Permit •
I t CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2009 -00151
1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/04/2009
• T
Parcel: 2S102BD02201
Jurisdiction: Tigard
Site address: 9980 SW WALNUT ST 27
Subdivision: Lot: 0
Project: Chalet Village
Project Description: Install fiber optics for Verizon.
FEES
Owner:
CHALET VILLAGE LLC Description Date Amount
TWO CENTERPOINTE DR STE 210 Restricted Energy Permit 06/04/2009 $75.00
LAKE OSWEGO, OR 97035 12% State Surcharge - Restricted Energy 06/04/2009 $9.00
PHONE:
Contractor:
NORTH SKY COMMUNICATIONS INC
11818 SE MILL PLAIN BLVD, SUITE 410
VANCOUVER, WA 98687
PHONE: 360 - 254 -6920
FAX: 1- 866 - 905 -4907
Type of Use: MF
Class of Work: • ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: Y Fire Alarm: N
HVAC: N Instrumentation: N Total $84.00
Intercom/Paging: N Landscape /Irrigation: N
Required Items and Reports (Conditions) . •
Landscape Lighting. N Medical: N -
Nurse Calls: N Protective Signal: N
Security Alarm: N - Other: N
Other Desc: •
This permit is issued subject to the regulations contained in the Tigard Munlapal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952- -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: OA/ /5 - T/D#\/
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' Date:
LICENSE NO.
Call 603.639.4176 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. • - ,
I
RECEIVED
JUN 01 2009
Electrical Permit Applicatlef -.. FOR OFFICE USE ONLY:: ,;... - .. : ::. ? ?,.•j, OF TIGARD .
• ' ' City SW Tigard DI �ASIMM vennu "".'k t2 -• /0 —
� 13125 SW Hal( Blvd . Tlgur '!��
r
Phone: 503 639.4171 Fax• 503 598 1960 Other Pooh.
TIGARD Inspection Line: 503.6394175 DateReady / ® See Pone 2for
Internee www.dgnid -or gov Notified/Method. MI Supplemndnllnformatinr
TYPE OF WORK '• . - - PLAN REVIEW -
❑ New cow: Unction 0 Addition /alteration /replacement Pltn.c chat :al Out apply (suba 3 sets in !lens olacros (inked hclon):
0 cewice or (ceder aun,.. p, or owe ❑ anl,ding over a,mt ato•:es
0 mm011110,1 Other: whew ito:uo.lilahle fad! enrlmll ❑ Mannar amt hnuly•uAc
• CATEGORY OF CONSTRUCTION , - - .' . ea'CCdr 10.000 mops at ISO tole. or 0 f loringbwWmga
Ion to gruuml. oreeeredr 14000 0 CannlrorcPll•moag Icuhurd
❑ I - and 2- fmnily dwelling ❑ Co,nmcrcinl /inchlstrial ❑ Accessory building mops tor nil other ludnanuuos bluldu>gs.
O 84'111i-family 0 Maale' builder ❑ Olhe, • 0 Fite p ❑ Inanllncion of 7S KVA Or
' 1 JOB SITE. INFORYIATION AND LOCATION Q Ln.Crgcu y rymml• Iarhr r uepvnmly ACrived ry■uecr.
' 0 Addition or etwmotAr i n adof ❑ "A "•I) "I- 1'•'I.1.
Job no., Job sue address: 9980 SW WALNUT rlklHP urmelt Ixellpancy
Q Sir In lucre rcrirleouul voile. ❑ Reercurinnal selri,.le !trio,
City/State /ZIP: TIGARD, OR 97223 0 Heaun•ea,e sedum, 0 supply vlurage fro nwre luau
Q Ha/aulous lululn)10. 600 vole nnminul
Suuc /bldg. /aph no '1 Projcct name: CHALET VILLAGE ❑ Scrvi.0 0r ter da IMO o,npr „o,
' . FEE 'SCHEDULE '
Cross snccl /c(ircctions to job sae: V ` ur,rrhubm 1 Oa. I Pm. I 'mini I .
New resiientlul single. or nudtl4x,nlly dwelling unit.
Includes nttnched garage,
Subdi vision: Lot no.: 1.000 sq. It. or Icon 145.15 -- � d
Tax nu,p /p :vcul Ito.: La. add'I 500 'Ai It. or pomnn 33.40 1
Limited CIICI'gy. rechim ial
75.00 2
DESCRIPTION OF WORK (Oil, doiue Slim.)
INSTALL FIBER OPTICS FOR VERIZON L,n„tedtenergy, malll- Ittlnlly 7500 2
residenlidl (with nh,rve « n.)
Scrvtces or fecdcra ina1nitntIon_oltcradon, and/or rrolavatlon
200 mops or Icon 80.30 ' 2
.'❑ PROPiiR'1'Y.OWNER ' '❑ TENANT ' - 201 map% lo 400 maps 106.85 2
Name: 401 Amps to 600 Amps 160.60 2
601 amps to 1,000 amps 240 60 _ 2
Address. Over I,000 or volts ^— 454.65 2
City /Stone /ZIP: 'temporary her vicev or feeders installation, :dtcrtilon, and/or
relocation
Phone: ( ) Fox: ( ) 200 amps of Ie.r 66.85 I
Owner instullnitun: This installation is being nodc on properly dial I own which is not 201 amps to 400 amps 100 30 2
intended for sale, lease. rem, or exchange, according to OHS 447, 449, 070, and 701. 401 amps to 599 amps 133.75 _ 2
Branch circuits - new, idleratlon or exlcnslon per Panel
Owner signature: Dale: ___ . _ .. _ __ ___ A 1'CC for brooch cireuJS nrrb P P '
❑ APPLICANT I CI CONTACT PERSON above u, vice or feeder fro,
•
rich brunch circuit 665 2
Business name: NORTH SKY COMMUNICATIONS, INC. B. Fee for branch circuits '
Concoct name: ERIK SCHENCK without scrvicca !ceder fee, 1685 2
lint broach circuit
Address: 11818 SE MILL PLAIN BLVD STE. 410 Each am' blanch ci,cllil I 6.65 2
Miscellaneous (service or feeder out includedL_
City /Slate /ZI VANCOUVER, WA 98684 Each munufaclured
Phone: (503 ) 969 -7729 I Fax:: 866 d`vettioa, wrvice nnNur (cede,
00.90 2
( ) 452 -4853 Reconnect only 66.85 2
E -mail: mduorlanorthskycofllm,com Pump orrn;gadunctrclu 53,00 2
CONTRACTOR Sign or outline. lighting 53.40 2
Businessna111e: NORTH SKY COMMUNICATIONS INC, Mgn°leheol`(`)nrtimited-
rangy panel, Aeration. or
Address: 11818 SE MILL PLAIN BLVD. STE 410 ex'er'tion Describe: 1 P,,goz $75.00 2
City/State/ZIP: VANCOUVER, WA 98684 Each eddllionxllimpeclion over allatrnhioIn any of the above
Phone: ( 360) 254 -6920 Fox: ( ) 1 -866- 530.4325 _ Per inspection 62.50
Grvcaligndna per hour ii hr mien 62.50
CCB Lie.: 14117 Electrical Lic.17 -154CL Stipp, Lie.: 173LEB htdnhnial plant (whom' 73.75
' - ELECTRICAL PERMIT FEES '
Suprv. Electrician Signature, required: Subwlnl: $75.00
Print lining:: JACK CAGLE Date: 6/1/09 Phm review (25% m permit fee):
State surcharge (12% of permit fee): $9.00
Annumir_ed signature: 4 0, TOTAL Pf;Bhll
'ftilil5: $8L1,00
Print "nme. ETHAN A. DOLPH Date: 6/1 /09 't'lrls limeade upplh nduo v.pirvr If :I parson Is not obmltted utddn 180
lops Ace II h.0 ben, aecepled A. wulplcl,
• Number orlusptrdun, ulluwed Ixr rxr
nla,nu ngv'rrna,al. C reon.App.rIoe OIavo4 err 4131Ymuns/COatnv, :n