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Permit • CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT a COMMUNITY DEVELOPMENT Permit #: ELR2009 -00231 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/31!2009 Parcel: 2S 115AA00100 Jurisdiction: Tigard Site address: 16190 SW 108TH AVE 209 Subdivision: DURHAM PARK APARTMENTS Lot: 36 Project: Brightwaters at Red Hawk Project Description: Install fiber optics for verizon. Owner: FEES DHP TERRACE LLC & Description Date Amount DHP ANNEX LLC, BY AKAWIE & LAPIETRA PC, Restricted Energy Permit 07/30/2009 $75.00 13 HERON DR 12% State Surcharge - Electrical 07/30/2009 $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 through OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246 or 1.800.332.2344. Issued By: .. �, . f (I I I 1 , Permittee Signature: C ° 4 APP - 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. r RECEIVED Electrical Permit Application, G 9 Z� �' ... : ' " FUTt USF. UhLY . . City Tigard •_ ► rr►r., !� ., 13 +25 SW i Blvd., Tigard, OR 47223 OUILDING DIN i . CITY OF i �� i�.e3 ( • c� =, - s I none: 503.639.4171 Fax: 503.598.196 Wm rennin TIGARD inspection Line: 503.639A175 Daln Ready /Hy: . k: 0 co Page 2 Cot !mewl: w,wv.dgnrd- or.gov NudncdIMndnnl: Supplcmcnlnl information TYPE OF WORK P1,AN RfVIBw. 0 New construotion CI Addition /alteration /replacement Pies4chcck ;in <h+u apply (submit a Sete apee Weiranscheekcdlaluw): [I Uolm01iti0n ©Other; 0 Snvloo or fonder 405 amps or nave 10 O rkttrrg over ism* cto, res. .--�. o o . r T � Miele rho Available Or lr tumor 0 Mnriius and Nutty:rnis. . CATEGORY 01? CONS'IOWL'1'toN_ : • :' :.'., exec «Is 10,000 rrps ISOrv4i..r 0 Ratting buildings. tar to gr•vino.l. or ox rods 14,000 0 •ununordal•uso al rkuturm) 0 I • and 2- family dwelling 0 Commercial /industrial 0 Accessory building oyes for all oilier inxmlhniuns. buitdiugs. EMaiti•family 0 Master builder ❑Other: [lithe anew. 0 1ostaltnriun 0(75KVA or "` `: ," . 'JOB SITE INFORY3A'rION AND LOCATION Oenureeacy a v it largersepat»cety derived syssom. OAddilimrnlncwn„wnrlu:ulnl tj"A " "1•; °,"1.2 " "I•} Job no.: Job site address: 16190 SW 108TH AVE 1501-0 or mom. unmpancy. 0Si.t or were reric(catial sniro, 0 Rcrntr i real veto rlo parks. City/Stare/ZIP: TIGARD, OR 97223 0 Itevlth.cur exeialie/, 13 Supply vnuatc for MOM dlan • ��.. , 0 Haracdons locations. 6110 ours nominal. Suite /bldg. /61x. no, 209 -216 Project AMC: BRIGHTWATE RS @ REDHAWK 0 Serviro or feeder 600 unpin or mare. -FEE 'SCHEDULE • ' - • Cross street /directions to job site: _ oe, <nl,u I 41r• L I'o I 'r Ant t Now residential single• or mullldantuy dwelling volt. Includes attached garage. +_ Subdi vision: Lot no.: 1,000 seq. 11. or less 145.13 - 4 — Tex nutp /parccJ no,: lia. ad <t'I 500 sq. li. or portion 33.40 1 Limited energy, residential 75.00 2 DOSCRII"r[ON OP WORK (wait shove 4 ii.) INSTALL FIBER OPTICS FOR VERIZON Limitud onagy,multl- 12m,;1y 7500 2 rceidentil0 (wide AWN srl, n•) Services or feeders instaflntlon and/or Mocldtan 200 amps or lea. 80.30 2 • '©PROPER'I'Y:OWNER.' ... 'I .,'0•TENANT ' 201 amps 10400 amps 106.85 2 Name: 401 mops to 600 amps 160.60 2 601 amps to 1,000 amps - 24/.60 _ 2 Address: Over 1,000 amps or volts 454.65 _ 2 City /Suite/ZIP: 'Coatpnrary services or feeders lnslullatlun, rtllandiou, and /nr relocal ton Phone: ( ) Vas: ( ) 200 amps or less 66.85 1 Owner instullntion: This installation is being made on property that. I own which is not 201 amps to 400 amps 100.30 2 intended for sale, Tense, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 ;rri rs to .599 rumps 133.75 2 Owner signature: __,. Date: Branch ci' cults- ne, v ,alteration,ur9de»ston, per panel - A. Fee for broach eit'cuiro tcirh • 0 APPLICANT ..ij ' • ' • 0 CONTACT PERSON ' above service or lesdor l'eo, 6.65 2 each branch circuit Business name: NORTH SKY COMMUNICATIONS, INC. 13.Fee tor branch citettits Contact uaine: now service or feeder fee, ERIK SCHENCK first bnmchdievil 46'85 2 Address: 11818 SE MILL PLAIN BLVD STE. 410 Each ada'Ibntnchcircuit — 6.65 2 Miscellaneous (service or feeder nol included) City /State /ZAP: VANCOUVER, WA 98684 Each manufactured or modular I dW011inn, service nail /or fccdcr 40.90 2 Phone: (503 ) 969 -7729 1'05 :: ( 866 ) 452 -4853 Reconnect only 6685 2 G•nlaii: mduor northskycomm,coln Pomp or irrigation circle 53.40 2 CON'hRACfOR Sign or outline llghling 53.40 2 13uain0ss Oan1C: S igurd clrcuit(s) or li»4ted- _ NORTH SKY COMMUNICATIONS, ING, energy panel, alleration,ur Address: 11818 SE MiLL PLAIN BLVD, STE 410 extension. Describe: 1 Page 2 $75.00 2 City /State/ZIP: VANCOUVER, WA 98684 Each additional Inspection ovet. allowable in any of the above • Phone: ( 360) 254 -6920 Fax: ( ) 1- 866.530 -4325 Per inspection - 62.50 levomigntion per hour0 br m 62,50 COB Lie,; 14117 Electrical Lic.17 -154CL Suply, Lie.: 1 73LE6 Industrial plant pee hour 73,75 .. ELpCTRiCAI, PERMIT FEES Suprv. Electrician signature, required: - Subtotal: $75 Print ammo' JACK CAGLE Datt:: 7 /29/09 Pion review (25% of permit fee): Stare srIsctr (I 29& of perrsrit fee): $9 Authorized signature: TOTAL prtn P1717.' $84,00 not o ' l'It, pornrlt upplicnttun ospleur if a omit Is not Mad within 180 Print name: ETHAN A. DOLPH me: 7/29/09 anyt offer ith :ubrotncrotedavromplety. a Number orinspeclluus allowed per trmnn, Taiknkrtnw 'erniiietti,C•parere4gp,dnc 005.0106 sap 461}'rtt uttvcom.Avnii