Permit 111 CITY OF T I GA R Dt ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00384
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/5/2007
PARCEL: 2S104AA -90011
SITE ADDRESS: 12666 SW KAREN ST 1 ZONING: R -12
SUBDIVISION: BELLWOOD TERRACE CONDOMINIUMS LOT: 001 JURISDICTION: TIG
PROJECT: BELLWOOD TERRACE CONDOMINIUMS
Project Description: Install low voltage fiber optics for verizon in units 1 - 6.
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 q - tions to OUNC at 503. • x.6699 or 1.800.332.2344.
Issued By: / /// Permittee Signature: A
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 10:10 FAX 00 0 2/0 0 6
ilie e i 1 V./ 16(- tt il I )(- MC' / — go . ,& - 5,.40
Electrical Permit Application : FOR OFFICE USE ONLY'
City of Tigard
ii 13125 SW Hall Blvd., Tigard, OR 97223
n 5 67- S
M ill
: ' Phone: 503.639.4171 Fax: 503.598.1960 Received i r
Date/By: /l/
Plan Review
Date/By: Permit No.: E. _wee/
Other Permit:
TIGARD
inspection Line: 503.639.4175 Date Ready/By: J,0 e ...... El See Page 2 for
www.iigard ww.tigard Notified/Method: Supplemental Information
0 1 * . Of!' r 4 i ik r n i gttitiCilt . .l f : ''....: '::::''.."::::...:.: "..;
0 New construction jaAddition/altertion/reXctrnPnr 1 = 0 L -I Please check all that apply (submit 2 sets of plans whims checked below):
0 Service or feeder 400 amps or more 0 Building over three stones.
O Demolition 0 Other: ' 4 7007 where the available fault current 0 Marinas and boatyards.
CATEGORY OF CON'1RL1CTI exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 0 Commercial-use agricultural
E 1- and 2-family dwelling 0 Cominercial/irWalar It,' I c •_v_building amps for all other installations. buildings.
LAW ••
%multi-fan-lily 0 Master builder • * her. • FM 0 Fire pump. 0 Installation of 75 KVA or 0 Emergency system. larger separately derived system.
. , !PP' - .§ITg -1 N.F9 1 01119N:;A19 ,.. : 1 ; 6 C4i.P1' 1 ..; . :'' '' ::"' ' 'S :...'.. , :' :I 0 Addition of new motor load of
r i, 10011P or more. occupancy.
Job no.: Job site address: VitAf c N . ' tk \/- `: .
0 Six or more residential units. 0 Recreational vehicle parks.
1 J
City/State/ZIP: \ ; () n'' 'tar); . T• '‘ (A - 17 2.: ;2-) 0 Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
, • ,, ,■ 1
Suite/bldg./apt. no.: tfi I ---y) Project name: 9 CV\ ‘ ‘17 t r ....,0 (KC> 0 Service or feeder 600 amps or more.
: iSO40OU
Cross street/directions to job site: Description ( qtv. I Fee. I Tutu! 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'l 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential
75 00 2
i' (with above sq. ft.)
A 6 1 . /
\ , ,..
yv K v. , Obi ,..,.,;). ii..4 •1(:?/t('k'9,..0() Limited energy, multi-family
residential (with above sq. A.) 75.00 2
t , Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
. - . ... .• . ••, ...•• •., . ,. , - •... ••_,• . • : .. • . .
L:1 PROPERTY : pyy.N4: ,..:: .:.' : .:.1:1 .':' :.:. : . l.: ..:....-.: , 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
. Temporary services or feeders installation, alteration, and/or
City/State/ZIP:
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85
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
. ,.:1:1 . :4 . pi):L,J0,1■11" ,.::::::;,:,:,.. ]:.::: ' CONTACT ,.:.::1- .• PERSON !:. ! ... : .:• .. above service or feeder fce,
6.65 2
each branch circuit
Business name:
1 -A ( r );', ; C C "S• ' i k '; ' • , 0" - 1 ' •,
1t13 ‘ -; j- , ,./..it 1 ti\ i ( ,:.!), ,,0,1,--)A. B. Fee for blanch circuits
without service or feeder fee,
Contact name: Mb y\e \\cqeivi)c..., first branch circuit 46.85 2
Address: •
1 k t.) S'i-> W\ '\ P\AA(1. ii .,, ' Each add'I branch circuit 6.65
Miscellaneous (service or feeder not included) 2
City/State/ZIP: VotAt'Arj), 1,, c)y i Each manufactured or modular
90.90 2
. dwelling, service and/or feeder
Phone: ((00) k Fax: : (gipt ) 5.30- Li ?
Reconnect only 66.85 2
E-mail VVjcvcxbc efovion54... UM kii( . Ct_ W1 Pump or inigation circle 53.40 2
.. 0 - .0r4 - 7, , ,e - t :Ii..: ...:...:... . si or outline lighting 53A0 2
) WV\ -e, ek.- 06V 1)--' Signal circuit(s) or limited-
Business name:
energy panel, alteration, or
I ,
Address: ‘ \(
extension. Describe: Page 2 1 2
W ‘ ' f \ (AM
City/State/ZIP:\ O \M A 9(n 81 Each additional inspection over allowable in any of the above
1 Per inspection 62,50
Phone: (72V,0 ) 7,94 ---V-il,-.4) Fax: ( ?,*-,0 ) .4LI -- r A o —1
-_-_-,u 1 I Investigation per hour (I hr min) 62.50
CCB Lic.: \ /..4 1 \ -1 1 Electrical Lie.: Suprv. Lie,: Industrial plant per hour 73.75
t.LECTRIGAL:..PERMIT.:FECS'':''
Suprv. Electrician signature, required: Subtotal:
Plan review (25% of permit fee):
Print name: Date:
: State surcharge (8% of fee): --t, co
t- ,,:,„--)_„ .. „_._ .--, ,
Authorized signatu ----- „.. TOTAL PERMIT FEE: %1 •.---
, , .._
. application expires if a permit is not obtained within 180
Print name: <fv i iN . v\n,,y.,. c ,c.... : Date: , its. , ... - L - 0.1 This permit days after it has been accepted as complete.
/ " — . ., -
* Number of inspections allowed per permit.
I: \ Building \ Permits\ ELC-PennilApp.doc 05/23106 440.461 ST( I I /05/COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: FLR2007-00384
13125 SW Hall Blvd., Tigard, OR 97223 •.- DATE ISSUED: 10/5/2007
Phone: (503) 639-4171 Ar4Pipit
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 10/17/2007 TIME: 7:02AM PAGE: 12
SITE ADDRESS: 12666 SW KAREN ST 1 CLASS OF WORK:
SUBDIVISION: BELL WOOD TERRACE CONDOMINIUM LOT #: 001 TYPE OF USE:
PROJECT NAME: BELLWOOD TERRACE CONDOMINIUMS
DESCRIPTION: inSi all low voltage fiber optics for verizon in units 1 - 6.
OWNER: K1OZINSKI, STEVEN P, PHONE #:
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-254-6920
Inspection Request Scheduled For: Date: 10/17/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical finI 057784-01 503-84a.5198
Corrections/Comments/Instructions:
(N,
PASS 7 PARTIAL APPROVAL 7 CANCEL NO ACCESS
FAIL CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: CT B Date: IC( I 1101 Phone #: (503) 718- 7
•