Permit 4 CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00292
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/15/2008
PARCEL: 1 S135CA -01704
SITE ADDRESS: 09760 SW NORTH DAKOTA ST ZONING: R -12
SUBDIVISION: GREENBURG HEIGHTS LOT: 008 JURISDICTION: TIG
PROJECT: DAKOTA KNOLL APARTMENTS
Project Description: Units: B1 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
FEES Reg #: ELE 17- 154CLE
LIC 14117
Description Date Amount
[ELPRMT] ELR Permit 10/15/200E $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: ` `r,4 ,'23 N 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'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.
•,'X.' :3 :i. :.;,s : ;,� : :� ;\ ,s^ :` : :rd :n :;¢} ',: :in' :: 4, :i;,,, ,i,,,, Y,i,, .. : • Electrical Permit Apt > ED ' 't. ` pg�OF�'Ig ,. T fi r N Received
city of ri �T(I Da1e ►': 1
t; 4 2008 Permit No.:
13125 SW Nall 111vd. Tigard, UI{{��`{�X�1, � Nan Rev I „ i ,�- v
1111
_ , Phone: 5031)39.417 I 1 Fax: 503!49R.19O)I D:ue/Oy: Oilier I'eraic
T10ARD. M a c r o tV
Inspection Line: SU3.639'1 OF TIQARD Date Ready /lays hni <• ® sou Page Z Car
IntcrnCl; ww.ligtu'd -Ur.ed NotiftccUP4ahod: _ Supplemental Information
-- 108 DIVISIOW PLAN REVIEW •
❑ New Construction 0a Addition /alleralion /replacement rlense chock all that apply 6 rbnt it2setsor ' aims w /iiems checked below):
❑Service or feeder 400 amps or more ❑ Building overdure stork.
❑ Demolition ❑ Other: -- wheie the available Paola current ❑ Miidlias soil hott1- ruI .
. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO voile or ❑ Floating buildinei.
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less to ecoeutd, or exceeds 14.000 ❑ Commercial•tiec a °_I i cnlnur.0
❑ I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building I amps for :ill udtci insiaualions. NI ildinpi.
Multi-family ❑ Master builder ID Other: � ❑ hire pump. ❑ lusl:dhtiui of 75 KVA in
JOB SITE iNCUR' IATION AND LOCATION ii ❑ L•me ,cncy system. k ;0r Cl) s; rateiy tleiivcd system.
❑ Addition of new motor load of ❑ "A" "G" "I.7." "I -,
Job no.:
Tlob site address: 9760 SW NORTH DAKOTA ST. loortr or more. occupancy.
y.
❑Six or mote rcrdcntial units, ❑ Recreational vehicle pail.
City /Slatc/ZIP: TIGARD, OR 97223 ❑ tenhh -care Ikciriiic,. ❑ Supply voltage Mr morn than
❑ Hasard locations. 600 rolls nominal.
Suite /bldg./apt. no.: B 1 -4 Project name: DAKOTA KNOLLS DI SC, viceur feeder MO amps or maim
-- FEE SCHEDULE
('toss street/directions In job site: » „,, I vt I Per. 1 _ __ 1 •
- i - � - - - - - New residential single- or multi - family dwelling unit.
__• --
Includes attached gnnage.
Subdivision: I Lot no.: 1 1.000 sq. II. or Icss 145.15 -- 4
Ea. ;WWI 500 sq. 0. or portion 33'W 1
Tax neap /parcel n0. Limited energy, reiideulial -- — — --
DIiSCRIPTION OF WORE (with above sq. I:.) 75.00
INSTALL FIBER OPTICS FOR VERIZON I "`l cnel`y, "'alai- rltniiy _ 75.00 2
residential (with at.nem 11.) _
Services or feeders installation, alteration, and /or relocation_
200 amps or less 80.30 2
❑ PROPERTY OWNER • I ❑ TENANT 201 amps to 400 amps 106.85 2 ,
Name: 401 :taps to 600 amps 160.60 _ 2 i
-' -- - 601 :amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or moils 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 twine made on properly that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according Io ORS 447, 419, 670, and 701. 401 :maps to 599 amps 133.75 2
Branch circuits - new, adteratio 1, or cstension, per panel
Owner signature: -- - - - - _- .- ._ ...... ............_.D:te:
- A. Fee for branch circuits with
❑ APPLICANT In CONTACT PERSON - above service or feeder fee.
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each branch circuit I 6.65 2
nusiless e: NORTH SKY COMMUNICATIONS, INC. 13. Fee ror branch circuits �- —
Contact name: RYAN ROBERTS 1 1, m branch circuit or feeder (cc, l 46.85 2
lirst branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each idOl branch circuit 6.65 2
i - -- -- - - -- - .. -- Miscellaneous (service or feeder not included)
City /State/ZIP: VANCOUVER, WA 98684 Each manufacnucd or modular f —
dwelling, service and/or feeder I 90.90 2
Phone: (503 ) 519 -5264 I Fax: : ( )1 866 - 905 -4907 Reconnect only j 66.85 ; 2
E -mail: mduorenorthskvcomm.com Pump or irrigation circle I 53410 1 2 "
CONTRACTOR Sign or oudinc lighting 53.40 I 2
Business (lame: NORTH SKY COMMUNICATIONS, INC. energy circuit(s) t r•tioi` o -
, _ cncrg)' Patcl, alteration. or
Address: 11818 SE MILL PLAIN BLVD. STE 410 cxtensioln. Descr'ibc: 1 Paget $75.001 2
City /Stale /ZIP: VANCOUVER WA 98684 _Each additional inspection over allowable in any of the above -
3 60) 254 -6920 1-866-530-4325 st 62.50
I'Itonc: ( Fax: ( ) 1 866 - 53 -43 — Investigation perhour (i hr win) - ----- -... -_ - 62.50
CCI3 Lie.: 14117 electrical Lic•17 -154CL S»prv. Lie.: 173LEB tndt.,!6,ti phlnl per hour l 7175
ELECTRICAL PERMIT FEES
Suprv. Electrician sign inure, required: Subtotal:
Print name: JACK EAGLE Doc Plan review (25% of permit fee):
10 -14 -08 State surcharge (12% of permit fee): $9.00
Aul hori7.cd signature: TOTAL. PERMIT rill:: _$84.00 0/4 _ _ . This permit application expires if n permit is not obtained uillrin ISO
Print n:tmc: ETHON A. DOLPH Date: 10 -14 -08 day, atm.it has been accepted as complete.
J Number of inspections allowed per permit.
hmhs adanatrrnsi,u t C.I'.•rme.tpp.dnc 05 /251116 .1.10 Jr, r .51(I upi /CnSIAx,in
CITY OF TIGARD
BUILDING DIVISION PERMIT #: CLR2006 -00292
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/15/2008
Phone: (503) 639 -4171 Ate �r lit,
Inspection Requests (24 Hrs.): (503) 639 -4175 % _
INSPECTION WORKSHEET FOR DATE: 10/21/2008 TIME: 7:00AM PAGE: 20
SITE ADDRESS: 09760 SW NORTH DAKOTA ST CLASS OF WORK:
SUBDIVISION: GREENBURG HEIGHTS LOT #: 008 TYPE OF USE:
PROJECT NAME: DAKOTA KNOLL APARTMENTS
DESCRIPTION: Units: 51-4. Installing fiber optics for Verizon.
OWNER: DAVIS, PETER S & KAREN M BOROSKE, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-25 -6920
Inspection Request Scheduled For: Date 10/21/2000 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 076978.01 971 -563 -9326 N
Corrections /Comments /Instructions:
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( 7 .-- -- - ---*
6L 7_ ., ,,
DZ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ C LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: �e��� /�� Phone #: (503) 718-