Permit • -A ' CITY OF TIGARD e, ELECTRICAL PERMIT
PERMIT #: ELC2006 -00724
' COMMUNITY DEVELOPMENT DATE ISSUED: 12/21/2006
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 102CC -01100
SITE ADDRESS: 13680 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: Additional service for cell site. Job No. 592
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
TIGARD LODGE NO. 207 MONTI ELECTRIC INC
OF AF + AM PO BOX 30478
ATTN JOHN HAVERY, SECY PORTLAND, OR 97294
TIGARD, OR 97281
Phone: Contact #: PRI 503 - 491 - 4909
' FAX 503- 665 -7200
FEES
Description Date Amount Reg #: ELE 26 -1018C
[ELPRMT] ELC Permit 12/21/2001 $80.30 LIC 135326
[TAX] 8% State Surcharge 12/21/2001 $6.42 SUP 4591 S
Total $86.72 REQUIRED ITEMS AND REPORTS
This Permit • iss""Pd subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work ill be done I = ccordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspe ded for more than : 0 • - ENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center.
Thos rules are set forth i• • • • • ' • • _ • • -0010 through OAR 952 -001 -0100. You may obtain • =se rules or direct • uestions to OUNC at
503. 46.6699 •r 1.800. , I •
Iss ed By: Permittee Si na • . / , i , ►M
—Nor /
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:
1.�P/ S
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.
Dec 21 06 01: 00p Monti Electric 503 - 665 -7200 p.1 •
&ie t r c Permit Appl * ,, , f:1, r FOR OFFICE t': t ;1: ONE.)
rilikt City of Tigard R eceived i Permit No.:
131 SW Hal Blvd., Tigard, OR 97223 Plan Rn /A gib /Ar ...e07..„
, ,
Phone: 503.639.4171 Fax: 503.598.1960 r„r: { "w:' I Other Permit:
Date/By.
DEC Inspection Line: 503.639.4175 21 _.:!_ 'I � Date Ready/By: Jurir ® See Page 2 for
m
'rteet: www.ci.tigard.or.us � 1 I i Notified/Method / G I Supplemental Information
‘ Ater( 11`I , PLAN REVIEW
El New construction �1 Please check all that apply.
❑ Demolition ❑ Other ®r
0 Service over 225 amps, cotnm'I ❑Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. it.,
CATEGO,N OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1 - and 2- family dwelling Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family El Master builder ❑Other ['Building over three stories ['Feeders, 400 amps or more
['Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
r ❑Healthcare facility ❑Othee
Job no.: J �� I Job site address: �?, f „Q ��1 J i Submit 2 sets of plans with any of the above.
/
City/State/ZIP: i �� ` /, 9 qa,..2 .� The above are not applicable to temporary construction service.
SuiteibldgJapt. no.: Project name: e 1( _ 1B Description I FEE Qty. I SCHEDULE
Qty. I Fee I Toter 1 ••
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea addi 500 sq. R. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
,,,///��� i dwelling, service and/or feeder 90.90 2
__/ /i ..i i :z. ' .r_ (�J 4 -_�� V7 Services or feeders installation, alteration, and/or relocation
/ 200 amps or less / 80.30 �(f -.V 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2 _
`.ddress: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
-- City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) I Fax: ( ) relocation
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 10030 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT I CONTACT PERSON A. Fee for branch circuits with
. service or feeder fee, each 6.65 2
Business name: ,I � J , - �;�� branch circuit
B. Fee for branch circuits
Contact name: f J. without service or feeder fee,
each branch circuit 46.85 2
Address: Each add'I branch circuit 6.65 2
City /State/Z1P: Miscellaneous (service or feeder not included)
Phone: ( Fax:: ) `` �7 �7 � Pump or irrigation circle 53.40 2
-' /. - , 'off .e`7 � Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
• extension. Describe: Page 2 2
Business name: in 1.�, t eei1 J - �] i
Address: � � . B D � , I r " / 7E +� ice' Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: pn-r1 672 9')JL Investigation per hour (1 hr min) 6150
Phone: I/5) V (� r ^9 I Fax (4 '' // 7,9_073 Industrial plant per hour 73.75
c�(J l� t. f ELECTRICAL PERMIT FEES*
CCB Lic.:i3 Z Electrical Lic.1 ._/� p Suprv. Lie.: I/511I57 Subtotal ( 80 2
Suprv. Electrician signature, required: 7 G 7 ` - Plan review (25% of permit fee)
tint name: �� - D� � State surcharge (8% of permit fee) ��
a ( !� TOTAL PERMIT FEE f 10 :
Authorized signature: (i V ,rte 'Ibis permit application expires if a permit is not obtained within 180
w • (� days after it has been accepted as complete
Print name: S //I '/� n / Date: 1 'J /0 /1 • Fee methodology see by Tri-County Building Industry Service Board
..„/
I
CITY OF TIGARD
BUILDING DIVISION -- PERMIT #: ELC2006- 00724
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/21/2006
Phone: (503) 639- 4171���:I;����
Inspection Requests (24 Hrs.): (503) 639 -4175 _..
INSPECTION WORKSHEET FOR DATE: 1/2/2007 TIME: 7:00AM PAGE: 23
SITE ADDRESS: 13680 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: CELL TOWER
DESCRIPTION: Additional service for cell site. Job No. 592
OWNER: TIGARD LODGE NO. 207, PHONE #:
CONTRACTOR: MONTI ELECTRIC INC PHONE #: 503-491 -4909
Inspection Request Scheduled For: Date: 1/2/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message •
115 Electrical service 041676 -0' 360-608-7782 Y
L. 1
Correct'ons/ o ments /Instructions: - ` \ M`
■
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: -‘P Oa (Q Date: I - 2 6 9 Phone #: (503) 718- 2J 44( '
r.
r
CITY OF TIGARD •
BUILDING DIVISION A PERMIT #: ELG20000724
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/21/2006
Phone: (503) 639 -4171 a� �iI�l
Inspection Requests (24 Hrs.): (503) 639 -4175 11-.
INSPECTION WORKSHEET FOR DATE: 12/2212006 TIME: 7 :Q0AM PAGE: 76
SITE ADDRESS: 13680 SW PACIFIC HON CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: CELL TOWER
DESCRIPTION: Additional service for cell site. Job No. 592
OWNER: TIGARD LODGE NO. 207, PHONE #:
CONTRACTOR: MONTI ELECTRIC INC PHONE #: 503 -491 -4909
Inspection Request Scheduled For: Date: 12/22/7OQ6 Pour Time:
Code # Inspection Description Confirm # Contact # Message
105 Underground/slab cover 041457 -01 503- 572 -5666 N
Corrections /Comments/ Instructions:
Nes? ciieT.L TA fir (.014r1&
APASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Nc\g LC Date: '2--11- 64) Phone #: (503) 718- ZCitb'