Permit Er * tITY O F TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00409
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/5/2007
PARCEL: 2S 103BB -03300
SITE ADDRESS: 12500 SW KAREN ST 2 ZONING: R -4.5
SUBDIVISION: KAREN COURT CONDOMINIUMS LOT: JURISDICTION: TIG
PROJECT: BROOKSIDE APARTMENTS
Project Description: Install fiber optic for Verizon. Building 2, units 3 & 4.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: DATA : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
SHEMORE DEVELOPMENT, LLC NORTH SKY COMMUNICATIONS INC
BY MARIANNE SHEEDY, MEMBER PO BOX 87550
12500 SW KAREN ST VANCOUVER, WA 98687
TIGARD, OR 97223
Phone: Contact #: PRI 360 - 254 -6920
FAX 360 - 254 -5097
FEES Reg #: ELE 17- 154CLE
LIC 141171
Description Date Amount
[ELPRMT] ELR Permit 11/5/2007 $75.00
[TAX] 8% State Surchaq 11/5/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
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 arth ii c ; R 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503.24 .6699 or 1.800.3' _ 44
Issue By: k r /� f Permittee Signatu . i;• ��
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.
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11 /05/ 2007 MON 10: 43 FAX
Is. I]003/005
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S- WO r
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Electrical Permit YOR OFFICE USE ONLY
City of Tiga'd
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. , ' , '‘.-:,,:' • . ,fflill! Received
,,,,. paws ,s #757 A Permit No.: e „,,., 7 .„,,,,9
; .. 13125 SW Hall Blvd., Tigard, OR 97223
• Phone: 503.639.4171 Fax: I ,
III
Plan I R B e y v , Review
Other Permit:
TIGARD
Inspection Line: 503.639417 11 ' .
1 " 2007 Date Ready/By: "7,- el See Page 2 for
Internet: www.tigaickw Notified/Method: (C Supplemental Information
. :,'...'. : ;: .•-• ;,,:::: : .;': .' , : ::: .: .1:.0' ' :: . ',:' ,. '.‘.: . : : . -..: :::..!,:440,i'Vf%ii& id , N : : :.'', '..;-'::,..,,'':...::::-,::- : '':::.: :',.:.::- .,.:
0 New construction B pail i .,d1)11gGnolpviSiluN- Please check all that apply (subinit 2 sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 DeDIOlitiOrl 0 Other:
where the available fault curlew 0 Marinas and boatyards.
CATEGORY OF COI"ST.RLICT1ON ; :. , . ; exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 0 Commercial-use agricultural
0 1 - and 2-family dwelling E) Commercial/industrial 0 Accessory building amps for all other installations, buildings.
' Multi-family 0 Master builder 0 Other: 0 Fire pump 0 Installation of 75 KVA or
..: ''".''',.
0 Emergency system, larger separately derived system.
'' S E .*:' ': '''•'..:‘'.
.. „ .. ,. ... . ....... ..
Job no.: Job site address: '2X)00 SW k ,.._.\-- . loofir or more.
CI Six or more residential units. occupancy.
0 Recreational vehicle parks.
City/Statc/ZIP: `. J4.— Olin?, .. 0 Hcalth-care facilities 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
,
Suite/bldg./apt. no.Ncei, if, 3,4Project name: .1 AV t '
c , 0 Service or feeder 600 amps or more.
l: SCHF)M.U.':,,: .:'.',: ;
Cross street/directions ?o job site:
Description I On. I Fee, I Taint i .
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add') 500 sq, ft. °rpm 33.40 1
Tax map/parcel no.:
75.00 2
Ii000.17.10r4:0T,..A : (with above sq Limited energy, residential
:::'.,-.. . JO
. \ Limited energy, multi-family
11/1af,T,P,/ Vi,f'sr)r) residential (with above sq.111 75.00 2
9
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
0 : PROP.F..1271Y -, :,i.:..:. .'•-; Q '.1 :;:.1::.- -1: • 201 amps to 400 amps 106.85 2
Name: 401 amps 10 600 amps 160.60 2
601 amps to 1,000 amps 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: ( ) Fax: ( ) 200 amps or less , 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps 10 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new alteration, or extension, per panel
Owner signature: Date:
A. Fee for branch circuits with
: : ,.;...•.',.: '.: i '' :PERSON ;:l •.:. ... ''-.. above service or feeder fee,
6.65 2
each branch circuit
Business name: t,( (.,' ci Li '1 A ( 0 )'" -g14. E. Fee for branch circuits
Contact name: without service or feeder fee,
ne: MOV\e c \iem)...c. first branch circuit 46.85 2
. , , ,„/ t
Address: 1 ( (4 1 / V A 1 \ I 0 Ov‘i \ A \fa \ Each addl branch circuit 6,65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: \Whenj,..Vtv/ WA <,-)A L671 Each inanufacturecl or modular
dwelling 90.90 2 , service and/or feeder
Phone: ( '&30) '15t.,/,... vqw■ Fax: : v 530,- q 2 ) 2,5 . Reconnect only 66.85 2
E-mail: tE.,ii_qms_en0v0A9"--.\1(tivy\63 Pump or inigation circle 53.40 2
014.:4AcTlpk,: ',-,..:::,-;::,',:.,;.': ,:..':,.:: .:' :. ,.:::,' ' '....,:,',.,'. Sign or outline lighting 53.40 _ 2
Business name: 0
) CPY\A 42, ,-toov-e- Signal circuit(s) Or 1111111.0d-
energy panel, alteration, or
Address: 1 \ SI S e" V am 7\v extension, Describe: Page 2 1 2
City/State/ZIP: ‘\ ay\c v,, I.A, 9Nfigl Each additional inspection over allowable in any of the above
Per inspection , 62.50
Phone: (7,V0 )2.1 --1.20 Fax: ( '.,,00) 7,„Gt-t — /,',30.61 1 Investigation per hour (1 hr mitt) 62.50
CCB Lie.: \I...V\ 0 1 Electrical Lie,: Suprv. Lie.: Industrial plant per hour 73.75
.'.•:1 :
Suprv. Electrician signature, requited:
Subtotal:
Plan review (25% of pennit fee):
Print name: Date: —
State surcharge (8% of pennit fee): LO
Authorized TOTAL PERMIT FEE:
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This permit application expires if a permit is not obtained within 180
Print name: -' N . \IVVYAR,IA(../. CPC) '
Date -
I ' : II.--(--)-01 days after it has been accepted as complete.
'' Number of inspections allowed per permit.
1:113uilding \PermitslDhC-PermitApp.doc 05/23/06 440-4615TO 1/05/COM4WEB
, .
Or) OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007-00409
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/5/2007
Phone: (503) 639-4171 A -
thy04 41410(Iii"
Inspection Requests (24 Hrs.): (503) 639-4175 A-1,91■ 1.I..
. INSPECTION WORKSHEET FOR DATE: 11/8/2007 TIME: 7:00AM PAGE: 52
SITE ADDRESS: 12500 SW KAREN ST 2 CLASS OF WORK:
SUBDIVISION: KAREN COURT CONDOMINIUMS LOT #: TYPE OF USE:
PROJECT NAME: BROOKSIDE APARTMENTS
DESCRIPTION: Install fiber optic for Vorizon. Building 2, units 3 & 4.
OWNER: SHEMORE DEVELOPMENT, LLC, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-254-6920
Inspection Request Scheduled For: 11/012007 Pour Time:
Date:
Code # Inspection Description • Confirm # Contact # Message
199 Electrical final 059237-02 503-049.5190 N
Corrections/Comments/Instructions:
.
/s i
n PASS 1 I PARTIAL APPROVAL FI CANCEL n NO ACCESS
n FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Cy-. i\VSGL. Date: II ' 8 (Y Phone #: (503) 718- 1)4
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