Permit C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT P ERMIT #: ELR2008-00290
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/15/2008
PARCEL: 1 S 135CA -01702
SITE ADDRESS: 09740 SW NORTH DAKOTA ST ZONING: R -12
SUBDIVISION: DAKOTA KNOLL APARTMENTS LOT: 008 JURISDICTION: TIG
•
PROJECT: DAKOTA KNOLL APARTMENTS
Project Description: Units: D1 -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
FEES Reg #: ELE 17- 154CLE •
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: /
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.
y ] • � F '� e� \� ^�4 :'!:' �ti3l_ Z4 C. - l+, :t 2'
Electrical Permit ApplicatiREC 41, -,•, mod. g ,.
7 Vii''" City Of rl BIYI Itcrci ;cJ ash vo
rl 131 SW ii II 11131vtl.. Tig:u•d OR 97221 OCT 14 2008 Dare!!{ �� �• f/i Z� � �v
• P1::l Itcry :cw
1 Phone: 503.639:1 Fax: 503.59S 9 Dale /Ity: Other Permit:
T IGARD , Internet: Inspection Line: 503.639.4175 1 OF 'MARS Date Ready/11y: , see ratio a e'lvuctignrd- ur.gnv I ti4cdlhte nd: _- -- -' -- It& Supplcmonlallfor nlot•mation
TYPE OF PLAN REVIEW
❑ New construction 121 Addition /alteration /replacement Picric check: all that apply (submit 2 w, or plans AvOie a checked Irlowt:
❑ Ser vice or feeder 100 amps or more ❑ Building over three stories.
❑ Demolition !- -_^ CJ Other: where the::vaiklble EMI cuircnt ❑ Marinas and hies yards.
CATEGORY OF CONSTRUCTION exceeds 111.0011 ntips at 150 volts or ❑ Floating buildings
less 10 grst intl. or cxcccds 14,0(10 ❑ Cusunercitd -use agticuluu:d
❑ I - and 2- Tinily dwelling ❑ Commercial /industrial ❑ Accessory budding ;imps fur all other installations. buildings.
Ea Multi - faintly 0 Master builder ❑ Other: I ❑ File pump. ❑ Installation of 75 (VA or
_.�... i ❑ Emergency .system. larger separately derived system.
—_ JOB SITE, INFORMATION AND LOCATION
� -_--_
CI Addition of n u
ew rotm• Inad of CI '
"A ' " I.2" "1.1"
Job no.: Job site address: 9740 SW NORTH DAKOTA ST. utolirnrn:me. R eci e u ncy.
- -� ❑ Six ar nw:c raxidcmial units. ❑ o a a ncy. al vehicle pmts.
City /State /ZIP: TIGARD, OR 97223 ❑llanllh•etrrC useiliii.. ❑ Supply rul t:rs'e for mire than
__. - -- ❑ lia'tar,!nus lucuitns. (t00 volts nominal.
Suite /bldg. /apt. no.: D 1-4 Pr)jcct name: DAKOTA KNOLLS ❑Service it, feeder 600 amps or more.
- -' --' - FEE SCHEDULE '
Cross street /directions to job site: Desvr,l,ur.,r Qt,•. r.,- ' r :,t - _ 1`
-T " - - ` -- New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: - - -- ---- -. - - ° - 1-01 no.: IA00 sq. ft. or less IrlS.l 4
__ — ^_
1_n. add•I 500 sq. It. or portion 33.40
'l'ax map /parcel no.:
Limited energy, residential
- ( 75.00 2
DESCRIPTION OP WORK (with shove mi. itJ
INSTALL FIBER OPTICS FOR VERIZON I, imiledlcilcrgy ,llta►ti- 1Ittniiy 75.00 2
residential (with :dx)tre sq. Ii.) _
Services err feeders installation, alteration, and/or relocation _
200 amps or less 80.30 2
0 PROPERTY OWNER - - - -- ❑ TENANT 201 amps to400 snips - 106.85 2
Name: 401 amps to000amps 160.60 2
601 slop.: to 1,000 amps 240.60 2
Address: Over 1.000 amps or volts 454.65 2
City /Slate /ZIP: Temporary services Ur feeders installation, alteration, and/or
relocation
Phone: ( ) 1 Pax: ( ) ! 200 amps or less 66.85 I
Owner installation: This installation is being made on property that I own which is not 201 sups to 401) amps I00.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 :imps to 599 antis 133.75 2
Branch circuits - new, alteration, or extension, er and
Owner signature: _.._..-.._ .__--- .__._.._._..- .._.....__ -. _._..___._......._..._.,..Date: _....._..._-.___.--
- -- A. Fee for branch circuits with
❑ APPLICANT d CONTACT PERSON above service or feeder rep.
i 6.65
melt branch circuit
Business name: NORTH SKY COMMUNICATIONS, INC. 13.Fceforbranchcircuits - •
without Son'icc or fcccicr I'Cc,
Contact name: RYAN ROBERTS 46.x5
_ lust branch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Faelladd'I branch circuit _ 1 6.65
- -- -""-' — - Miscellaneous (service or feeder not included)_
City /State /ZIP: VANCOUVER, WA 98684 Each manufactured or modular
Phone: (503) 519- 5264 Fax: : ( )1 - 866- 905 -4907 dctelline. service amVOr feeder 9o.9�T
Reconnect only I 66.65 I 2
1E•ntail: mduoraa northskycomm.com Pimp or irrigation circle - ; 51.40 I 2 .
--
CONTRACTOR Sign or outline lighting I 53.40 2
Business Rattle: NORTH SKY COMMUNICATIONS, INC. energltpanel,alterlimittn. ,----- t energy panel, ahcruiun. tn
Address: 11818 SE MILL _ PLAIN ____ STE 410 extension. Describe: 1 Paget $75.00' 2
City/State /ZIP: VANCOUVER WA 98684 Each additional inspection over Amyl hie in any of the above
Per inspection 62.50 -
Investigation per hour (1 hr min) 62.50
Phone: ( 360) 254 -6920 " 1 Fax: ( ) 1- 866 - 530 -4325 -' --" "- - r -
CCD Lie.: 14117 Electrical Lic.1 154CLE Snprv. I.ic.: 173LEB iii,hi n•in1 plant per hour .. 73.75 - ._ -
Snprv. Electrician signature, required: i -_ _ ELECTRICAL PERMIT FEES
Subtotal: -
-- $75_40__
Print Hama: JACK CAGLE Dale' Plan review (25% or permit fee):
10 -14 -08 State surcharge (12% of permit fee): '.9.00
Authorized signature: /:-.) TOTAC. PERA11'1' FEE: $84.00
'chi,: permit a pplication expires it a permit is not obtoined within It O
Millilame: ETHON A. DOLPH Date: 10 -14 -08 days after it l,ag been accepted as eoanlncle.
- a Ntnnlx:r of irtipeelicns allowed per permit.
I:HL,iklin5,t'ouahsn4I.C•Pvsti App.dnc OV?.trn! .uo.arr lord vu,+ ;Comvnit
CITY OF TIGARD 1
BUILDING DIVISION PERMIT #: ELR2008-00290
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/15/2008
Phone: (503) 639 -4171 �t�6�'Hi� �liI
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/21/2008 TIME: 7:00AM PAGE: 18
SITE ADDRESS: 09740 SW NORTH DAKOTA ST CLASS OF WORK:
SUBDIVISION: DAKOTA KNOLL APARTMENTS LOT #: 006 TYPE OF USE:
PROJECT NAME: DAKOTA KNOLL APARTMENTS
DESCRIPTION: Units D1 -4. Installing fiber optics for Verizon.
OWNER: DAVIS, PETER S & KAREN M BOROSKE, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360 - 254 -6920
Inspection Request Scheduled For: Date 1W21/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 076978-03 971- 563-9326 N
Corrections /Comments /Instructions:
f'
---!.
Z PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CA L FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: / Phone #: (503) 718 -