Permit „4
li 4 CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00293
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/15/2008
PARCEL: 1S135CA
SITE ADDRESS: 09780 SW NORTH DAKOTA ST ZONING: R - 12
SUBDIVISION: GREENBURG HEIGHTS LOT: 008 JURISDICTION: TIG
PROJECT: DAKOTA KNOLL APARTMENTS
Project Description: Units: C1-4. 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:
DAVIS, PETER S & KAREN M BOROSKE NORTH SKY COMMUNICATIONS INC
14570 SW HART RD #257 11818 SE MILL PLAIN BLVD
BEAVERTON, OR 97007 SUITE 410
VANCOUVER, WA 98687
Phone: Contact #: PRI 360- 254 -6920
FAX 1- 866 -530 -4325
Reg #: ELE 17- 154CLE
FEES LIC 14117
Description Date Amount
[ELPRMT] ELR Permit 101151200E $75.00
[TAX] 12% State Surch 10/15/200E $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:
Al*
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 E1 �EIVED p r r L" .' .,4. 7• y ` ..
p ,.,: „ .3. r x ' ' e �'OR.OFFI:CF. U S.. ONLY i� r s Y„ .„ I „t .'
Ii
<' :rt:: < I•CiveJ J �U.t , nit Nu.: 7�� 4, W IY Y
City of Tigard pate /B .: f RG
t 13125 S11 Hall Mud.. Tiprd.�}(� �22.i 2008 1'I:ur Revpcw
3 =': ' ' Phone: 503.639:417 (4(s: 5(15.5%. Oatc /ny: Other Permit:
Ins =firm Line: 501 A p Ready/11y: Jodi: 9 . t Sec Page 2 for
T I( 3 ARD . ial OF TIGARD � pl
Inrea'ncl: sysvw.li ^m'd•ur. Nug iCal /n4u (trtl: y'u dcmcntnl lnfarmalion
- - out itINGOIVISION PLAN REVIEW
Pleas k ecince all that apply (submit 2 sett of plans w /items checked below):
❑ New construction of Addition/alteration/replacement
❑ Ser vice or tceJel 400 amps or more ❑ Duihling over ((tote stories.
❑ I)CI110l1hOlt El Other: where the available Ihu it current ❑ nl arutas and boatyard,.
CATEGORY OF CONSTRUCTION 1 exceeds 10.001) amps at 150 colts or ❑ Floating building..
less to grouml, or enccotls 14.000 ❑ Commercial -use agricultural
❑ I - and 2- family dwelling ❑ Conm,crcial /industrial ❑ Accessory building amps for all She installations. building).
0 Multi - family ❑ Master builder ❑ Other: ❑ fire pump. ❑ Installation or)S KVA or
❑ Emergency system. larger separately derived system.
JOB 51'0'6 INFORMATION AND LOCATION
❑ Addition nl' new moor load nl ❑'. A" "G' •'1 -�" "1•l"
Job no.: - - - -- Job site add 9780 SW NORTH DAKOTA ST. 10014Pormore. occupancy.
1 ❑ Six or more residential units. ❑ Itecrutiunal vehicle p:mks.
City/State /ZIP: TIGARD, OR 97223 ❑ Hcalth -cvc facilities. ❑ Supply voltage for wore than
_ 0 I(arardnus locations. 9)0 volts nominal.
Suite /bldg. /apt. no.: C 1 -4 Project name: DAKOTA KNOLLS ❑ Service or Feeder 00 amps or more.
err; SCHEDULE
Cross sure /directions In job site: osae,yn[an Qw. T" um I 'Polo I •
--------- New residential single- or multi - family dwelling nail.
-- -_ - •- ' - - -'- Includes attached garage.
Subdi vision: _ - - -- - '- Lot no.: I 1.000 sq. Ii. or less 145.15 4
Ga. add'I 500 sq. ft. or portion 33.40 I
Tax map/parcel 110. -c - IMoiled energy, tcsidcnli,al
DESCRIPTION OF WORK (with abuec0).(t.)
75.00 2
INSTALL FIBER OPTICS FOR VERIZON - Limited energy, n "'l`i•f :oily
75.00 -
residential (with above so.l)J _
- - --
Services or feeders installation, alteration, and /or relocation
-- 200 amps or less $0.30 2
❑ PROPERTY OWNER - II ❑ TENANT 200 amps to 400 maps ____
- _ 106.85 2
401 amps to 600 amps 160.60 0
Name:
- -' 601 amps to 1,000 ;cups - 240.60 2
Address: Over 1,000 amps or volts - -- 454.65 2
City/State/ZIP: - - Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I f=ax: ( ) 200 amps or less - - -- 66.85 I
Owner installation: '1 installation is hcin_ made on property that I own which is 1101 201 amps to 400 amps 1(10.3(1 I 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 ;cups to 599 amps 133.75 j
Branch circuits- new, alteration, ur extension, per p:utel
Owner signal Ore: __.'- __�_._. - -' Date: - '
- - A. Pee for branch circuits with
❑ APPLICANT 0 CONTACT PERSON above service or (ceder fee, i 6.65 2
each branch circuit
I3LISIness name: NORTH SKY COMMUNICATIONS, INC. B. Fee for branch circuits i `
wirirooi s ervice or feeder f
Contact Hanle:
RY ROBERTS I ns ( branch circuit
46.s5 2
Address: 11 SE MILL PLAIN BLVD STE. 410 Each add'( breach circuit - 645 l 2
-- - Miscellaneous (service or feeder not included)
City/Slate/ZIP: VANCOUVER, WA 98684 Eachn,adufacuncd
dsv llinr, service and /or feeder I 90.t�0 -
Phone: (503 ) 519 -5264 Fax: : ( )1- 866 905 -4907 Reconnect only ;�
66.05 2
E -mail: mduor /v omm.com -_ -- �-' Pump or itrigalion circle I 53.40 j 2 -
CONTRACTOR Sign or outline lighting �� -- 53.40 I 2
F Busittesstlalne: NORTH SKY COMMUNICATIONS, INC. e ergy panel, ( l -
Address: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Page $75.001 2
City /slate /ZIP: VANCOUVER WA 98684 Each additional inspection ever allowable in any of the above
Phone: Per inspection 62.50
P
( 360) 254 -6920 Fax: ( ) 1- 866 - 530 -4325 - -- -- -- - 6 --
_ -� Invcsti ; aria» per hour (I hr min) 62.50 _
CCD l..ic.: 14117 Electrical Lic•17- 154CLE Supry. LIe.: 173LEB Indnsnial plant per hour L 73.25 �_
- -- - - - - -- ELECTRICAL PERMIT I +EFti,
5uprv. Electrician signature, required:
Subtotal: $75.09..
Print name: JACK EAGLE Dane. Plan review (25% of permit fee): -
10 - - Stale surcharge (I 2% of permit fee): $9.00
Authorized signature: ....... „,.' 0
, - - -' - - TOTAL PERMIT FEE: '.84.00
This per - nit application C ))t .s if n permit is not obtained willtio ISO
Prim name: ETHON A. DOLPH Date: 10 -14 -08 days after it has been aekeptedasWilli/10r.
- " Number of inspections allowed per permit.
Ian„adineWcn, 5,tI i.C•P ;ro,enpp.anc 0500) 5 .:10-1613111 Vo ;2OhrAsli11
CITY OF TIGARD
BUILDING DIVISION - PERMIT #: ELR70l)8 AU q3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/16n008
Phone: (503) 639 -4171 04 �,, �
Inspection Requests (24 Hrs.): (503) 639 -4175 F__..
INSPECTION WORKSHEET FOR DATE: 10/21/2008 TIME: 7:00AM PAGE: 17
SITE ADDRESS: 09780 SW NORTH DAKOTA ST CLASS OF WORK:
SUBDIVISION: GREENBURG HEIGHTS LOT #: 008 TYPE OF USE:
PROJECT NAME: DAKOTA KNOLL APARTMENTS
DESCRIPTION: Units: C1 -4. Installing fiber optics for Verizon.
OWNER: DAVIS, PETER S & KAREN M BOROSKE, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 36(1. 25469'20
Inspection Request Scheduled For: Date: 10/21/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 076978 -04 971 -563 -9326 N
Corrections /Comments /Instructions:
Th
,_ __,
______,-.
LK PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CA L FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: fob-, l v 1 Phone #: (503) 718-