Permit al
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00350
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/18/2008
PARCEL: 1 S135CD -00900
SITE ADDRESS: 11511 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: 11511, 11513 & 11515.
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 12/18/200€ $75.00
[TAX] 12% State Surch 12/18/200€ $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 50 .246.6699 or 1.800.332.2344.
•
Issued By: m Q„ �AW Permittee Signature: R Q 0 CA J"a1\
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 ,� FOR OFFICE USE ONLY
Cit of Ti and ace' d
Y / d G8
$ �� D aalny: /� f ✓ ei(4eV
Permit No . 9 ' d P
lir 13125 SW Hall Blvd., Tigard, OR 97 a Plan Review
Phone: 503.639.4171 Fax: 503.598. �QQ patc/By: other Penns:
TIGARD
Inspection Line: 503.639,4175 • � jy • Ready /By: loco: it See Page 2 for
Internet: www.tigard- or.gov i'
V ® ��,� M dlMdltud: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New Construction 171 Atklition /alteratio el m '41 P10ase cheek all that apply (suMmit 2 sou amens wlitoms clucked below):
Q Service or feeder 400 amps or more ❑ Building over t stories.
El Demolition d Other: where the available lank cumin ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 maps at ISO volts or O Floating buikl(ngs.
loss to ground, or exceeds 14.0(0 ❑ Coamterekd - use agrieldi rat
I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
12 Multi - family ❑ Master builder ❑ Other: : Once pun 0 Installation of 75 KVA ur•
JOB SITS. INFORMATION AND LOCATION C7 Pmcrgeucy system. larger separately derived systoo
0 Additkai of new mow toad of
❑ -A" 'p" 1.3 "I - ",
Job no.: I Job site address: 11511 SW 98T1-1 AVE. cHPormote. occupancy.
0 Six or more residential unite. ❑ Ramwtkmal vehicle parks.
City /State /ZiP: TIGARD, OR 97223 0 Hcatih- c.re!Italics. 0 Supply vohage for more than
_ Q Haxanlons locations. 6110 volts nominal.
Suite /bldg. /apt. no.: nsrt.nsw.nsys Project name: GLACIER LILY OScrviec or feetice 500 amps or mote.
FEE SCHEDUL ' .
Cross street /directions to job site: ne.cdpaau I Ote. I P. I '1111_ I
I New residential single- or multi- family dwelling unit.
_ —. . Includes attached garage,
Subdivision: Lot no.: 1,000 sq. ft. or loss 145.15 4
Ea. add' 1 500 sq. ft. or portion 33.40 1
Tax Wrap /parcel no.: Limited energy, residential
75.(X) 2
DESCRIPTION OF WORK (with above sq. ft.)
Lii energy, multi -family 7500 2
INSTALL FIBER OPTICS FOR VERIZON
tnsidemtial (with above MI, IQ
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER • I - 0 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 less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.3(1 2
intended for sale, lease, rent, or exchange, according to ORS 447, 419, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: _ Date: Branch circuits - new, alteration, or extension, par panel
APPLICANT
[] A. Fee for branch circuits with
[/ - CONTACT PERSON above service or feeder foe. 6.65 2
each branch circuit
Buaiiness name: NORTH SKY COMMUNICATIONS, INC. B. Fee for branch circuits
Contact name: RYAN ROBERTS without service or feeder fee,
46,85 2
first branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP: VANCOUVER, WA 98684 Each manufactured or modular -
dwelling, service and/or feeder 90.90 2
r
Phone: (503 ) 519 -5264 I Fax: : ( )1 866 - 905 - 4907 Reconnect only 66.85 2
E -mail: mduorlutr�northskvcomm.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
r Signal citcuit(s) or limited-
Business name:
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
F ax; ( ) 1 866 -530 -4325
Phone: ( 360) 254 -6920 Investigation per hour (I hr min) 62.50
CCB Lic.: 14117 Electrical Lic.17 154CL: Suprv. t.ic.: 173LEB industrial plaza per hour 73.75 _
ELECTRICAL PERMIT FEES
Suprv. Electrician 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): $9
Authorized signature:
de TOTAL PERMIT crass $84,00
This permit application expires if a permit is not obtained within 180
Print name: ETHON A. DOLPH , Date, 12 -16 -08 l days Mier II has liven invented as complete.
Number of inspections allowed per permit.
lA nvillingWermiis11 11,C- PerarhApp.dnc 0931/06 44046 I 3'I'(flraticostAvan
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR 2008- 00%0
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/ 020013
Phone: (503) 639-4171 AA,
r ..iii
Inspection Requests (24 Hrs.): (503) 639-4175 ,..1
INSPECTION WORKSHEET FOR DATE: 1/&2009 TIME: 7 PAGE: 18
SITE ADDRESS: 'I 1611 SW 98TH AVE CLASS OF WORK:
SUBDIVISION: GLACIEI LILY APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: GLACIER LILLY APARTMENTS - - ---- ---
DESCRIPTION: Install fiber optics for Verizon. This is for units: - -. -. -
OWNER: SHARON DEVELOPMENT CO, LI.C, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-254-6920
. .
Inspection Request Scheduled For: Date: •/6/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
136 Low voltage 079407 503-563-4082 N
Corrections/Comments/Instructions:
Q.
• Q?
0 PASS 0 PARTIAL APPROVAL 0 CANCEL Li NO ACCESS
0 FAIL E CALL FOR INSPECTION E ADDITIONAL FEES ASSESSED
Inspector: G it\) Date: 1 ' *6 ' Phone #: (503) 718- /44