Permit , . ., , CITY OF TIGARa' a ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPM PERMIT #: ELR2007 - 00383
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/5/2007
PARCEL: 2S 104AA - 90191
SITE ADDRESS: 12654 SW KAREN ST 19 ZONING: R - 12
SUBDIVISION: BELLWOOD TERRACE CONDOMINIUMS LOT: 019 JURISDICTION: TIG
PROJECT: BELLWOOD TERRACE CONDOMINIUMS
Project Description: Install low voltage fiber optics for verizon in units 19 - 27.
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
FEES Reg #: ELE 17- 154CLE
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 •uestions to OUNC at 503 46.6699 or 1.800.332.2344.
Issued By /� � /� Permittee Signature: loch on
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 05/ 0 0 6
.
'it' ''"- -.'. ''. i 1-6 Plt I) 1 if, atC) / i
. it 11 ,
Electrical Permit A • • licaf by- . ,..-, ,... i
fl FOR OFFICE USE ONLY
City of Tird . . -,
.1 13125 SW Hall ga Blvd., Tigard, OR 97223' '''
Er
Phone: 503.639.4171 Fax: 503.598.160
: : .- 9
,:: 4 2007
t Received
Date/B :
Plan Review
Date/By: ONO S Permit No.: _ 4 ,..... si 53
Other Permit:
Inspection Line: 503.639. 4175 Date Ready/By: lu 6._ See Page 2 for
TIGARD CITY OF fIGARD FA
Internet: www.tigard-orgov Notified/Method: Supplemental Information
9ti ill niNADIIIIION
: ?; : ` - ''**4'*;:j0::*7 - PiTk" . ' , .:'.::::''',::::i - ':':: ',::'::::, •.::..:.1s.::' ,•:,.:':'.'=',".:,:,:.: :'::•::
D New construction ,Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below):
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.
exceeds 10,000 amps at 150 volts or 0 Floating buildings.
01tOok.:pt ::,...:-..-,. .. :, ,,: :.:?:: ..:::. :. :: ,,:
less to ground, or exceeds 14.000 0 Comtnerciai-use agricultural
ED 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations, buildings.
p ' Multi-farnily E Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
, 0 Emergency system. 0 . l . a A rer ,, s 5 e , pa , r , a 1- te 2 1!I l e - r 3 iv , ed system.
-- ',.'.1 :;,:,,::;'a'.;'!: ,JO '....,,:':.::::::-, 0 Addition of new motor load of
100HP or more. occupancy.
Job no.: Job site address: \ .2 C. c; W 'it 0 \ c
. 1 - ..., , 0 Six or more residential units. 0 Recreational vehicle parks.
.
City/State/ZIP --.\ V) 6 \ ,?)., , iN. Q _, (A 'l 7,2-?—) 0 Health-care facilities. 0 Supply voltage for more than
,.. - t...! 0 Hazardous locations, 600 volts nominal.
Suite/bldg./apt. no.: IA: 1 - t; Project name: 12)e_Au .T.- c on k 0 Service or feeder 600 amps or more.
.: SeHEDUtt.';,::;
Cross street/directions to job site: Description I Qty. I Fee. I Total I .
. New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. fi. or less 145.15 4
Ea. addl 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential 75
.00 2
. . :•::::: -..::', ':,; J..1(*SCRIIIIIION':'.010;.'0910<:' ::':; : ::::::::::,-::.:::. (with above sq. fl.)
\
1/1 .:AP 0 - / \9P/t/ ( XV ' ).'\ 1- ):.e/k/V2,,CY) Limited energy, multi-family
residential (with above sq. ft.) 75.00 2
1. Services or feeders installationoilteration, and/or relocation
. 200 amps or less 80.30 2
:,:-::;,;.:.: 0 :.PROP*Iefy 10 :::: :,: : ;?: ...0: :„.i:::: 201 amps to 400 amps 106.85 2
Name: 401 amps to 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
amps 100.30 2
to 400 am
Owner installation: This installation is being made on property that I own which is not 201 amps P
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
, 0 . :. ,A iip t;ic xki....J : ..' ‘: 1, - : , ' , PERSON .:, ,,, :! above service or feeder fee,
6.65 2
each branch circuit
Business name: O DAM t `..\ : "/ . „4 C,t,") ilq t :GA) ( 0 ,ICI T"," 6 B. Fee for branch circuits
without service or feeder fee,
Contact name: \\A bt/\ Or' \\.\ 4 `).- first branch circuit 46.85 2
Address: 1 i (j 1 Y S'E, vv\ 11 I V\ 0:1(AU i() ' Each add'i branch circuit 6.65 2
Miscellaneous (service or feeder not include)
C - '
City/State/ZIP: 0: V\! A 3 y., , I , 1 Each manufactured or modular
90.90 2
, dwelling, service and/or feeder
Phone: (1, w Fax: : (Vp( ) ? ?5 ,
Reconnect only 66.85 2
- E-mail: \ 6 ( \9, 1\101)C en uviut■ \(--q umArt . c., M Pump or inigation circle 53.40 ' 2
'' ;, ? :.:'.,::::;,,,‘, '..,:;' t '.::::,,,,-.;, Sign or outline lighting 53A0 2
Business name:
) CAM -e. 0 O' -e-, - circuit(s) or litnited-
(
energy panel, alteration, or
,
extension. Describe. \ Page 2 1 2
Address: 1 \ SI ( 3, , \ ( \ k \ - \\ c - A (jli 9 2\vri t
City/State/ZIP: ay\C,n\N\icv ‘ A \ 0 9 8 0 g- Each additional inspection over allowable in any of the above
I ' ''' Per inspection 62.50
Phone: (7A0 ) ,i-4 ..t..,q 7 Fax: ( ?),O) ?AL( — i. 1 Investigation per hour (l hr min) 62.50 _
CCB Lie.: \1.\'\ \ 11 Electrical Lie.: Suprv. Lie.: , Industrial plant per hour 73,75
0(UTRItAt'
Suprv. Electrician signature, required: Subtotal:
Plan review (25% of permit fee):
Print name: Date: —
___ State surcharge (8% of pennit fee): tA (9
Authorized signature:.' TOTAL PERMIT FEE: \ ,---
I This permit application expires if a permit is not obtained within 180
6,
Print name: -1 1 V \A /_.(A l f-) C., , (:)D ,. Date: . 10 . ..- LA ...-0 . days after it has been accepted as complete,
y * Number of inspections allowed per pennit.
1: \ Building \ Permits \ ELC-Permit App.doc 05/23/06 440-4615T(1 I /OS /COM/WEB
r e '
CITY OF TIGARD
BUILDING DIVISION
c PERMIT #: ELR2007-00383
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1(360007
Phone: (503) 639-4171 ( A4 01114,10
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 10/16/2007 TIME: 7•01Am PAGE: 54
SITE ADDRESS: 12654 SW KAREN ST 19 CLASS OF WORK:
SUBDIVISION: BELLWOOD TERRACE CONDOMINIUM LOT #: 019 TYPE OF USE:
PROJECT NAME: BELLWOOD TERRACE CONDOMINIUMS
DESCRIPTION: Install low voltage. fiber optics for varizon in units 19 27.
OWNER: MOZINSKI, STEVEN P, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-2546920
Inspection Request Scheduled For: Date: 10/16/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 067657-02 503-849-5198 N
Corrections/Comments/Instructions:
•
1
PASS 1 1 PARTIAL APPROVAL El CANCEL I I NO ACCESS
FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: 6--, i•K:•e) Le" Date: loll 6101 Phone #: (503) 718-
(