Permit •
414. i •
TY O R D ELECTRICAL RESTRICTED ENERGY PERMIT
°.' COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00408
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 1 ZONING: R -4.5
SUBDIVISION: KAREN COURT CONDOMINIUMS LOT: JURISDICTION: TIG
PROJECT: BROOKSIDE APARTMENTS
Project Description: Install fiber optic for Verizon. Building 1, units 1 & 2.
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 hs<80 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are forth in OAR 9 0 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503.246.6 99 or 1.800.332.2 • • .
Issued B : Permittee Signatu
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.
ell / 05/2007 MON 10:42 FAX 00 0 2 / 0 0 5
e iluso 2,i( 1-t r 0 Mci/ i-84 Y b- 530 -4 '275
- Electrical Permittit 1 , SI4ka 91\11u1,1111 FOR OFFICE USE ONLY
City of Tigarfferk7
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Fax :1 Dale Ready/By: 5 ;i .4n A .LID ' // 6 . ... )e Permit No.: Ekk,q(197-eo o g
13125 SW Hall Blvd Tigard, •
GO AON Plan Review
Phone: 503.639.4171
Date/By: Other Permit:
Inspection Line: 503.639.417
TIGARD
:
-1 :41e. s formation
Internet: www.tigard-or. 7-- ikk,
ov Notified/Method:
-
,..i: ..;-' .. '';'. ';';'. ;:;•;.:::::.' -....:*:. •".: ; •;':':;.; •: :;•.: . ' '; i :
0 New construction
... ,,„ r ,• /al eration rep acemen -.. . ,,,....... , ..-4,-,- -.•-:,-, 77,1■11
Please check all that apply (submit 2 sets of plans willows checked below):
4 - -
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition El Other: where the available fault current 0 Marinas and boatyards.
.:::,. ''-1 '-: ; •'; ,',:•;;',::•:;;' , S eATEdOW6i?, cOisttRtErioN..-•, :::. .-• ':.:.' • .-:;.-., ,, exceeds 10,000 amps at 150 volts or 0 Floating buildings
, .
' less to ground, or exceeds 14,000 0 Commercial-use agricultural •
El 1- and 2-family dwelling 0 Commercial/industrial El Accessory building amps for all other installations. buildings.
%Multi-family CI Master builder El Other: 0 Fire pump. 0 Installation of 75 KVA or
-. . . „ .. . . . 0 Emergency system. larger separately derived system.
' 2 '•• ' :,:. ; ; l l . 1.. •Jo4 ' ' - .': : ' - ' " - 0 Addition of new motor load of
Job no.: \ , i
Job site address: "V . ,k . ) . 1 1 /,-;ay\ s...\- - or more.
0 Six m more residential units. occupancy.
0 Recreational vehicle paths.
City/State/ZIP: ui 4,13 \ ‘''' ).
, , t, Vt 1 ( ,' (4 1 22 , 0 H ealt e facilities.
°Hazar iocations. 0 Supply voltage for more than
600 volts nominal.
Suite/bldg./apt. no.:NCt ' roject name: 9-2 0 Service or feeder 600 snips or more.
, 3
Cross street/directions to job site: Deseripoon I Qty. t Fan. I Total I
New residential single- or multi-fatnily dwelling unit.
Includes attached garage.
Subdivision: 1 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.:
Limited energy, residential
75.00 2
: ":„ ."-ic:::',:.. l'I :::,' : pgsejoi .:.,:'; ::'L. ...::: (with abo sq. 11)
Limited energy, multi-family
11 ,c1 -?/17 Q,,. [X ) residential (with above sq. 11.) _ 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
1:1- ::::.: : 1 -.; : :::,:::: .... .:121:71*NANT. .. :: .. • 1 201 Sins 10 400 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
Cit y/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 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: --- /..--- --. A. Fee for branch circuits with
. , . . ,- . ... .... ,.... ,,
• . , . '-' ...:: • ',' • ' 0 ..APPLICANT. •::. ' ' - . •:':: • ; .,-';;'... •: . ..... above service or feeder fee,
6.65 2
1
each branch circuit
Business name: No.,/.dp, Q'y /1 '• r Adyn ht;'•1\ [ U ', , 0 )10''
1, kt• - 4 ,i vi - k B. Fee for branch circuits
without service or feeder fee,
Contact name: '' \ \I c 4...A1)C' first branch circuit 46.85 2
Address: 1 ( (6 ST. VA . t1 Pot* ' Each add'I branch circuit 6.65 2
, Miscellaneous (service or feeder not included)
City/State/ZAP: V44116',:./Vtiv ,l'\) A (.,-‘.Y. 1,„9 71 Each manufactured-or modular
90.90 2
dwelling, service and/oi feeder
Phone: ((0)2,r i Fax: : (%6 ) '30.- Li 2 5 , Reconnect only 66.85 2
E-mail: ,M\JNOMS 1') ( t) 41. CA3 fir\ Pump or irrigation circle
53.40 2
:.'.:;,„ . ,h,:..: ..;;:,':-;.:,,". ,,' , ;:.‘ ', i : :„ CON1A; ..-.:.': -::. ':':‘ .,... - .: : -1 ' Si or outline lighting 53.40 2
Business name: 0
' e - CL%. V -P--- Signal circuit(s) or limited-
energy panel, alteration, or
Address: \ SI e, ti ' \ ?\ a io v v - t extension. Describe: Page 2 1 2
City/State/ZIP: tAIAC.0076( ins 9N, Each dditional inspection over allowable in any of the above
i Pcr pection 62.50
Phone: VA& ) -- i Fax: ( ',..,0) 2/94 - ,-..,- 1 Investigation per hour (1 sir min) 62.50
CCB Lic.: \\\'-' i Electrical Lie.: Suprv. Lie.: Industrial plant per hour 73.75
...-: .,,' ....:..,',;iELECTRICAL, :FEES '•.:.'" ':':''''..'...,,::;
Suprv. Electrician signature, required:
Subtotal:
Plan review (25% of permit fee):
Print name: Date:
State surcharge (8% of pennit fee): 19j
Z -
Authorized signatiii'.e - ''"''' TOTAL PERMIT FEE: \ /
'f his permit application expires if a permit is not obtained within 180
Print name: - r rf' , A . A N . wr r , c- - D Date: U.---C...,....01
days after it has been accepted as complete.
* Number of inspections allowed per permit.
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BUILDING DIVISION '
~°~°"~~~~""�~� ~°"°"~~"~~"~ ' PERMIT #: FLR2007-0M013
| 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/5/2007
Phone: (503) 639-4171
Inspection Requoa��4Hmj:�%�S3Q��175 *��� ^�- ..
INSPECTION WORKSHEET FOR DATE: 11/8/2007 TIME: 7:00AhA PAGE: 61
SITE ADDRESS: 12600 SW KAREN ST 1 CLASS OF WORK:
SUBDIVISION: KAREN COURT ONDOMINIUMS LOT #: TYPE OF USE:
PROJECT NAME: BR&0KSIDE APARTMENTS
DESCRIPTION: Install fiber optic for Verizon. Building 1, units 1 & 2.
OWNER: SHEMORE DEVELOPMENT, LLC, PHONE #: '
CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-254-0920
Inspection Request Scheduled For: Date: 11/8K2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 059237-03 503-849-5198 N
Corrections/Comments/Instructions:
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Q.
n PASS 0 PARTIAL APPROVAL n CANCEL 0 NO ACCESS
FAIL I] CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
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|Inspector: ~�� ^ �~W^~mm�«� C� Date: V �^�� - ~� � Phone #: (503) 718- �'0'��c)