Permit 4 fa r
F CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
I
C q
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00317
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/13/2008
PARCEL: 2S102DC -02100
SITE ADDRESS: 09355 SW MCDONALD ST ZONING: R
SUBDIVISION: EDGEWOOD LOT: 018 JURISDICTION: TIG
PROJECT: WOODLAND HEIGHTS
Project Description: Units: entire first floor. Installing fiber optics for Verizon.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
• TOTAL # OF SYSTEMS: 1
Owner: Contractor:
GERALD JR & CHAREE CROW NORTH SKY COMMUNICATIONS INC
26 BECKET ST 11818 SE MILL PLAIN BLVD
LAKE OSWEGO, OR 97035 SUITE 410
VANCOUVER, WA 98687
Phone: Contact #: PRI 360- 254 -6920
FAX 1- 866 -530 -4325
FEES Reg #: ELE 17- 154CLE
LIC 14117
Description Date Amount
[ELPRMT] ELR Permit 11/13/200€ $75.00
[TAX] 12% State Surch 11/13/200€ $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By Permittee Signature: C am -
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'N: 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.
. .
..... , -
Electrical Permit Application
ID ":-
City of Tigard
" 13125 SW Hall Blvd.. Tigard, OR / 7
9720
• - ' Phone: 503.639.4171 Fax: 503.598,1 Received i illyk7V1,4421,2013M Mrlangib I
Dawn,: I
, Nail Review
A t1611 Date/By: Other Permit:
Inspection Line: 503.639.4175 0 '1.. Date Ready/By: Saris: 0 Sec l'nge 2 for
TIGARD Internet: www.tiganl-or.gov
tk\Ck)-N .iincd/ivicil,,,d, -rat Supplemental Information
. .
• TYPE OF WORK
Or 1- 1 1, 1 ,Nsw— • PLAN REVIEW -
0 New construction 1:11 Addition/alteration . • • 130 Please cheek all that apply (submit 2 sets M plaits whinns checked below):
0 Service or feeder 400 amps or more 0 Building over date stories.
0 Demolition El Other: Ngt where lie available fault cui rent 0 Marinas and boat yards.
CATEGORY OP CONSTRUCTION exceeds i 0600 amps at 150 tults or 0 Floating buildings.
less to pound, or exceeds 14,000 0 COIllilICYCini•llia awiettlittral
0 I - and 2-ramily dwelling 0 Commercial/industrial 0 Accessory building amps tor an other insert tar ions, buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation nf 75 KVA oi
0 Buiergettcy system. larger separately detived system
' JOB SITE INFORMATION AND LOCATION .
0 Addition army mom load ot
Job no.: 1 site addresN: 9355 SW MCDONALD ST. I 001IP Or i min:. occupancy.
0 Six or inure residential units. O Itccieational vckiele parks.
,
City/State/ZIP: TIGARD, OR 97224 citicalth.eare facilities. 0 Supply voltage (or oaore than
0 H3zacdons kkotioni. 600 volts noiliiisal,
Suite/bldg./apt. no.: 1st Floor 1 P nam e: WOODLAND HEIGHTS 0 s,:rVice Ilr (Ceder 60n ailipS Or morc.
FEE SCHEDULE
Cross street/directions to job site: Doxu I Qv. I Fee. I Ti' I •
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: I 600 sq. R. or less 145.15 4
W . II.
Ea. ;WI 500 sq or portion 33.40 1
Tax map/parcel no.: —
limited energy, residential
7 5.00 2
DESCRIPTION OF WORK (with above sq. 6.)
,
INSTALL FIBER OPTICS FOR VERIZON Limited energy, multi-huni iy 75.00 I residential (with above mi. O.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2 .
o PROPERTY OWNER' I 0 TENANT 201 amps to 400 amps 106.85 2 1
_
Name: 401 amps to 600 amps 160.60 2
601 amps to 1600 amps 240.60 2
Address: _
Over i amps or volts 4.54.65 2
City/State/ZIP: 'temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 t 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner si gnature: D ate: B ranch circuits - new, alteration, or extension, Rer panel
A. Fee for branch circuits with
0 APPLICANT 1 0 CONTACT PERSON above service or feeder lee,
6.65 2
each branch Circuit
Business name: NORTH SKY COMMUNICATIONS, INC. B. Fee ror branch circuits
without service or feeder fee
Contact name: RYAN ROBERTS , lirst branch circuit 46.85 2
Address: 11818 SE MILL PLAIN BLVD STE. 410 uach .m.14;1116 circuit 6.65 2
tvliscellnneous (service or feeder not included)
City/Stale/ZIP: VANCOUVER, WA 98684 Each manufactured or modular
90
dwelli ice andfor feeder .90T 2
ng. sery
Phone: (503 ) 519-5264 Fax: : ( ) 1 Reconnect only 1
66.85 I 2
E-mail: mduoranorthskvcomm.com Pump or irrigation circle I 53.40 I 2
-
CONTRACTOR Sign or outline lighting 53.40 I 2
—
Signal chrtrit(s) or limited-
Buttitte ° WC: NORTH SKY COMMUNICATIONS, INC. energy panel, alteration. or
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: I Page 2 $75.00 2
City/State/ZIP: VANCOUVER, WA 98684 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( 36c) 254-6920 Fax: ( ) 1-866-530-4325 Investigation per hour (I hr min) 62.50 .
CCB Lie.: 14117 Electrical Lic.17-154CL StlPrv• Lie.: 173LEB industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required:
Subtotal: $75 .
Plan review (25% of permit fee):
Prim name: JACK CAGLE Dale: 11-12-08 _
State surcharge (12% of permit fee): $9.00
Authorized signature: .,Z,.......‘.....20, TOTAL PERMIT PEE: $84.00
purest This ientit ap plicalitin CNIIirel ir ti rmit is not obtained within 180
Prillt name: ETHON A. DOLPH Date se
'. 11-12-08 clays after It has [wen accepted as complete.
* Number of inspections allowed per permit.
lAllallainArumilwn.C.PcnnitAnn.4.ne 05.t23506 .1.III.Jri I W4 I 1/115/COMAVI:11
-
.._
CITY OF TIGA m _
BUILDING DIVISION PERMIT #: ELR2.008 003'17
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 11/13/2008
Phone: (503) 639 -4171 1l'1I�I1
Inspection Requests (24 Hrs.): (503) 639 -4175 ,a rt ' ..
INSPECTION WORKSHEET FOR DATE: 11/20/2008 TIME: 7:00AM PAGE: 17
SITE ADDRESS: 09355 SW MCDONALD ST CLASS OF WORK:
SUBDIVISION: EDGEWOO[) LOT #: Q18 TYPE OF USE: C
PROJECT NAME: WOODLAND HEIGHTS
DESCRIPTION: Units: entire first floor. Installing fiber optics for Verizon.
OWNER: CROW, GERALD JR & CHAREE PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 36A -25 -6920
Inspection Request Scheduled For: Date: 11/20/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Elec1iical final 078311 -02 503 -849 -2025 N
Corrections /Comments /Instructions: •
•
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: /( — 2 — C3 Phone #: (503) 718-