Permit CITY TIGARD' ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00386
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/5/2007
PARCEL: 2S 104AA -90131
SITE ADDRESS: 12658 SW KAREN ST 13 ZONING: R -12
SUBDIVISION: BELLWOOD TERRACE CONDOMINIUMS LOT: 013 JURISDICTION: TIG
PROJECT: BELLWOOD TERRACE CONDOMINIUMS
Project Description: Install low voltage fiber optics for verizon in units 13 - 18
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:
MOZINSKI, STEVEN P NORTH SKY COMMUNICATIONS INC
ZAKOCS, EDWARD JR PO BOX 87550
PO BOX 189 VANCOUVER, WA 98687
YAMHILL, OR 97148
Phone: Contact #: PRI 360 - 254 -6920
FAX 360- 254 -5097
Reg #: ELE 17- 154CLE
FEES LIC 141171
Description Date Amount
[ELPRMT] ELR Permit 10/5/2007 $75.00
[TAX] 8% State Surcha 10/5/2007 $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 forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 50 .246.6699 or 1.800.332.2344.
Issued : 6 /i j / `/� � Permittee Signature: jj,L, P , / i tc17
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.
10/04/2007 THU 10:11 FAX 00 0 4 / 0 0 6
.'• '4.,..7.. A_ r i 1-6 ibi I) I if7 Mc. 1-3.i4y - 5 -
,
Electrical Permit Application , - - '.. - FOR OFFICE USE ONLY
City of Tigard
q 13125 SW Hall Blvd., Tigard, 0* 22
7
2 : '- Phone: 503.639.4171 Fax: 503 8 19 . :.
= ^'
il ::: 7 60 CEIVE 1 i J i / ,.. s
Plan Review
Date/By: Permit No.: CLIZ Zotpg- —0034
Other Permit:
TIGARD
Inspection Line: 503.639.4175 t I I • I 4 2007 Date Ready/By: in rLs:...._ El See Page 2 for
Internet: www.tigard i Notified/Method: 7 / . Supplemental Information
.: :,-..-:', •:".. :..: ' !'': . '' ,:',..;:;;,:.'f :::.1.5': ,;
0 New construction Please cche all that apply (submit nets of PlataSWiiteans checked below):
SgAddition/alteration/replaceQ16
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current' 0 Marinas and boatyards.
..„ ... . , . ..., ..,...
'..-.,....;..... ::c,A1* ri:; ,.::::: ,::::,:,: e 10,0 atnps at or C om bui ricuiturni
0 1 - and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
% Multi-family El Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
•:::::::::.•::;:...'"...: ' :4
0 4
. ii# 4 *0Ai ' .0.4.0 4 :''.. 1 ....!::::: : ::, ;: '; E E Addition c :f new system, larger separately derived system.
0. tor load of 0 "A", "E", "1-2", "1-3",
Job no.: Job site address: i 2,(1)t ,, ,s W Vq,Ly-ex SA-- . 0 100HP or more.
Six or more residential units. 0 occupancy.
Recreational vehicle parks.
City/State/ZIP' -- 1 . ‘\ 0 0 y r.), 1 r Q__ O 17,7-.7,7 0 Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal. •
0 Service or feeder 600 ateps or more.
Suite/bldgiapt. no.: IA-.. \ ',..., „ Project name: 12) e:A ---r cv,dA
,L ,. ,:-:.,::.,-:::-.':,:..:;1;
Cross street/directions to job site: Description 1 Qty. I Fee. I Total 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. addl 500 sq. ft. or portion 33.40 1
Tax map/parcel no.:
7500 2
Ot..c1 (with above sq
. :'.` , ,I;gi : ;;: : : 'f',:':X::,'?:::;!:::-;:g Limited energy, residential
'.: . a.)
litil .0 \91.>i (1 ,,( Ve/1/1/7JTn Limited energy, multi-family
residential (with above sq. R.) 75.00 2
1 Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
0 .g.;:io# ............... :..:: 0.:::*00,7 ;:: :::..: :::;:::.::,::'...:: 201 atnps 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
Temporary services or feeders installation, alteration, and/or
City/State/Z1P:
. '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 to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for blanch circuits with
APPLICANT •.:•;,:,.,,;: ...::.;.. ,,. ,•:: ;,.. 1Y .. CONTACT PERSON : , :' ; :: ,;;'„ above service or feeder fee,
6.65 2
each branch circuit
Business name: Niag ( .6 1 \iA ( 'APA it.itA,., ( atitilT- B. Fee for branch circuits
without service or feeder
Contact name: M 6 i e \I cqe ')..C- first blanch circuit fee, 46.85 2
Address: t. , , „t t ,
( t) SE, Wk il P\ a-1( \.-) 4 a Each addi branch circuit _ 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: v4, kkilk c U `i., / Each manufactured or modular
90.90 2
• dwelling, service and/or feeder
Phone: ( (42,0 k Fax: : (kaw ) s?" if ?V . Reconnect only 66.85 2
E-mail: .M\\10 e 11 OVOI■Y- \,,, t)V\ kfiq . CA VO Pump or litigation circle 53.40 2
C ON1 It:R:;Vi:M::: Sign or outline lighting 53A0 2
Signal circuit(s) or
Business name: name: S CAMA -1 D--%. 0-0DV -e= energy panel, alteration, or
Address: \ SI S Y\O\ (il\ (J1 ‘92\vd extension. Describe: 1 Page 2 1 2
City/State/ZIP: tky\C(mVe \( v3 A 9 N 8 I Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ("),21,0 ) 2)94 ---t 1...X..) Fax: ( "Nr.O ) 2 - 45 Oal " Investigation per hour (1 hr mita) . 62.50
CCB Lic.: 11.ki \ i I Electrical Lie.: Suprv. Lic.: . Industrial plant per hour 73.75
El.
Suprv. Electrician signature, required: Subtotal:
Plan review (25% of pennit fee):
Print name: Date:
— State surcharge (8% of pennit fee): tO 193
-,/....,-...,--?.
Authorized signitikez...:, 'kwiz:ItZ;Z:Ezti:-.-7- ...... _ TOTAL PERMIT FEE: % \ ,----
yo (...., application expires if a permit is not obtained within 180
6/
Print name: -1 i N . .N...,,,,G; , .. 71 This permit C Date: AC) ,- 4 ., days after it has been accepted as complete.
Number of inspections allowed per penman.
1: \ Elu Rd ing1Permil e‘ELC-Pcrrn itApp.doc 05/25/06 440-4613T(11/05/COMIWEB
CITY OF TIGARD
BUILDING DIVISION ?" PERMIT #: ELR2007 -00386
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/5/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: •10/17/2007 TIME: 7:02AM PAGE: 10
SITE ADDRESS: 12656 SW KAREN ST 13 CLASS OF WORK:
SUBDIVISION: BELLWOOD TERRACE CONDOMINIUM LOT #: 013 TYPE OF USE:
PROJECT NAME: BELLWOOD TERRACE CONDOMINIUMS
DESCRIPTION: Install low voltage fiber optics for verizon in units 13 •• 18
OWNER: MOZINSKI, STEVEN P, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360.:5 -8920
Inspection Request Scheduled For: Date: 10/17/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 0577t34 -03 503 - 849 -5198 Y
Corrections /Comments /Instructions:
A
PASS ❑ PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
n FAIL I I CALL FOR INSPECTION U ADDITIONAL FEES ASSESSED
Inspector: v ` 4 3 Date: to( /1161 61 Phone #: (503) 718- 2i1.14