Permit C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00289
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/15/2008
PARCEL: 1 S135CA -01702
SITE ADDRESS: 09720 SW NORTH DAKOTA ST ZONING: R -12
SUBDIVISION: DAKOTA KNOLL APARTMENTS LOT: 008 JURISDICTION: TIG
PROJECT: DAKOTA KNOLL APARTMENTS
Project Description: Units: E1 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
L1C 14117
Description Date Amount
[ELPRMT] ELR Permit 10/15/200x: $75.00
[TAX] 12% State Surch 10/15/200€ $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 questio I s 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.
Electrical Permit A �licati ,> `- -,,4, `�..., `' � , _Q ' `Y . Yo.,
. / p y Pl i v�D h; ,`' F�OOFIC Ei , QNY.. . . P o�' ( ;� \ >�� � "
`t .. - 4 City of r11gA CC� D.,,ms , : w ArA G Permit No.: .. A nlfl (I ;�
3 = 1 3125 SW 11:111 Blvd.. Tig, d. Ilan !review -. Va L
• Ph 503.639.4171 Fax: 503.595.19 0i 4 ioaa OlherPc
l).uc /Ily:
'TIGARD Inspection Line: 503.639.4175 0 Date Rattily/By: J VI See Page 2 for
-- • Internet: www.tigard- or, _ov NulifcdAlclhcd: o Supptemental Information
TYPE \ PLAN REVIEW
❑ Nnw COILS) ruelion 1511 A(hl 1 1p��)�` �� IIt( Ploasm cheek ;dl dl :u apply (submit 2 soli of plans w /item: checked below): "M
iJ Sc vice or ceder 100 unpo or inure ❑ Building over three modes.
El De1710111101) - E:1 01 I1U. where the available. (sail current ❑ Marina and h euy;ud5.
CATEGORY OF CONSTRUCTION exceeds 10,0Ull amps at 151) volts mr Q Floating buildings.
105) to gloulld. Ore xceodS 1•I,S00 ❑ Cummncrciai•nsc nlicmhural
❑ I - and 2• family dwelling 0 Conmtcrcinl /industrial ❑ Accessory building
amps tin all odor iustall:nirn5. buildings.
C3 Multi- family ❑ Master builder ❑ Oilier: I CI Fire pump. 0 hlnr or 75 KVA to
JOI3 S1TE INFORI•IATION AND LOCATION i peu,crncncy larger sc(111II y
_ _--__._ ❑ Addition of new motor load of ❑ "A" _( "I?" "I i"
Job no.: 1 Job site address: 9720 SW NORTH DAKOTA ST. IUOtiP or mote. occupancy.
Q Si!: or MOM It:U(1011 l unite. ❑ Recreational vehicle p:aka.
City /State/ZIP: TIGARD, OR 97223 ❑ Hnahh -emro racililicr. ❑ Supply vol Inc for more than
❑ Hazardous !tendons. 600 volts luminal.
Suite /bldg. /apt. no.: E 1 -4 Project name: DAKOTA KNOLLS ❑ set,•kc mr fteder 600 amps ea
�' - -- - - -"-- FEE SCHEDULE
Cross street /directions to job site: nr.r,;,,,o, ) o• I r- (, r „I,1_ I
-- - -- -- New residential single- or multi - family dwelling mail.
-- _ includes attached garage.
Subdivision: - 1 Lot no.: ! 1,000 sq. ft. or less x145.15 I 4
-- - - -- - - - - - -- �_
Ea. add'I 500 u). l). or portion 33.40 I
'I_ax mai /parcel no.: I Limilcd energy, rosidentidl - '- --•-
75.00 2
DESCRIPTION OF WORK (will, above stn. I•) _
Limited energy, ( multi-family INSTALL FIBER OPTICS FOR VERIZON 7500 2
residcnunl (With alm,ec,q. B.) _
Services or feeders installation, alterat ion, :mator relocation
2 00 amps or less 80.30 2 1
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: - - 401 amps to 600 amps 160.60
-
- -� -' 601 amps to 1,000 lamps 240.60 2
Address: _ Over 1,000 amps or voles _- 454.65 I 2
City /Suue /ZIP: Temporary services or feeders installation, alienation, amt /or
_________ relocation _
Phone: ( ) Fax: ( ) 200 amps or less t 66.85 I
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 Co 599 amps 133.75 2
Brunch circuits - new, alteration, or extension. ter panel
A. Pee for branch circuits II -1!11
_ _. _ _ --
- _.___W. _..__._ -_._ -._. __._ ................ ...___ ._.
❑ APPLICANT 0 CONTACT PERSON above service or feeder fee, I
each branch circuit 6.65 2
Business name: NORTH SKY COMMUNICATIONS, INC. I3. Fee for branchcircttil.
RYAN ROBERTS :iJna,rr service I.cdct fee, 46.85 2
Contact name:
lust blanch circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 (:ach...dd branch circuit 1 6.65 2
1 -` -- - Miscellaneous (service or teedet• not included)
City /Slalc /ZIP: VANCOUVER, WA 98684 Each manufactured or modular
dwelling, service and/or feeder 90.90
2
_
Phone: (503 ) 519 -5264 - -- Fax: : ( )1 -866- 905 -4907 Reconnect only i 66.85 I 2
(.- 1t)ail: mduor( northskvcomm.com Pllmporinigationcircle `� - 53.40 2
CONTRACTOR Sign or outline lighting I 53.40 i 2
U -
_._. _.._... ...._...... Signal circuit(s) or limited- -
Bnsincsstlalne: NORTH SKY COMMUNICATIONS, INC. energy panel, alteration, or
Adclr(:ss: 11818 SE MILL PLAIN BLVD. STE 410 extension. Describe: 1 Page 2 $75.001 2
City /State /ZIP: VANCOUVER, WA 98684 Each atlditi011a1 inspection Ove1• allowable in any of the above
Fax: ( ) 1 - 866 - 530 -4325
Per inspection 62.50
Phone: (
360) 254 -6920 investi per hOnr hr milt) 62.50
CCI3 Lie.: 14117 Elccttical Lic.17 -154CL Sultry. Lie.: 173LEB Indllstriad plant P ., hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: $75m
Plan review (25% of permit fee): -
Print name: JACK CAGLE _ Dale:
1 10 -14-08 State surchulgc( permit fee): $9
Authorized signature :__ /. ' . _._ TOTAL PER mr1' 11Eli: $84.00 -
�'�'- 'Phis permit applit•aliun expires if a permit is mot Ohl :titled within 180
Print mllne: ETHON A. DOLPH - -- Dale: 10 -14 -08 lass aver It has been accepted as complete.
- • Number of inspections :dluwcd Per 10rnh.
I: Ilnildingt 1 Il5I1hf,( JJ0.s l 1(1 I/IOCOSIAI•I +n
CITY OF TIGARD
BUILDING DIVISION PERMIT #: EI-R ?008- 0t12t�9
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10f15/2008
Phone: (503) 639 -4171 /aau „I1I I
Inspection Requests (24 Hrs.): (503) 639 -4175 ` - -
INSPECTION WORKSHEET FOR DATE: 10/21/2008 TIME: 7:00AM PAGE: 19
SITE ADDRESS: 09720 SW NORTH DAKOTA ST CLASS OF WORK:
SUBDIVISION: DAKOTA KNOLL APARTMENTS LOT #: Q08 TYPE OF USE:
PROJECT NAME: DAKOTA KNOLL APARTMENTS
DESCRIPTION: Units: E1 Installing fiber optics for Verizon.
OWNER: DAVIS, PETER S & KAREN M BOROSKE, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360 - 254 - 69:10
Inspection Request Scheduled For: Date: 10/21/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 076978 -02 971- 563 -9326 N
Corrections /Comments/ Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
A Inspector: Date. 0 V ' / Phone #: (503) 718-