Permit Ill - n CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00346
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/18/2008
PARCEL: 1 S 135CD -00900
SITE ADDRESS: 11491 SW 98TH AVE ZONING: R -12
SUBDIVISION: GLACIER LILY APARTMENTS LOT: JURISDICTION: TIG
PROJECT: GLACIER LILLY APARTMENTS
Project Description: Install fiber optics for Verizon. This is for units: 11489 & 11491.
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
FEES Reg #: ELE 17- 154CLE
LIC 14117
Description Date Amount
[ELPRMT] ELR Permit 12/18/200E $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: p Permittee Signature: sat2 Q may���"
( }(� Q 3i r
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OWNER INSTALLATION ONLY "' `y � {. ��� v`
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 V lk FOR OFFICE US E ONLY
City Received of Tigard
n Plt u
t 13125 SW Hall 131ud., Tigard, OR 9 OQp
E
�' � Phone: 503.639.4171 Fax: 503.59 .19 0 �_ 1 � /0 r. iew /i2 /4* 44 PcrmuNo.: E q 003 3 Other Permit:
InspeclionLine, 503.639.4175 �''+ sZR )nu ' See Jo s 2for 4.
Internet: www.tiglyd- or.gav � ,t r l '7 (C /. ® Supplemental Information
Al ` _ , r
TYPE OF WORI�,�\ Q� /ZV PLAN REVIEW
❑ New c011Slrfu(lon 0l Additio11 /alterattol� . Please clock; all that apply (submit 2 sets Of plans whims clucked below):
❑ Service or (ceder 4u° amps or Move ❑ Ilnitding Over Ihlae stories.
❑ Demolition ❑ Other: where the available Paull current ❑ MerisIZIS and boatyards.
- CATEGORY OF CONSTRUCTION • exceeds 10,000 amps at 150 volts or ❑ ('tenting buildings.
less to ground, or exceeds 14,000 ❑ Commercial -lee agricultural
pi- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps Far an other humiliations. s. buildings.
0 Multi - family ❑ Master builder ❑Other: - ❑ Fire pump. 0 Enstalladunof75KVA
JOB SITE INFORMATION AND LOCATION - El Energoncy system. tarp». separately derived system. • ❑ Addition or new motor load or ❑ "A" "fi" "I - ?" 'Y •t'
Job no,: Job site address: 11511 SW 98TH AVE. 10° r more r 's. R e s afa'tey.
❑ Six or more rCSitlCntial units. ❑ ttecmalional vehicle parks.
City/State /ZIP: TIGARD, OR 97223 ❑ Health -care facililics, ❑ Simply voltage for more than
❑ Hazardous locations. (1)0 sobs nominal.
Suite /bldg. /apt. no.: 11489,11491 Project name: GLACIER LILY ❑ Se•i(..e or feeder 000 ;uups or mere.
FEE SCHEDULE
Cross street /directions to job site: Description I Oro. I see. I Total I . '
I:1 r � 019 r New residential single- or multi- family dwelling unit.
Includes attached gauge,
Subdivision: Lot no.: 1,000 sq. ft. or Tess 145.13 4
00, add') 500 sq. R. or portion 33.40 1
Tax map /parcel no.:
Limited energy, residential
75,00 2
DESCRIPTION OF WORK (withal m: su. it.)
INSTALL FIBER OPTICS FOR VERIZON LidnIltdenel'gy , l "mti- Illnily 7500 2
residential (with above sq. rt.)
Services or feeders installation, alteration, and/or relocatio
200 amps or less 80.30 2
❑ PROPERTY OWNER ' ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
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 [cps 66.85 l
Owner installation: This installation is being made on property that I own which is not 201 amps 10 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 snipe t 133.75 2
[ branch circuits - new, alteration, or extension, er patiet
Owner signature; _-_._ ._...._.....,Date:., -- A. Fee for branch circuits with
❑ APPLICANT 0 CONTACT PERSON above service or feeder fcc, 6.65 2
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. B. Fee for britoclt circuits
Contact name: RYAN ROBERTS fir st b circuit ui feeder fee, 46.85 2
first brunch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each add'I branch circuit — 6,65 2
Miscellaneous (service or feeder not included)
City/Stale /ZIP: VANCOUVER, WA 98684 Each manufactured or modular 1
90,90 2
dwelling, service and /or feeder
Phone: (503 ) 519 -5264 Fax: : ( )1 - 866- 905 -4907 Reconnect onl 66.85 i 2
E-mail: mduorcni-northskvcomm.com Pump or irrigation circle 53.401 2
CONTRACTOR Sign or outline lighting 53.40 2
Business Menlo! Signal circuits) or limited-
1
NORTH SKY COMMUNICATIONS, INC. energy panel, alteration, 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
Phone: ( 360) 254 -6920 Fax: ( ) 1 -866- 530 -4325 investigation per hour (I hr min) �. 62.50
CCR l ' ie '' 14117 Electrical Lie- 1 -154CL Suprv, Lie.: 173LEB Induslt'ial plant per hour 71.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required:
Subtotal. $75.00
Print name: JACK EAGLE Date: Plan review (25% of permit fee):
12 -16 -08 Slate surcharge (12% of permit fee): $9.00
Authorized signature: �.. 1e 0,. _ TOTAL pGE2tvlft' ITC: $84.00
This p ermit a expires it a purmil is not obtained within 180
Print name: ETHON A, DOLPH Da te; 12 -16 - 08 days after it has been accepted an complete.
" Number of inspecl alloaverl per permit.
lnl lsiblieencnnirOl il.C- PemitApp.dne 05 /1006 .Wtl•461 1•(I IH15 /COMA48a
CITY OF TIGARD
i3UIL ®IIVG DIVISION PERMIT #: EI 82008 -0OW
- 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 12/18/2008
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 ._.! F'L L..
INSPECTION WORKSHEET FOR DATE: 1/6/2009 TIME: 7 :OOAM PAGE: 22
SITE ADDRESS: 11491 SW 98TH AVE CLASS OF WORK:
SUBDIVISION: GLACIER LILY APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: GLACIER LILLY APARTMENTS
DESCRIPTION: �; is .,�... 9. ,ti'
In.,tall libel Optic. for Veri;e�an. This i. for units: �1r��= 1 "��,31�
OWNER: SHARON DEVELOPMENT CO, LLC, PHONE #:
CONTRACTOR: NUft'H SKY COMMUNICATIONS INC PHONE #: 360 -254 -6920
Inspection Request Scheduled For: Date: 1/6/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
136 Low voltage 079407 -07 503563082 N
Corrections /Comments /Instructions:
yi PASS _ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: N v W Date: t ' 1 ! Phone #: (503) 718- 3-Aq_t_
CIDV-OFTIGARD
gUILDING DIVISION
PERMIT #: ELR1008.00346
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/18/2008
Phone: (503) 639-4171 z aftig/00O n
Inspection Requests (24 Hrs.): (503) 639-4175 ,d4A11.,
INSPECTION WORKSHEET FOR DATE: '12/19/2008 TIME: 7:00AM PAGE: 9
SITE ADDRESS: 11491 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 is for units: '11489 & 11491.
OWNER: SHARON DEVELOPMENT CO, LLC, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-254-6920
Inspection Request Scheduled For: Date: 12/19/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 079154-07 503-209-7014
Corrections/Comments/ Instructions:
mi
MI/
•
1 1 PASS PARTIAL APPROVAL ANCEL El NO ACCESS
FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL F ES ASSESSED
e
Inspector: Date: ( 15 Phone #: (503) 718-