Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
IN 11
' ' COMMUNITY DEVELOPMENT Permit #: ELR2009 -00228
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/31/2009
Parcel: 2S115AA00100
Jurisdiction: Tigard
Site address: 16182 SW 108TH AVE 187
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 - 0011- 7 0 e 100. You may obtain a copy of the r ules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: �� .l "Jt Q ;1 l Q ,� ��_ t Permittee Signature: zuu-Ani-.)-
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.
RECEIVED
w 9 2009
Electrical Permit Application _ FOR OFFICE USE ONIN .
City '1 Tigard CITY OF 1 �n� 1Q70CX't r C ` a a8
3' S I Period No,;
_ � ... rt 1312 SW KIN Blvd., Tiourd, UK t r it . DINO DIVISIOI '. a ,ie,v
phone: 503.639A 171 lax: 503.5 .19 DalclOyt Other Moon:
TIGARD inspection Line: 503.639.4175 Dale Reacylliy: Jnr' : -- W See Page 2for
Interne(: www.tiytrd- or.gnv Notf dfhloduni; 1C 1 SupplcmentN t n fnrneMlot
TYPE nF `WORx P],AN nrvCCW.'t : °'.:
❑ New construction el Addit ion/al teratiolllrcplacemeyi Plcaae Clack an that apply (submit 3 ton ur plans wliiemn choked atone):
0 Seivicc or fcoder imps or: tore ❑ nullniyg over trao.ao.oe.
❑ DOan011ti0n ❑ Other:
Miens the available Ishii current 0 Mariner awl Mnatyards.
• CATEGORY -UF CONS1'RUCTWN : exceeds 10,000 mop5 ;,1 t so ,A,o,,,., 011 ting buildings.
less to groutxl, or excecde 1. ❑ CunmWCI:11•uso agdeulnrnl
❑ I- and 2- family dwelling ❑ Comtuercinl/intlustrinl 0 Accessory building amps for all ontoriatntikntent, hnildingi.
EI Multi. family 0 Master builder ❑ Other: fits pinup, ❑ Int;dlnliun of 75 KVn or '
JUR SITE INTUR4IA'fION AND LOCATION ❑E ergencysystem. larger nrparuicly derived ny.ten,,
'. - El Mai lieu Cr ncwmoi6r load of ❑ "A" "If" "I.1" "l.3 ",
Job no.; 7 lob site address: 16182 SW 108TH AVE 11d1HP or c reii 16:11 ass it
❑ Six M MOM M6,1 nark i dcruadonxl vehicle parka.
City /Stare /7_IP: TIGARD, OR 97223 ❑Hcxnh.rac ❑ Supply vouagc fur more ihan
Q HSla1'6)11Y 101;4011i. (410 voile nnntinul,
Suite /bldg. /apt. no, 185 -192 I Project name; BRIGHTWATERS @ REDHAWK ❑Servico ar feeder 000nenpsur
'••PEB SCIIEnULE
Cross street/directions to job site: Dmcrlpdon I Qin. ( rm. 1 'I',dul 1
"'-" New residentiai single. or nnitlt- fxndly !livening run.
includes nitnclicd garage.
Subdivision: Lot no,: L000 sq. IL or 1c05 145.15 4
Ton maplparcCl 10.: lea. ;14(1'1 sq. II. or portion 33.40 1
talc tcd clergy, resitlernial 75 DESCRitrfCON Or WORK ' (wilt;tlxtoc sq.li.) 2.
INSTALL FIBER OPTICS FOR VERIZON
Limited energy, ",nht- 13m,uy 75,00 2 '
mid enam (with d.i,a n n,)
Services or feeders insltdtntion uiteratfon, and/or telocntin
200 amps or les 80.30 2
Q PRUPER'fY'OWNER . ' 0' TENANT 2
Of amps l0 400 amps 106.85 2
Nance: 401 amps to 600 nuips 160.60 2
— """'" 601 amps to 1.000 :mills 240.60 2
Address: Over 1,000 amps or voile 454.65 — 2
City/State/ZIP: 'rcneparnry sar vicoy or feeders InsinlhtH °n, niter:igen, un
relocation
Phone: ( ) Fox: ( ) 200 amps orless 6685 1
Owner installation: This installation is being made on properly that 1 own which is not 201 mops to 400 ;onus 100.30 2
intended for sate, lease, TM, or exchaoge, according to ORS 447, 440, 670, and 701. 401 mops to. 090 reps 133.75 _ 2
Ownervignature: Date: ( bunch circuits — new, tdter:tllon, extension, for pant
A. Fee for branch circuits tvirh
• Ej APPLICANT ' :; j ' . • ..Ca CON'('ACC PF :RSON ' above service or feeder fee, 6.65 2 '
each brunch circuit
Rusine.ssname: NORTH SKY COMMUNICATIONS, INC. D. Fee tbr brunch circuits -
ContnCt name: widow service or reciter fee, 9
ERIK SCHENCK run brunch circuit 46.86
Address; 11818 SE MILL PLAIN BLVD STE. 410 Each add'i branch cheek I — 175 — -_ - -`
Nliscelianoous (service or feeder not it
City /State /ZIP; VANCOUVER, WA 98684 Each lnunut)ectured on modular 9090 2
dw cl lint , service and/or feeder
Phone: (503 > 969-7729
I Fax:: ( 452 4853 Reconnect only 66.85 2
0 -mail: I • t 1 • g 1 x ••••• • 1/ Pump or irrigation circle — 53.40 2
(()N'1'RAOTOR - Sign or outline fighting 5140 2
f3usinass t ell e: Signal circuil(s) or limited -
NORTH SKY COMMUNICATIONS, INC. energy pond, allocation. or
Address: 11818 SE MiLL PLAIN BLVD. STE 410 exleasion.I)CSeribo: I Page $75.00 2
City /State/ZIP: VANCOUVER, WA 98684 - EachadditionalInspectionoverau wtiitioinrotortheabovc
Kw Phone: (360) 254 -6920 1Fax: ( ) 1 -866- 530 -4325 Investti 6'50
hrvesli lll>er hour(1 6r mint 6., , SO
CCs Lie.: 14117 Electrical Lic.17_154CL Suprv, Lie.: 173LEB ineustriai plant per hour 73,75
• •K! (.1'R1CAf, PERMIT FEES -
Saprv. Electrician stgnoturo, required; Subtotal; $75.00
Print uamo: JACK CAGLE I Date: 7 /29/09 i u t review (25% of permit fee):
�` Skate surcharge 62% of permit fee) $9,00
Authorized signature: /..•A.. d• 0, TOTAL Ptmn'r Pal: $84.00 _
Print name: ETHAN A. DOL PH Data: 7/29/09 '11'6,m-cull uppneMlun oxphvy rf a avrnth Is not obtnhmd uithat 180
Ant's otter If fins been neteplerl ar complete,
' Number ul'Inspcetluna alrorced per moon,
iSOnittingu'em,hdlil,C.1emli1 App. too 01/20/06 4411 J6 I S'III 1rn4WMIAY1;11