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Permit 7 , 1 ,-,. '; 11 CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00411 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 4 ZONING: R -4.5 SUBDIVISION: KAREN COURT CONDOMINIUMS LOT: JURISDICTION: TIG PROJECT: BROOKSIDE APARTMENTS Project Description: Install fiber optic for Verizon. Building 41, units 9 & 10. 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 Surchaq 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 forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.66 or 1.80 33 . 1 , Issued / - 0 • , � � . ' Permittee Signa ure: /( r 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. ; r 11/05/2007 MON 10:44 _., 2005/005 / K itb Wei / /-8&)6 - 530 - 5 -- , lectrical Permit App ica ion FOR OFFICE -USE ONLY - ' Ciy Tigard NOV 0 5 2007 Received lEr 13125 t S W of Hall B Tigard, OR 97223 Datc /B I / ©0 � / Plan Review Phone: 503.(39.417 x: 5 5 Date /By: Other Permit: In Inspection Line: 503.0 5 1 l�! T[GARA s p Date Ready /By: Internet: Jwi 0 Supplem See Pave 2 Internet: www.ti o , Notified/Method: D 6 DIVISIOr- 1 Noti (G ental Information . TYPE OF. WORK : •: ` PLAN'REVIEW. : ::.: ` ❑ New construction OAddition /alteration /replacement Please check all that apply (submit Z sets of plans w /items checked below): t ❑ Demolition ❑ Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories. where the available fault current ❑ Marinas and boatyards. ,, , ' CATEGORY. OP - CONSTRUCTION exceeds 10,000 amps at 150 volts or (] Floating buildings. ❑ 1 - and 2 - family dwelling ❑Commercial /industrial ❑ Accessot buildin less to ground, or exceeds 14,000 ❑ Commercial -use agricultural Y g amps for all other installations. buildings. Multi- famil ❑ Master builder ❑ O ther: ❑ Installation of 75 KVA or .;.JOB SITE iNF'.ORIi4ATION `AND. LOCATION • . , e Emhencysyst arg crsc p erivc y ' t arately d d system. s �� � - � ❑ Add of new motor load of ❑ 3 A ", "E ", "1 -2 "I -3 ", Job no.: Job Site address: 2,500 ,'\.) ` IJ ' f y n S of ni nnore. occupancy. �V�`' ❑ S or more residential units. ❑ Recreational vehicle parks. / City /State /ZIP: �i L ' 1 . I O i. � ' 1 '� ❑ Health -care facilities. 0 Supply voltage for more than 1 Y G't t I ❑Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.F t, t11I.) Project name: ❑ Service or feeder 600 amps or more. Cross street /directions to job site: e. EIC:;SCHCDULE Description l Qtp- T Fee. 1 Mini I . New residential single - or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145,15 4 Tax map /parcel no.: Ea. add'I 500 sq. ft, or portion 33.40 1 Limited energy:.. „ residential , resid 75.00 2 DESCRIPTION OF WORK' ;: (with above sq. fl.) [� (�. / 1 r� ` Limited energy, ulti- family 7 51n( 121)• /c ' \ N bt9� 'll iii i VP/V W ) g ( y 75.00 2 t i J residential with above sq. ft.) Services or feeders installation, alteration, and /or relocation 200 amps or less 80,30 2 :'.❑ PROPERTY;OWNER. .':. :: : ` a TENANT,. :,'.,. ,:. :"`' , - 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 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 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel — A. Fee for branch circuits with ❑' :APPLICANT _ CONTACT.:PERSON' above service or feeder fee, Business name: �'� /��h Il �T, r 'r.:�4'��� Wi C (1 each branch circuit C• 2 /Jt- ( l Y V �., v't � V,`� l { 1 � B. Fee for branch circuits Contact name: `\� 1� , without service or feeder fee, " 4 p `� ` `_Ar(7 first branch circuit 46.85 2 Address: ' (<(j 1 C4 SL"' t� V/ i 1 \ t P (k � ; f �'f 4 I Each add'1 branch circuit 6.65 2 t" ` t .. Miscellaneous (service or feeder not included) City/State/ZIP: 1 , r ld) Cit y �t,) �(�•��V"1/V 1 ,��,1� � ���� �F � t Each manufactured or modular • Phone: ( ) l Fax:: t• 7 dwelling, service and /or feeder 90.90 2 -(..( zo ( 8b ) (�7r5 }\ , t7 Reconnect only 66.85 2 E 'VV.10(�)S . enol�A,fK k.1(L) 1 C ONTRACT R'- „ �� .. 53A0 Pump o � ungatuon circle 53 0.0 2 Sign of outline lighting Business name: c) ('i (\,$ O'.j ' Signal circuit(s) or limited- energy panel, alteration, or Address: ` \S 1 e , \,\A\-\ � l /1 9 _ z - extension, Describe: k Page 2 16 2 City/State /ZIP: t\ (0 N V, s �, II\ 9p)(4 ( C -I Each additional inspection over allowable in any of the above ' f 0 4 _ Per inspection 62.50 Phone: ( ) ?, -1, Fax: ( �,O) L( -• nn _ �lJ1 � Investigation per hour (] would ) 62.50 CCB Lie.: \ 1....1 \ -1 1 Electrical Lie.: Suprv. Lie.: lndusttial plant perhour 73.75 Suprv. Electrician signature, required: >] ELECTRICi L” PERMIT( FEES.' :'S...:? ': :: Subtotal: Print name: Date: Plan review (25% of permit fee): — .- State surcharge (8% of pcnnit fee): ld d Authorized sigma rte: ?"°°' ` ':=�; _ - I -: TOTAL PERMIT FEE: F This permit application expires If a permit is not obtained within 180 �. Print name: f/i 1 I\ . V\ n' i l (� /1 ( ` J� i y ` 5 Date: 4 -� (r - days after it has been accepted as complete. * Number of inspections allowed per permit. t:\ anitdiee \Permiis\ELC- PcrmimApp.doc 05/23/06 440. 46157(11 /05 /COM' \VEB " CITY OF TIGARD BUILDING DIVISION PERMIT #: FM2007-00411 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/5/2007 Phone: (503) 639-4171 Atbi inAill ill\ Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 11/8/2007 TIME: 7:00AM PAGE: 53 SITE ADDRESS: 12500 SW KAREN ST 4 CLASS OF WORK: SUBDIVISION: KAREN COURT CONDOMINIUMS LOT #: TYPE OF USE: PROJECT NAME: I?3ROOKSIDE APARTMENTS DESCRIPTION: Install fiber optic for Verizon. Building 41, units 9 & '10. OWNER: SHEMORE DEVELOPMENT, LLC, PHONE #: CONTRACTOR: NORTH SKY COMMUNICATIONS INC PHONE #: 360-25(4-6920 Inspection Request Scheduled For: Date: 11/8/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 059237-01 503.849-5198 Y Corrections /Comments/ Instructions: DV) — I I PASS PARTIAL APPROVAL El CANCEL NO ACCESS _ 0 FAIL El CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: G" K ( Se) 1 .--g - Date: ti • t* 01 Phone #: (503) 718-