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Permit � r ; , p ' r � CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT . 2 ,:,, COMMUNITY DEVELOPMENT Permit #: ELR2009-00248 1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/04/2009 TIiARI? Parcel: 1S135DD03703 Jurisdiction: Tigard Site address: 11624 SW LOMITA AVE C -1 Subdivision: Lot: 0 Project: Park Place Project Description: Install fiber optics for Verizon. Owner: FEES 1616 SHORELINE LLC & Description Date Amount LOMITA WEST LP, PO BOX 15516 Restricted Energy Permit 07/31/2009 $75.00 FREMONT, CA 94539 12% State Surcharge - Electrical 07/31/2009 $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. t`3 0 (`'1 '�� Issued By: ��. Yi Q c �X� 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. k r� CCtl `��YYY JUL 2 9 2009 Electrical Permit A t)licatior CITY UIL DING NISI . • .:::::..'. =;:; °: OEOilIC us* ive.v: :,:� : ° ;';. : ':':`: = �`:: p Ci ty of T(gard �� i_ � . 8 i ' t 3125 SW Hail Olvd., Tigard, OR 97223 OF TIGARD Ptah Review t tr + Phunc: 503.630.4171 Fox 503.590.1960 D ;IIw /g Olhct Permit, TIGARD 01s500110u Line: 503.639.4175 Date Ready/By: a in 61 Sec Pop 2 for I nternee wtvw.rio;nd- or.;ov Non(ed /Mahout: Suppler v.soI Infnrnmtlun ❑ New constntC1iOf1 Q Addit ioin /alteration /rely /f(cernCt11 Plosie chock ;4 111+,n:q+ply ( sufnuil2 of /clans wPoa,u•chcoOed :olds): [ Demolition ❑ Other: 0 Sc,vlac or froder 4o0 amps 10 move ❑ nandmg nvcraude lco. at ne dto tvailahle Soil entrmit ❑ WOWS anti hnoty:mit, .. •" CA'IF:GORY 01" CONSTRUCTION catacds10,W0aotp<nt151) lI or ❑flnatlnpbulWiugi. 61,10 stuun 1, or erevedi 14,1)60 ❑ Conallorel:ll•oo, ngllCllnlrnl 0 I - and 2- tataily dwelling ❑ Colm»ercinl /industrinl ❑ Accessory building mops I'm ndlothcriasulttutians. bilitdincs. GI Multi•flunily ❑ Master builder ❑ Other: Q She pumps. 0 lint li ni„n nt 75 KVA ar :.'. SITE •INI%ORWATION AND LOCATION 0¢nkrgcte,a(m ,argot e parmIp C Ie .r_ � � � • QAdditinn ninuy ntm mror load a � "�" •�>( � , ,, I.3 " II I.1 •vii yslcm• ' Job no.; lob site address: 11624 SW LOMITA AVE in6Hp or nanc. an.cnp:mcy. 0 siC OP mdtc (O$MOnliml uOiii, ❑ RcM:1110 1,chide parks. City/State/ZIP: TIGARD, OR 97223 ❑ licanh•c,ncrarilitics• 0 Supply vtiltngo (Dr MOT titan 0 Hnoaltlunn locality ts. 01110 volts nom1n01, S/lite /bldg. /apt. 110, Cl - C7 Project name: PARK PLACE 0scrviea nt feeder ego maps to Inure. '.•. . • %TPEE SC((EDULE ' Cross s(feeddircclions to job site: note no 111 MMI1 — '•• "�-- """""' Nosy residential single- or nmhidnmily dwelling null. Include's attached gacnne. _ Subdivision: Lot no.: 1.000 sq. It. or lass - 145.15 Q j Lt. .dd'l 500 sq. Ii. or portion 111111 33. Tax map /parcel Ito.: L,intilcd cno ICSI lIG11lIR) DESCRIPTION OF WORK III 75.00 � (/tint Alec sl , ll.) INSTALL FIBER OPTICS FOR VERIZON Limiter re nlia energy, l(witn 1H0tolly 75.00 -e • esidcl (wiUl ofinver n , n.) Services or fec/lers InstellatIon,ulterdtlon, and/or relacallo 200atnpsorlegs 80.30 3 ' PROPER•t'Y. - OWNER • . %Li'TENAN'I' ' • : 201 amps to 400 amps 106.85 2 • Nance; 401 mops to 600 amps 1 (60.60 2. — — 601 :nips to 1.000 mops 240.60 2 Address: Over 1,000 amps or volts 454,65 2 ' City /St:tie /7AP: 'fcuipnt•ary services or fccders Installation, :Mention, and /er relocation Phone: ( ) Fax: ( ) 200 amps or loss III 96:85 1 Owner installation: This insudlnuion is being made on property that I own which is not 201 amps to 400 lumps 100.0 2 intended for Cate, tense, rein, or exchange, according to ORS 447, 449, 600, and 701. 401 ;unps to 590 going 133.75 2 Iira»th circuits - new, niter:Won, or extension, per panel _ , -- _ _. Dale: , Owner signature: ___ '- A. Fee for branch ci rcuits wilt) t "' © APPLICANT ' ' -: ' • " :1 ' `O - CONTACT PERSON above sot vice or feeder l'00, 6.65 2 • each hr(alch 111111th! Rnsiness NORTH SKY COMMUNICATIONS, INC, 0. Fee without service or f e e d e r fee, Concoct »alnc: ERIK SCHENCK 46.85 2 lint branch circuit Address: 11818 SE MILL PLAIN BLVD STE, 410 Each 5dd'Ibinnchclleldt 6.65 2 Misectlaneous (service or feeder not included) City /Stole/ZIP: VANCOUVER, WA 98684 Each lnnnutocturcd or trodulur dwelling. service and/or feeder 9U 2 Phone: (503 ) 969 -7729 Fnx:: ( 866 ) 452 -4853 Reconnect only 66.05 2 G'nlaii; mduoraenOrthskycomm.com Pump or litigation cir'cic 53.40 . 2 Cf)N'fRA(T(1R •• • • Sigtt outline lighting 53.40 2 Businoata nanl ; NORTH SKY COMMUNICATIONS, INC e erg pa limited. t energy panel, altcrdion. ur Address: 11818 SE MILL PLAIN BLVD. STE 410 extension, Describe: 1 page 2 $75.00 2 City /Statc/ZIP: VANCOUVER WA 98684 Endladdllionnlhspection Over nllolru11101n any of the :drove Fat: ( ) 1- 866 -530 -4325 Per stigit 62.50 Phone: (360> 254 -6920 htvciligmien hour prrmity 62.50 CCB Lies; 14117 Electrical Lic.17 -154CL a Spry. Lie.: 173LEB 1n(10Cni(4 ptlol per hour 73,75 i . o ''- LFC,TRtCAL PERMIT FEES • Stiprv. Clcctricinn signature, requil•col: w. Subwu +lc $75.00 Print name: JACK CAGLE Dote: 7/29/09 Ploit review (25% of penult fee): Stile surcharge (12% or permit fee): $9.00 Authorized signature: /G._. 7 TOTAL PFIRMI'r(loll: $84,00 'I'Id m i ni) uppliiMion ospti o If a outwit is not obinlncd 115111111 180 priotnnlltc ETHANR..�OLPH Dote: 7/29/09 days niter IIlim been ncevplod ascualigne, 1 N{1101.:1 or lnapecllunl ((Vetoed lion moth, I: lOt. lleingg Wf0it.tnl,C•YVhndSpp.nrr, 050006 401 l /n$1COltAYlil1