Permit , CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00659
r ill : . '
COMMUNITY DEVELOPMENT
DATE ISSUED: 11/15/2006
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 102 CC -01100
SITE ADDRESS: 13680 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: New equipment on existing 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: 2 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 11/15/200( $93.60 LIC 135326
[TAX] 8% State Surcharge 11/15/200( $7.49 SUP 4591S
Total $101.09 REQUIRED ITEMS AND REPORTS
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 rul e rth in OAR 952 - 001 -0010 through OAR 952 -001 -0100. You may obtain co•'= • hese rules or direct questions to OUNC at
503.24 .6699 or 1.80 .3 -
Issue By: � -
( ( Permittee Signa :r
re: / 1�/ /
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:
- = NTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: 1- ;.,+ 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.
Nov 14 06 11:44a Monti Electric 503 - 665 -7200 p.1
Electrical Perkiit Applica CE��/E volt orrlc l_ I. sl_ 0yI.1
• i of Tigard may: /1 /5/ .06 i -X Permit No.: ELe Pe600 ' r!i!� t '57
13125 SW Hall Blvd., Tigard, OR 97223 NOV 1 4 Z 2 ► 1 6 Plan Review
Phone: 503.639.4171 Fax 503.598.1960 `''" I Date/By; Other Permit.
Inspection Line: 503.639.4175 CITY OF TI -r,I., r 'q . Date Ready my: �
7u: See Page z for
'temet www.ci.tigard.or.us BUILDING • Y • ' Notified/Method: ' d, I ® Supplemental Information
\� E OF WORK PLAN REVIEW
❑ New construction Addition /alteration/replacement Please check all that apply:
❑ Demolition ❑Other. ❑Service over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGOOY 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 ❑ Master builder El Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lightingplan RV park
Job no.: Job site address: ' °Health -care facility ❑Other.
I ` _ . 1 • Submit 2 sets of plans with any of the above.
City/ State/ZIP: '� t I The above are not applicable to temporary construction service.
.14 DDescription n FEE* SCHEDULE
Suite/bldg. /apt no.: , Project name: /l ,(� ` 5 . :.3
' ` l Qty. ' Fe6 I Total I
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. add't 500 sq. ft. 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
dwelling, service and/or feeder 90.90 2
�/.z44.4,1 4 1 ,� �- Services or feeders installation, alteration, and/or relocation
r 200 amps or less I 80.30 VO . 2
❑ PROPERT 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
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 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 ,.....Date:
ACT PERSON A. Fee for branch circuits with
M � service or feeder fee, each V Business name: / r t t/ / 1 � P-1131-,11/* branch circuit 6.65 2 !
S � r `n r .
B. Fee for b circuits
Contact name: without service or feeder fee, 46.85 2
each branch circuit
Address: Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) I Fax: ( ) Sign or outline Lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
n� •
�r • extension. Describe: Page 2 2
Business name: fr (a1n
Address: e( SP �� OQ "L f 7 7 Each additional inspection over allowable in any of the above
Per inspection 62.50
City/ State/ZIP: j� �/( � 9 9471 Investigation per hour (I hr min) 62.50
Phone: ( ! / Fax: ( _ Industrial plant per hour 73.75
tirl • I i..r ELECTRICAL PERMIT FEES*
CCB Lic.: 3 53x4 Electrical Lic.: _ /)) Suprv. Lic.:4,59 /S Subtotal Q-3 6°
Suprv. Electrician signature, required: / 4 ' Plan review (25% of permit fee)
?tint name: S tek..4 „ �"J -I/1,
Authorized signature: te: / /�� State surcharge (8 % of permit fee) Lig
f�J "� � ..../ � TOTAL PERMIT FEE J� L / 502 nature: � , y� /) `L � / V\! 1 ed
g expires if a permit is not ob ned within ISO
Print name: Date This permit appueation expires
alter It has been accepted as complete
V� ' �' �� .. F ee meth od ology set by 7Yi Cowry Building Industry Service. Board
: ...,,,.....,,,,, I'
CITY OF TIGARD - .
BUILDING DIVISION PERMIT #: ELC200G- 10659
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 11/1512006
Phone: (503) 639 -4171 � i I11
Inspection Requests (24 Hrs.): (503) 639 -4175 `__..
INSPECTION WORKSHEET FOR DATE: 12/21/2006 TIME: 7:00AM PAGE: 54
SITE ADDRESS: 13680 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: CF_LL TOWER
DESCRIPTION: New equipment on existing cell site. Job No. 692
OWNER: TIGARD LODGE NO. 207, PHONE #:
CONTRACTOR: MONTI ELECTRIC INC PHONE #: 503 -411 -4909
Inspection Request Scheduled For: Date: 12/21/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
10 5 Underground/slab cover 041400 -01 503 -572 -6666 N
Corrections/Comments/Instructions:
67 K.a(E> 6
ww 5" TW.
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P "'y ' 17
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❑ PASS ❑ PARTIAL APPROVAL CANCEL ❑ NO ACCESS
'❑ FAIL ❑ CALL FOR INSPECTION IN : 5 MI ON FEES ASSESSED
Inspector: a N C. ti Date: 1 Ot Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2006-00659
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/15/2006
Phone: (503) 639 -4171 /rra
Inspection Requests (24 Hrs.): (503) 639 -4175 �'I
INSPECTION WORKSHEET FOR DATE: 11/16/2006 TIME: 7:00AM PAGE: 413
SITE ADDRESS: 13680 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: CELL TOWER
DESCRIPTION: New equipment on existing cell site. Job No. 592
OWNER: TIGARD LODGE NO. 207, PHONE #:
CONTRACTOR: MONTI ELECTRIC INC PHONE #: 503-491 -4909
Inspection Request Scheduled For: Date: 11/16/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
1 Misc. inspection 039862 -01 - 503-860 -2682 Y
�� 676 (J
co — - - - = .. S"-- • structions:
I A— F-►Not
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: N 66 LE Date: IL iiS V 0 Phone #: (503) 718- 2-�
4