw
M
- Phone: 503.639.4171 Fax: 50 li pis I Date /By: Ouor Permit;
TiGARD Inspection Line: 503.639.4175 (r m , e . � );uc Ready/By: /ury ®Sec ['age 2 for
lntenot: www.tigar'd t' led /Method: 470. Supplemental information
• �\ `
TYPE OF VV + � - PLAN REVIEW
1, � Please check all that apply (submit 2 seta of plans w /item. checked below):
• ID New construction Gil A(Idition /attest y` :$
c O Service err (ceder 4W) amps or more ❑ Building over ranee stories.
❑ Demolition ❑ Other: .? where the available fault current ❑ Marinas nut boatyards.
et 4
CATEGORY OF CONY CTION . - exceeds 10,000 amps et 150 volts or ❑ Floating buildings.
less to ground. or exceeds 14,0110 ❑ Commercial.use agrlcohurel
❑ 1 - and 2- family dwelling ❑ Commercial /industrial 0 Accessory huiiding amps for all other insndhnioru. buildings.
17 Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Insi of 75 KVA or
. JOB SITE INFORMATION AND LOCATION [] Curnrgcncysystc »,. larger opeer lcly <tc, ;
- ❑ Addition of new motor load or ❑ "A", "IC' - 1.2 ", "1.3 ",
Job no.: Job site address: 11511 SW 98TH AVE. o IeokP orrnnre. rcupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
Cit y/Stale/ZIP: TIGARD, OR 97223 ❑ Hcullh -curt fhcilitics. ❑ Suppl voha for more than
❑ Hazardous locations. 600 volts nominal.
Su ice /bldg. /apt. no.: 1 Project name: GLACIER LILY ❑ Service of feeder 600 ;mt}x or s
FEE SCHEDULE
Cross street /directions to job site: . mseri I Oiv. I r,r. I 'recd 1 •
New residential single- or multi - family dwelling unit.
// y 3 / / l ; P q 7 Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 — 4
Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map/parcel Ito.:
limited energy, residential
DESCRIPTION OF WORK 75.00 2
(with ;torte sq. rt.)
INSTALL FIBER OPTICS FOR VERIZON
Limited energy, multi -family 7500 2
residential (with above, so. tr.)
Services or feeders installation, alteration, sand /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ' _1_ . 0 TENANT 201 am to 400 am 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 mops 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 l
Owner installation: This installation is being made on property that I 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 amps to 599 amps 133.75 2
Branch circuits - stew, alteration, or extension, pier panel
Owner signahu : --___ ----- Date: -.__ A. Fee for branch circuits with
❑ APPLICANT In CONTACT PERSON above service or feeder fee,
6.65 2
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. B. Fee for branch circuits
Contact name:
RYAN ROBERTS firs br a service c e or feeder fee, 46,85 2
first Sl branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each ddd'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /Slate/ZIP: VANCOUVER, WA 98684 Each manufactured ormodular
90.90
Phone: (503 ) 519 -5264 Fax: : ( ) 1-866-905-4907 i econ sect onlyc and/or feeder 66.85 2 ,
E-mail: mduor Pump or irrigation circle 53.40 2 +
CONTRACTOR Sign or outline lighting 53.40 2
Business name: NORTH SKY COMMUNICATIONS INC. energy anted-
>,_ energy panel alteration, or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Paget $75.00 2
City/Slate /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 mint 62.50
ccn Lie.: 14117 Electrical Lic.17 -154CL Suprv. Lie.: 173LEB industrial plant per hour i _
ELECTRICAL PERMIT FEES
Suprv. Electricians signature, required:
Subtotal. $75.00
Print name: JACK CAGLE Date: Plan review (25% of permit fee):
12 -16 -08 State surcharge (12% of permit fee): $900
Authorized signature: r).. TOTAL PERMIT PEE; $84.00
This permit application expires if a permit is not obtoined within ISO
Print name.: ETHON A. DOLPH Date: 12 -16 -08 days after It tints been ncccpted as complete.
e Number of inspections allowed per permit.
l5 tluitding \l'cr,nitdhil,C•P•r»,it, \pp -dnc 0923106 445.46 141'(11 /1)S /cosrAvu ll
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: ELR2008•00347
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/1812008
Phone: (503) 639-4171 Jritmt 1
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 1/ 6/20 0 9 TIME: 7 PAGE: 21
SITE ADDRESS: 11493 SW 98TH AVE CLASS OF WORK:
SUBDIVISION: GLACIER LILY APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: GLACIER LILLY APARTMENTS
DESCRIPTION: Install fiber optics for Verizon. This k for units: pr493:711:495
OWNER: SHARON DEVELOPMENT CO, LLC, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-254-6920
Inspection Request Scheduled For: Date: 1/6/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 079407-08 503-563-4082 N
Corrections /Comments/ Instructions:
. X PASS fl PARTIAL APPROVAL El CANCEL 0 NO ACCESS
FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: G N68 LC Date: 1 ' 4 ' Phone #: (503) 718- PA
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