Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00410
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/5/2007
PARCEL: 2S103BB -03300
SITE ADDRESS: 12500 SW KAREN ST 3 ZONING: R -4.5
SUBDIVISION: KAREN COURT CONDOMINIUMS LOT: JURISDICTION: TIG
PROJECT: BROOKSIDE APARTMENTS
Project Description: Install fiber optic for Verizon. Building 3, units 5 thru 8.
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 Surchar€ 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 set . • OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503.246...99 or 1.800.3 . .
Issue. Bye Permittee Signatur-: �tL ,
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.
•
i
.11 /05/2007 MON 10: 43 LX , ,..,,,, U004/005
Ei ,.
. ' °:! '''''' '',:.
.
:,..: ,..._„, pxy,,iix
Electrical Permit Abp 1 .- .' , .:. '-':'. '::',•,: • .1 OFFICE USE ONLY .. • •
:11 .,., City of Tigard NO 05 2007 Received
Date/By: 1/ 6 et 7 *y mit Per No.: . ea A -oc3 4.)
" 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
- 7 . Phone: : 503.639.417r9
5v uto IR_ j ARD Date/By. Other Permit:
TIGARD
Inspection Line: 503%.39-Fi 5 1 : Date Ready/By: itis--- El See Page 2 for
Internet: www.ti3doity Tr\TO Dr‘ji S I 0- I Notified/Method : ---, id" Supplemental Information
f ..:::::::-. ..•,•.- ;'..:''': • - .'' .- ..: ::';':::;•:::.:•
0 New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans Wilms checked below):
0 Service or feeder 400 amps or more 0 Building over three stories,
D Demolition 0 Other:
where the available fault curient 0 Marinas and boatyards.
::,....:..!..•::::::,:-::, .'..,::'.;.. i dA.T*(;00'10.:(01■jgAileTiON., ;1,1 :,'• :... ,.:,,,.. :-,::.: ..,'...:,' exceeds 10,000 amps at 150 volts or 0 Floating buildings .
- - less to ground, or exceeds 14,000 1:1 Commercial-use agricultural
El 1 - and 2-family dwelling 0 Commercial/industrial El Accessory building amps for all other installations. buildings.
%Multi-family Ej Master builder El Other: 0 Fire pump. 0 Installation of 75 KVA or
jOi3: il ...: ..,:,,::,, .. ... :,:: El A E I o e i i: c
s n Y e s w iel lnbior load of 0 La vta cynicism
Job no.: Job site address: 2_,500 )k) v,,, ;,..\-- . 100HP or more.
0 Six or more residential units. 0 occupancy.
Recreational vehicle parks.
City/State/ZIP: '141\ 1 0 V oi 7:22, 0 Health-care facilities. 0 Supply voltage for more than
, 0 Hazardous locations 600 volts nominal.
Suite/bldg./apt. no.ki ..,- Project name: Q k 0 Service or feeder 600 amps or more.
' ' - . Ftkt:SciiEpvLE , :...:
Cross street/directions to job site:
Description I Qty. I Fee. I Tool I 't
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'I 500 sq. ft. or portion 33.40 1
Tax map/parcel no.:
Limited energy, residential
DESCRIPTION OF WORK (watsnbovesq 0 ) 75.00 2
' Limited energy, multi-family
residential (with above sq. it) 75.00 2
Services or feeders installation _alteration, and/or relocation
-
200 amps or less 80.30 2
" -•.•. •-. .- .•, . . ._..:.... ... : .,
• :,' .:::::;- .:' 0;PAPPERTY, OWNER .' 7 .,• -. : :',.-,..:.:,:': ,'... -..-' - 0 TENANT -:;.,,-, :: - 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/Statc/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 to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps 10 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date:
A. Fee for branch circuits with
'' '::.., .....',.. - . :. - -. ...- .. ' i:ONITA6:PERSON ::.... ':''- above service or feeder fee,
6.65 2
il each branch
Business name: t\IDA 9;11A U(:)4'&.lik t/,:it-10, (. 0_11 B. Fee for bra»ch circuit circuits
\\. without service or feeder
Contact name: \ 0 y‘e fee, 4.-- 4)1(1)...C---- first branch circuit 46.85 2
Address: . 1 , ■.; (,:. t 0 ,
W\ i \ \ P ovk 0. Each addl branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: VoArltD/V-(A/ to\ (..)c u.,,, > -- 7 Each manufactured or modular
90.90 2
dwelling, service and/or feeder
Phone: ( b(';,0)2,C,---A-..., A2 I Fax: : (V ) 5 2
Reconnect only 66.85
2
E .TYA Ve)a)S enoviOAY-Ac.t)Ai\\in. Ct) M Pump or inigation circle 53.40 2
04:iNTRAtT.01,0.,::;:.2':::,.:.:=: ::::':;:„ ::'.;: '.: :,..•'::.' ''' :-.::::;-:: Sign or outline lighting 53.40 2
Business name: Q
0 OLP(A-E, (:k- 0-;(.)0\iL Signal circuit(s) or limited-
energy panel, alteration, or
'
Address: \ \S,1 'i, e, WO\ cA (iut/i ‘9 extension. Describe: Page 2 le 2
City/State/ZIP: ky\Go\j v , \ I t\ a
9 F gi Ech additional inspection over allowable in any of the above
' i . '' Per ins 62.50
Phone: 02(69 ) 2 ,r,-).[..... v ... i ..i Fax: ( v 2 „GO.-1 - 456:1 1 Investigation per hour (t hr min) 62.50
CCB Lie.: 14 \ 0 1 Electrical Lie.: Suprv. Lic.: Industrial plant per hour 73.75
..',:'.''', .ELECTItItALP-ERMIT-.E.ES:::::::'"::.-::::''.::'.:::::;2,
Suprv. Electrician signature, required:
Subtotal:
Plan review (25% of permit fee):
Print name: Date:
..__- .-) - State surcharge (8% of permit fee): i0 6)
Authorized signatiee' --7-7--"•*Z.174,----`..---:---.. TOTAL PERMIT FEE: % •-•""
Print name: f
This permit application expires if a permit is not obtained within 180
- 1 '.. -(?/vi „\, . \A \(,((/t ( - C 9 Date:
- 1 - - "-----) - days after it has been accepted as complete,
. Number of inspections allowed per permii,
1.3Building TcrmitsTI.C-PerrnitApp.doc 05/23/06 440-4615T( I I/05/COWWEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007-00410
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: •11/5/2007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 11/8/2007 TIME: 7:00AM PAGE: 49
SITE ADDRESS: 12500 SW KAREN ST 3 CLASS OF WORK:
SUBDIVISION: KAREN COURT CONDOMINIUMS LOT #: TYPE OF USE:
PROJECT NAME: BROOKSIDE APARTMENTS
DESCRIPTION: Install fiber optic: for Verizon. Building 3, units 6 thru 8.
OWNER: SHEMORE DEVELOPMENT, LLC, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-25443920
Inspection Request Scheduled For: Date: 11/8/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 059237-04 503849-S198
Corrections/Comments/Instructions:
PASS PARTIAL APPROVAL IJ CANCEL 0 NO ACCESS
I I FAIL 0 CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: Qr. fS 61-e Date: it - 01 Phone #: (503) 718- 14%)