Permit '4 " a CITY OF TI GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00318
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/13/2008
PARCEL: 2 S 102 D C - 02100
SITE ADDRESS: 09355 SW MCDONALD ST ZONING: R-4.5
SUBDIVISION: EDGEWOOD LOT: 018 JURISDICTION: TIG
PROJECT: WOODLAND HEIGHTS
Project Description: Units: entire second 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 11113/200€ $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: �i�iL. �. 'ermittee Signature: $ e t 7p/C•47)
I1
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 CEWD F()R OFFICE USia orvLY
City of •rigar�l et WED it pip M - •
20 0 Date/II : -
Er 13125 SW Hall Blvd., Tigard. OR 97221 41j, Plan Review ' ' l � - O
Phone: 503.639.4171 Fax: 503.598.196Q,OV A.
Date/By: Other Permit;
TIGARD
Inspection Line: 503.639.4175 11�� nf1 Date Ready /fty: Lurie R) See Poke 2 for
Interact: www.tigard- or ' 11Gp►lw Milled /Meths& Supplemental Information
1'YI'i OF WO 1 us io .
PLAN REVIEW
❑ New construction 01 Addition /alter;t acemenl Please check all lieu apply (submit 2 sea of 'plans % /ilma checked below):
0 Service or racier 400 amps or more ❑ Bonding over (slue stories.
❑ Demolition ❑ Other: whine the available basil current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps ;x (50 volts of la Floating buildings.
less is ground. ur exceeds 14,000 ❑ Commercial antin tim
❑ I - and 2- I'anity dwelling ❑ Commercial/industrial ❑ Accessory building
amps Inv all other inxudlwious. buildings.
151 Multi- family ❑ Master builder ❑ Other: ❑ Fit's pump. ❑ Insodlatiun o(75 Kw, el
JOB SITE INFORMATION AND LOCATION ❑ emergency system. tar wr separately derived system.
• ❑ Addition or new motor load of '
Job no.: Job site address: 9355 SW MCDONALD ST. 1001IP or n:me, occupancy.
❑ Six or mom rcittlCn(i;d units, ❑ Becmztional vehicle Pinks.
City /State /ZIP: TIGARD, OR 97224 ❑ Health - rt re racibties. ❑ Supply voltage for more than
❑ Ha/ardmrs locmiuns. 6(10 soils nominal.
Suite /bldg. /apt. no.: 2nd Floor Project name: WOODLAND HEIGHTS ❑ Servn:nnr feeder 6n0amhxorMOM.
FEE SCHEDULE •
Cross street /directions to job site: ocsc (rrun,r I Ow. I Pe, ) Total 1 •
_.. -_ New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. II. or less 145.15 4
`- ._....-- -- ... - - --- —_ -- Et. WWI 500 sq. It. or p ortion 33.40 __ _ 1
Tax map /parcel no.: Limited energy, residential —
DESCRIP'TION OF WORK 75.00 2
INSTALL FIBER OPTICS FOR VERIZON Lintitcdenergy, muhi- family 7400 2
residential (with ;move sq. It.)
Services or feeders installation, alteration, and /or relocation
200 amps or Icss 80.30 2 I 1
❑ PROPERTY OWNER • I • ❑ TENANT 201 amps to 400 mops 106.85 2
Name: 401 amps to 600 :imps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /Slate/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 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 snips 133.75 2
Owner signature: —__• Dille: _• -. - -_ Branch circuits - now. alteration. or extension. per panel
-- — A. Fee for branch circuits with )
❑ APPLICANT GI CONTACT PERSON above service or feeder fee, I 6.65 ?
each branch circuit I
Business name: NORTH SKY COMMUNICATIONS, INC. 13. Fee for branch circuits I
Contact name:
RYAN ROBERTS without service or feeder fee, 46.85 2
first brunch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each ;tdd'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP: VANCOUVER, WA 98684 Each manufactured or modular r
dwelling, service and /or feeder 90.90 I ?
Phone: (503 ) 519 -5264 Fax: : ( )1 -866- 905 -4907
Reconnect only 66.85 2
E- trail: mduorc northskvcomm.com Pump or irrigation chicle 53.40 2
CONTRACTOR Sign mainline lighting 53.40 I 2
Business n a m e : NORTH SKY COMMUNICATIONS, INC. Signal circuit (a)or ` ..__,_ — _
i limited-
energy panel, alteration, or
Address: 11818 SE M(LL PLAIN BLVD. STE 410 extension. Describe: 1 Page 2 $75.00 i 2
City/State /ZIP: VANCOUVER, WA 98684 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (360) 254 -6920 Fax: ( ) 1- 866 -530 -4325 Investigation per hour 0 hr mini - - 62.50 '
CCB Lie.: 14117 Electrical Lic.17 -1 54CL Suprv. Lie.: 1 73LEB Industrial plant par hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required:
Subtotal: $75
Print mm�c: JACK EAGLE Dale: Plan review (25% of permit fee):
1 1-12-08 Suite surcharge (12r% el feet):
$9.00
Authorized signature 0
,
TOTAL PERMIT PEP.:: $84.00
This permit application wires if a permit is not obtained within (110
Print name: ETHON A. DOLPH bate: 11 - 12 - 08 days after It ha, been accepted its I:0111111 M.
. Number tte insiieclion; allowed per permit.
l5iioilr(in5U'er mit,U:i.0 -P sn:aApp.dne 115123/1)5 .IJ0.Jr,uv1 I 1/0i/('OIAVI >11
•
e — .s •
CITY OF TIG/�F ®,. i
BUILDING DIVISION PERMIT #: ELR2008 -00318
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/ imam
Phone: (503) 639- 4171ZN�I�I •
Inspection Requests (24 Hrs.): (503) 639 -4175 `° -_..
INSPECTION WORKSHEET FOR DATE: 11/20/2008 TIME: 7 :00AM PAGE: 19
SITE ADDRESS: 09355 SW MCDONALD ST CLASS OF WORK: \
SUBDIVISION: EDGEVWOOD LOT #: 018 TYPE OF USE: a r
PROJECT NAME: WOODLAND HEIGHTS
DESCRIPTION: Units: entire second floor, Installing fiber optics For Verizon.
OWNER: CROW, GERALD JR & (:HARES PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360 -254 -6920
Inspection Request Scheduled For: Date: 11/20/2008 Pour Time:
Code # Inspection Description Confirm # Cont ct Message
199 Electrical final 078311 -01 503848 -2025 Y
Corrections /Comments/ Instructions:
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: PLaCIA Date: /(--- — cP Phone #: (503) 718-