Permit o .
III CITY O F d'T I`A R D ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00387
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/5/2007
PARCEL: 2S 104AA -90281
SITE ADDRESS: 12646 SW KAREN ST 28 ZONING: R -
SUBDIVISION: BELLWOOD TERRACE CONDOMINIUMS LOT: 028 JURISDICTION: TIG
PROJECT: BELLWOOD TERRACE CONDOMINIUMS
Project Description: Install low voltage fiber optics for verizon in units 28 - 33.
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 questions to OUNC at 50 . 46.6699 or 1.800.332.2344.
g
Issued B . et Ai�L , 1 Permittee Signature: �� J��f�
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 10:12 FAX 21006/006
11 4 4} u7.0 -rah K '11' ) tiA /—s - Sao -17 :2 —
Electrical Permit Applicati FOR OFFICE USE ONLY
City of Tigard
lECEIVED Received ! o� S Pe nnilNo.: 6,j4,200,9---6638.1
Er t 13125 SW Hall Blvd., Tigard, OR 3
972 T 4 Plan Review
• Phone: 503.639.4171 Fax: 503.598.19 0 �oOf Date /By: i 0 J pate /By; OtlterPermit:
TIGARD Inspection Line: 503.639.4175 Cl i 6 1 Date Ready /By: Juris: 6'J See Page 2 for ow , Internet: www.tigatd- or.gov pp � Notifkd/Method: Supplemental Information
EVL,.
❑ New construction Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition ❑ Service or feeder 400 amps or more 0 Building over three stories.
❑ Other: where the available fault current ❑ Marinas and boatyards.
: CATEGOR]'' ;OF. ?,CONSTRUCTION : ` '.r : ;; '.` <'. 1 . ": exceeds 10,000 amps at 150 volts or ❑ Floating buildings-
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ i - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for ail other installations. buildings.
Pro
'Multi- family ❑ Master builder ❑ Other: ire pump. ❑ Installation of 75 KVA or
'":1..;.'.1'-::: .:::i: '. :,:: . r ,. >:. rgepately derived
. , , :.:.: .. , .:, : ,.: ❑ Cmerge syslcm is
. :. 4 U 1 (\ .�t
., . JOB SITE " INT.ORD7A � ON i+,T :�. ''; . ` � ::,.. . ,, . ❑Addition of new motor load of ❑`•A , • ••E •'1 •`1.3" system.
Job no.: Job site address: � .- l v > 100HP or !sore. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
Supply voltage for more than
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City /State /ZIP: \ 'I U \ i (\i �' ( -TI I 72-75 ❑ Health -care facilities. ❑ Su pP y g
l _. ❑ Hazardous locations. 6 volts nominal.
Suite/bldg. /apt. no.: f1 r 2 je ct name: r >•, (- ❑ Service or feeder 600 amps or more -
Cross street directions to job site: ' • .:.• : E =$01101.0'.' <: i c ::;;- : -::-: �r. >' _
.) Description I 4tZ 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
Tax map /parcel no.:
Ea. add'l 500 sq. ft. or portion 33.40 1
et residential
Limited energy, resid 75.00 2
.:.- DE ,OF =;• WORK :: r< ,, :::, "` ',: " }:::.;•;; ;:; ;. "..c. (with above sq. ft.
///� i //;; ((((1 � t - , multi- family I' ` %JA llT�- Ifl /s/ /, j \ 1.. r r \ ( )✓ �� �( � � Limited energy residential (with above sq. ft.) 75.00 2
Services or feeders Installation, alteration, and /or relocation
200 amps or less 80.30 2 • : D..PROPER.t.* : OWNER ?";: ;::1` .` .,Q :TENANT :;: amps ' '
, •, , 201 a nps 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
Branch circuits - new, alteration, or extension, per panel
Owner signature: Fee for branch circuits with
ate: — A. i
fee, 6.65 2
0 APPLICANT;•." ..' : :' : ' : CNTACT : PERSON . _:. .. feeder i . : ...I .:.... . ::::.'.. O' ` above service or feeder
each branch circuit • Business name: t , [4 t` . f /.k. , � 0 V I ) r k ... 1 l i (O.. i l B. Fee for branch circuits
Contact name: ` /�� l i / without service or feeder fee, 46.85 2
�� l i�� \\f� /'fl. first blanch circuit
� c /' ` ` 4 -
Each add'l branch circuit 6.65 2
Address: 1 61 ‘1 `> t`i �- i \ I `` t \ ��`N\ I /� t ` -- t v l
Miscellaneous (service or feeder not included)
City /State/ZIP: \ t ' A/ t�I i t} C J > _7 Each manufactured or modular 90.90 2
r� �, ( Fax: r "t f' y dwelling, service and/or feeder
Phone:
( d ) ✓ " (f7'I ?� V (� `Yl� a�? ` `I J �' Reconnect only 66.85 2
E -mail: \ )\ J m. '(1) \ t" u \ . C hr Pump or inigation circle 53.40 2
t Sin out' lighting o outline tin
NTR'S.C7' TY: �''
A r 5
.4
3 0 2
(1 C t Signal circuit(s) or limited -
Business name: 0 ( 'Vi f - J �. �/ �; energy panel, alteration, or
Address: !S' U \M\1\ 4, ( -• Q \ „ extension. Describe: ' Page 2 2
City / State/ZIP:"4 t \ t\c (l\i\ v o i, > 1 9B u , 8 Each additional inspection over allowable in any of the above
1 �� I Per inspection 62.50
Phone: (72l€0 ) . Fax: ( jO) - 150,1 (-{ 1 Investigation per hour (1 hr min) 62.50
CCB Lie.: \f,�1,I 1 ( Electrical Lie.: Suprv. Lie.: Industrial plant per hour 73.75
,, >t'EL CiTRICf' L::-PERMIT.:FEESa': •z' :i;:' :: %.` ":'S :
Suprv. Electrician signature, required:
Subtotal:
Print name: Date:
Plan review (25% of permit fee):
State surcharge (8% of pennit fee): Ii 1
Authorized signatu ?e >"r " ^" :- .„ -=' -
••�, �' � �- = "~`� TOTAL PERMIT FEE: �'
alp- Date: l
� � ��� This p ermit application expires if a permit is not obtained within 180
Print name: ( 1 f \. �(� 1 �_(� �/1(� days after It has been accepted as complete.
d Number of inspections allowed per pennit.
I:\ Building \Permi's\ELC- PermitApp.doc 05/23/06 41046I5T(t I /05 /COM/WEB
CITY OF TIGARD
, \--
BUILDING DIVISION PERMIT #: ELR2007-00387
13125 SW Hall Blvd., Tigard, OR 97223
A • 4
DATE ISSUED: 1015/2007
Phone: (503) 639-4171 roa
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 10/1612007 TIME: 7:01AM PAGE: 55
SITE ADDRESS: 12&46 SW KAREN ST 28 CLASS OF WORK: .
SUBDIVISION: BELLWOOD TERRACE CONDOMINIUM LOT #: 028 TYPE OF USE:
PROJECT NAME: BELLWOOD TERRACE CONDOMINIUMS
DESCRIPTION: Insia11 tow voltage fiber optics for verizon in units 28 - 33.
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 057657 503 N
Corrections/Comments/Instructions:
•
N y: - J PASS n PARTIAL APPROVAL fl CANCEL I NO ACCESS
Li FAIL CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: Cr—, N 1Z,81.:-e' Date: P 1 I tt 0 1 Phone #: (503) 718- Vflit)