Permit •
.� CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° ': COMMUNITY DEVELOPMENT Permit #: ELR2009-00251
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/05/2009
Parcel: 1 S135CA00800
Jurisdiction: Tigard
Site address: 11255 SW GREENBURG RD 1
Subdivision: Lot: 0
Project: Walnut Tree Apartments
Project Description: Install fiber optics for Verizon.
Owner: FEES
ANDEREGG JOINT LIVING TRUST Description Date Amount
BY ANDEREGG, FRED CHARLES /BEULAH CO, Restricted Energy Permit 07/31/2009 $75.00
17146 SE HWY 212 12% State Surcharge - Electrical 07/31/2009 $9.00
PHONE:
Contractor:
PHONE:
FAX:
Type of Use: COM
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 throug 1 ` C hfOAAR R9 1
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: 1 T 1) 1 & 91 Permittee Signature: ' 0_ ( 1 ai l
V 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.
i. i .
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JUL 2 9 2009
CITY OF TIGARD
Electrical Permit Application - Fox OUtcEIUSE(NLV
City FTI Tigard � 'tt � 'c • 009• C• 5
I Y Noon fen.; •
`I 13125 SW Half 01va., Tigurdl, OR 97223 Y'
r tr • • Phone: 503,639.4171 lax: 503.598.19 DurelDy. Oikerl'e 116 :
TIGAAD Inspection List:: 503,639A175 Date Ready/By: hair R See l'age 2 for
fntanct: wwvv.tioa,eI.or.gnv Nudncdrnlcttuel: T) 9j 6upplcmcrgnl Informntlun
• TYrE bF WORK •a•:•. .... .............. ... • .
Q Now cons eretion E] Addition /alteration /repineernent Plencechock: 01l y ply( euhmit2cet ;ol'ples,wfitcou•checked
0 Scrvlce or feeder 40(1 amps or niece 0 n ullrhng over time xto:ict,
El Demolition ❑ Other:
where Ore : e,liluhlc Ctolt Cancun 0 Mnrinav nod horny, nls,
CA'Cl?0 ORY • or .CONSTRUCTION toN, ; • cr.. It i0,000,roga nt 150 voli" in ❑ Moiling buildings.
ten in gitunisr. to encccd. Iyotl0 f] Cuuuucrci:d•u,o agricultural
❑ I- and 2- family dwelling 0 Commercial /industrial ❑ Accessory building f Mugs far so cibevi %Isltwions, beitdiv,
Multi- family 0 Master builder ❑ Other: 0 we mina. a 1Aandmi0a A( )A KVA in
: - - zyrtm larger repnitnely Qerivcd
.'• JOB SITE- INFORMATION AND LOCATION
... •.,. ..� •mcrgccy • . — - ... QAddilinn � "A^ •'g' ^1.2 ", "I.1"
Job no.: 1 Job site ndthnsa: 11255 SW GREENBURG RD HOHr ur mom nanp,mer.
0 Six or MCC reSlilenliar d 0 Itarua«unnl vehicle purkv.
Cily/Stnte/ZIP: TIGARD, OR 97223 0 Heal ihe(iretltricr, 0 Supply voliugefn, more drxe
0 Ha taahlire tucutions. 00 vo « s cr ovoal,
Suite /bldg. /apt, no. 1 -4 PrOjecttlime: WALNUT TREE APTS 0Ser✓sco orfccdcr (MO cows un MM.
:: : .;- • ' •• •FEE'SCHEDULE • • •
Cross street/directions to job site: ' nuerlN «m I pi,. I um I •'m.1 l
4 Neie resfdentiul single• or i ltl•fnmlly dwelling null,
Includes clinched garage,
Subdivision: Lot no.: 1,000 sq. I). or less 145.15 4
Tux tm,pinmrcci an.: I Lis, ;WWI 500 sq. It. or portion 33,40 1
l.Juiilcd energy, residential 75.00
DESCRIPTION OF WORK • (will,:dwec rut, 11.)
INSTALL FIBER OPTICS FOR VERIZON
Limited cnorgy. nruld•rn,nily 7500 2
residential (with ebove,tl• n,) a
Services or feeders installntlon,_ullerntinn. nnd/nr relucuttnn
200 amts m less 80.30 r 2
''(]PROPER't'Y•'OWNER :I ' .,'.i1 TENANT ' 201 carol to400mops 106.85 2
Name: V dOlnmpx 160.60 2
001 l to 1,000 amps 240.60 2
Address: Over 1,000 minx or votes 454.65 2
City /State /ZIP: 'Ccurpo4•nry acrvices or feeders Installation, Mention, and /or
relocnlfon
Mime: ( ) For: ( ) 200 amps er 1os 66.85
Owner instutintton; This inslnllntion k being made on property that I own which is not 201 amps to 400 (aps 100.30 2
intended for sate, lease, rent, or excitant:, according to ORS 447, 449, 670, and 701. 401 soizi..s 10,599 mans 133.75 1
Owner signature: Date: Brunch circuits - new, utter :utou, or cXtenslm� per panel
A. I'm (or branch circuits with with — `. ' 0 APPLICANT _ ' - M" ' CONTACT PERSON ' above service e feeder Cco, 6.65 2
each branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC, I). Fee ?ar brunch circuits _ —
Contact nnmo: ERIK SCHENCK li enNour scrviccor feeder fcc, , 4(1.85
li brooch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 1';.rehadayl breech citcuit I ; G,GS - •` -- •
�_.._.._ _ ...- _..... _ ....._.__...�. Nliscellaueous (service or Cceder nut included)
City /State /ZIP: VANCOUVER, WA 98684 0ac11 tnunu0tchucd or modular
Photto: (503) 969 7729 Fax 866 dwellinr, service noel /or feeder 90'90
> 452 4853 R econnect only 66,85 2
8.111001: mduorenarthskycomm. Pump or irrigation circlu 53,40 2
CON'CRACE(IR Sign ()redline lighllng 53.40 2
Business 11(01 NORTH SKY COMMUNICATIONS, INC. Sigurd c a n 1 , el or limited-
- energy p ahcrdiml, or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension, Describe: 1 Page $75.00 2
Cily/Stote/ZIP: VANCOUVER, WA 98684 Cncll additional liupeclion over allowable ln any of the ;die ve
Phone: ( 360) 254 -6920 Fee: ( ) 1 -866- 530 -4325 Poi* inspection
luvcsflgtuirolper hour (fNrmin) 62.50
CCB Lic.; 14117 Electrical Lic..17 -154CL Sup1y, Lic.: 173LEB Indus»icd phult 73.25
•
•'• CI,ECTRICAI. PERMIT PERS '
Sltprv. Electricinn signature, requirc(1: Subtotal: $75A0
Print 'lino: JACK CAGLE Date: 7/29/09 ph review(25%or permit foe):
Strum surcharge (12%ofpermit fco): $9
Authorized signature: / �..
.!_ TOTAL P(inh ll'r vox.; $84.00
.... /
not obtntucd l p aradt upplfcadun exphvr If x pond! Is not 180
Print name: ETHAN A. DOL PH Dnte: 7 /29/09 TN, tiny.. Alder 11 h;u been acnyded a, tu.plar.
I:vn<,ihrtn •V'enui,dGl,60em,�n, .,Inc Of4 } /O G ° Vun,bor ofluepecllum tdlu Ier perms.
8 I <• 4 4n. 1 hI5'I'(t I /0.000SIAVI;Il