Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2009 -00227
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/31/2009
Parcel: 2S115AA00100
Jurisdiction: Tigard
Site address: 16178 SW 108TH AVE 179
Subdivision: DURHAM PARK APARTMENTS Lot: 36
Project: Brightwaters at Red Hawk
Project Description: Install fiber optics for verizon.
FEES
Owner:
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 503.246.6699 or 1.800.332.2344.
Issued By: Willi L • f i
y: ! _ Permittee Signature:
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.
v , ..,,
9 2009
Electrical Permit Application FUI tUilt'IC� USE ONLY
• Cie of Tigard aA��++�R//D�'��� rtoacLcr _ D y [ SVI1I Damlflyc ,
Ou m t No,. : 2 �`
13125 SW Hall Blvd., Tiourd, OR 11223
r • Phone: 503.639.4171 Pax: 503.599,1960 VISION Plan Review wr Mini': Mini': Ualc /Oy: i Per
Dale, Ready/By: hit :
Inspection Line: 503.639.4175 Y ''f' 1I 81 See Page Z for
'
TIGARD n
Internee www.tiyard- or.9nv Nulllicd /Mceo,d: ! l u
- Supptcn,,mt Inforn,n[lue
rl
❑ New constntction 0 Addition /altcratioa /repincc - Pleate check Al hot aptly (submit ;. sett oflannswftcowolrcl:edxtow):
�f ❑ Scivlee or feeder 400 atom or nxue ❑ !hutting ova• IIINC stones,
l„•t Demolition 0 Other: Where alb available raw' cowl] ❑ Mob oas and houty :mar,
• ' • CATEGORY • OF CONSTRUC'T'ION :'• '; ' : • : •% t ❑ Mating buildings.
... CECCI.YIi 10,0Ufl em rx:U 150 svaly or
❑ I- and 2 -f mil dwelling . ' loan to grouoJ. or cxcccdr 19,006 t7 Cummorctat -,,,o aadrilinl at
y g ❑ Commercial /industrial ❑ Accessory building amp > fur on olherhnlinutions. buildings.
el Multi•futnily 0 Master builder Q Other: ❑ripe ittAt. ❑ (na;Jlatiun 75 KVA m
- . 4°13 'SITE INFORMATION AND LOCATION ❑rdrekcgeaaysystmp. hrgarscpmnely nrivrdry;teul,
-• � - � ❑ Addition nhtcry nxunt In:al of b "A" "Ir` "LT' ' ' ' 1 1:3 1.''d
' I J•',
Job f10.: Job Site aaarc's; 1 6178 SW 108TH AVE lumpur awvuponoy.
❑ Six ur more tcsidcnliel raids, ❑ kcarewhiled Which prim
City /State/ZIP: TIGARD, OR 97223 0 Hca €th•cmcGuflities. ❑ Supply volurgo for mom Ilran
• -..- 0 Hazanluas lnonliu,n. 600 vatlr nominal.
Suite /bldg. /apt. no. 177 -184 Project name: BRIGHTWATERS @ REDHAWK ❑Service or feeder 600 nowt ormore.
•""" FT:E'SCITEDULE ' • •
Cross s(rcclldircctictne to job Rite, -- — _ nc,rdpann 1 Qtr. I err. I 'Pool - 1 .
New resblcntiul single. or m dwelling non.
Includes nunclted garage.
Subdivision: Lot no.: 1,000 sq, n. Or less 145.15 4
Tax map /pa re(1 no,; I Oa add'I 500 s q. ti or (o 3340 i '
Limited e0clgy, residential 75.00 2
DESCRIPTION O( WORK (mu' Nave sq, Ii.)
INSTALL FIBER OPTICS FOR VERIZON 1, imitedcnmgy,muhf•fnnily 75.00 2 •
n
residential (with 'awe sq. h.)
Services Or feeders installnlfon, of ern Iron, and/or relncntlon
200 maps or less 80.30 2 • '•❑ PROPERTY'OWNER '1 •.. ' 0' TENANT -' : 201 amps to 400 claps 106.85 2
Nance: 401 amps in 600nrups 160.60 2
601 amps to 1,000 amps 240.60 2
-
Address: Over 1,000 amps or votes _ __ 454.65 � 2
City /Stale /ZiP: 'fcnpornry services or feeders installation, :Itter :nion, and /or
relocation
Phone: ( ) Fax: ( ) 200 maps or less 66.86 I
Owner Instuiintion: This insmilntion in being made on properly I hal I own which in not 301 maps to 400 tune6 1 00.30 2
intended for Sale, lease, rein, or exchange, according to ORS 447, 449, 670. and 701. 401 atilt.; 599 limps 533.75 7
Brunch circuits - new. Ott:ration, or exlci+slalt, per panel
()wile' si S 'n itU['C: Date; _ A. Pee for brooch circuits with
0 APPLICANT . ;'l ' •!: CONTACT PERSON ' above service or feeder leo, 6.65 2
each brunch circuit
Rusincssname: NORTH SKY COMMUNICATIONS, INC, D. Fee ror branch circuits
Contact name: ERIK SCHENCK ,pirharr service 0r feeder fee. 4685 2
first branch circuit i
Address: 11818 SE MILL PLAIN BLVD STE. 410 each add'I brunch circuit l 6.65 2
Miscellaneous (service or feeder not included)
City /Sinle /ZiP; VANCOUVER, WA 98684 Each munn0tctnrad ar'nodular
dwelling„ service outlier feeder 90.90 2
Phone: (503 > 969 - 7729 I Fax.: ( 866) 452 - 4853 Reconnect only 66.85 2
Email: E Insiusuanoiltisicycomms,seo Punt( orinigationcircle 5140 2
CONTRACTOR Sign orontlino bighting 53.40 2
Buxineoo "me: NORTH SKY COMMUNICATIONS, INC, sigtuticircuit(S) in- limited.
caergypinion, aharction, or
Address: 11818 SE MILL PLAIN BLVD. STE 410 exlension.Describe: 1 Page $75.00 2
City /State/ZIP: VANCOUVER, WA 98684 Rnchaddi tionalinspection over Minim hlo in any of the above
Phone: 1 360) 254 -6920 Fix: ( ) 1- 866 -530 -4325 _Per inspection 62 62.50 .50
Investigation per hour ii minion __ 62.5
CCB lit,: 14117 Electrical Lic.17.154CL Su111v• Lie.: 173LEB Industrial plant per hour 73,75
"ELECTRICAL. PERMIT PEES - .
Strprv. Electrician signsttn'c, requited:
Subtotal: $75.00
Print 150!1(: JACK CAGLE Date: 7/29/09 fist review (25% of penult fcc);
.r � • State surcharge (12 %of permit fee): $9,00
Authorized signature: ! .C/ TOTAL Pfi mrr rag: $84,00
Print name: Date: 7/29/09 mt., (oral[ uppllfnflun ustrh'r If [I oorodt Is not obloined 11(1910180
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Minax:r or 1nepcel1uos 090n•ed VC(' pcnnlh
1n 0alkiingWen0Nil,C•I'ewe,+pp.dne epp'uer 410- J610I<I Im.vcUswcit