Permit il
N CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 -00349
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/18/2008
PARCEL: 1 S135CD -00900
SITE ADDRESS: 11505 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: 11505, 11507 & 11509.
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 12/18/200E $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.
. I I '
Issued By: `_ a t • • , ` I . A ! A.4. Permittee Signature: _ • 0 AtitJ , as 4 _i A •
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.
r r
Electrical Permit A fleet' �` : >' FOR OFFICE USE ONLY
• City of 'Tigard A ` i � QU
l d Received
5 D ate /1)': // og e c— " N d,. : .ag -e-a3
Ili q 13125 SW Halt Blvd., Tigard R 223 ( 1 y �'
_ • • Phone: 503.639.4171 Fax: 503.598. I9 (. O oiler Permit:
TIGARD Inspection Lino: 503.639.4175 F� T r iliA A Tuc Rcadylay; ions: / / (L j II See Page 2for
Internet: www.tigard- or.gov `' 0 Nn ed /Met ui 7 Supplemcntnl Informat
TYPE Oh' — a PLAN REVIEW
0 New construction 171 Addition /alter *s 1 )IaCCITTettt Pirrse check all that apply (submit 2 sets of plans w /iteuto checked below).
VVV ���"' ❑ Service or feeder Jon amps or more ❑ Building over throe stories.
El Demolition ❑ Other: whets t1a available Loh current 0 Marinas and hnmynrds.
. CATEGORY OF CONSTRUCTION cxcecds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground. or exceeds 14,000 0 Cosintercia•usc agticofturd
❑ I - and 2- fatally dwelling ❑ Cnminercialli nduslrial ❑ Accessory building ;antis ror all °diet inai, tI i ens. buildings.
0 Multi - family ❑ Master builder El Other: ❑ Fire pump. 0 h
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived sy.item.
❑ Addition o f now motor load of ❑ ^p" ° °I -�' ^t. }.
Joh) no.: Job site address: 11511 SW 98TH AVE. 100HP occupancy.
❑ Six or more reidonti;d unit +. ❑ Rccrealioonl vehicle parks.
City /State /ZIP: TIGARD, OR 97223 ❑ Healih -care litanies. ❑ Supply voltage for more than
0 Haraaduus toc;nions. 600 volts nominal.
Suite /bldg./apt, no., rises noou.oaos Project name: GLACIER LILY ❑ se 'vico Of recd°' 600 amps or one.
FEE SCHEDULE '
Cross street /directions to job site: nesorli tlon I 0110 1 Pea I 9'0r01
j �5� 5t) �� 5 New residential single -or multi - family dwelling unit.
1 U cf Includes attached garage.
Subdivision: Lot no.: 1.000 sq. P. or less 145.15 4
-- En. mdd'1 500 sq. ft. or portion 33.40 I
Tax map/parcel no.: —
Limited energy, residential
DESCRIPTION OF WORK Co nth ;dove sq. ft.)
75.00 2
INSTALL FIBER OPTICS FOR VERIZON Limited energy, multi-family
above f`a'nny 75.00 2
residential (with alwvd; so. CO
Services or feeders installation, alteration, and /or relocation
I 200 amps or less 80.30 2
❑ PROPERTY OWNER ' l.. ❑ TENANT ' 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60
Address: 601 amps to 1,000 amps 240.60 2
Over 1,000 amps or volts 454.65 I 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 antes to 400 amps 100.3(1 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 ..
Branch circuits - new, alteration, or extension, per panel
Owner signature:_ Date: _.__�
-- -- A. Fee for branch circuits with
❑ APPLICANT O CONTACT PERSON above service or feeder fee,
each branch circuit 6.65
Business name: NORTH SKY COMMUNICATIONS, INC. B. Fee for branch eh cults
Contact name: without service or feeder fee,
RYAN ROBERTS 46.85 2
ling branch circuit
Address: 11818 SE MILL PLAIN BLVD STE, 410 Each odd'! branch circuit I 6.65 2
Miscellaneous (service or feeder net included)
City/State/ZIP: VANCOUVER, WA 98684 Each manufactured or modular
dwelling. service and /or feeder 90'90 2
Phone: (503 ) 519 -5264 Fax: : ( )1 - 866- 905 -4907 Reconnect only I 66.85 1 2
E -mail: rnduorannorthskvcomm.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 1 2
Business name: NORTH SKY COMMUNICATIONS INC, energy cir nel,alteration, COMMUNICATIONS, 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 hrmin) 62.50
CCB Lie.: 14117 Electrical Lic.17 -154CL Suprv. Lic.: 1 73LEB Indastrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtwdtl: $75.00
Print name: JACK CAGLE Dale: 12 -16 -08 Plan review (25% of permit fee):
Slate surcharge (12% of permit fee): $9.00
Authorized signature: ! TOTAL PERMIT 1,13.1:: $84.00
1,T ____
Print name: ETHON A. DOLPH 1 -1 - Th p ernil applicaliott expires if a permit i6 not obtained within ,so
Date: days after it has been accepted as complete.
0 Number of inspections allowed! Per permit.
I :Vluildingibn ins\Id-C•Pcrmil, \pp.dnc 0923rfs .140 4515'r/ l I /OS/CObf/\Vlin
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CITY ��N�~�� ���� �~U���������
OF mmn�m������
BUILDING DIVISION PERMIT ~°"�"~~"~~"" : ELR2O08003119
13125 SW Hall Blvd., Tigar . OR 97223 DATE ISSUED: vi 0200a
Phone: (503) 639-4171
Inspection Requea��4Hm.):(SD3)63A`4175 . /
INSPECTION WORKSHEET FOR DATE: 1/6/2009 TIME: 7:O0Ah4 PAGE: 19
SITE ADDRESS CLASS 1 WORK:
SUBDIVISION: GLACIER LILY APARTMEN1S LOT #: TYPE OF USE:
PROJECT NAME: GLACIER LILLY APARTMENTS
DESCRIPTION: Install fiber optics for Vmrizon. Thio is for units:
OWNER: SHARON DEVELOPMENT CO, Lie, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-254'6930
Inspection Request Scheduled For: Date: 1/6V2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 079407-10 503-583-4083 N
Corrections/Comments/Instructions:
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g PASS PARTIAL APPROVAL 0 CANCEL II NO ACCESS '
FAIL 0 CALL FOR INSPECTION [1] ADDITIONAL FEES ASSESSED
�� ����� 1 '104 � iw°
|na�goInspector: ��' /V`���0��4� Date: » �� � Phone #: /6O3)718' ��0�9
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