Permit � . v CITY OF TIGARD ELECTRICAL PERMIT
'' a '' COMMUNITY DEVELOPMENT Permit #: ELC2013 00014
T [CARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/09/2013
Parcel: 1 S135DC04600
Jurisdiction: Tigard
Site address: 9463 SW TANGELA CT
Project: Andover Properties Subdivision: TANGELA Lot: 1
Project Description: (1) 200 amps or less for panel replacement
Contractor: MONTI ELECTRIC Owner: ANDOVER PROPERTIES LLC
PO BOX 220 ATTN EARL ERNEST GUILE
TROUTDALE, OR 970660 5476 NW 146TH AVE
PORTLAND, OR 97229
,, PHONE 503 - 491 -4909 PHONE.
FAX: 503 - 665 -7200
FEES
Quantity . Description Date Amount
1 ea 12% State Surcharge - 01/09/2013 $12 08
Specifics: Electrical
1 ea Services or Feeders - 200 01/09/2013 $100 70
Type of Use: SF amps or less
Class of Work: ALT
Type of Const:
,R
Occupancy Grp:
Total $112 78
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law 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 the 180
days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952- 001 -0010 through O I
52 -001- 090 YoJ ay obttaina copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344.
Issued By: 52-001- Perm ittee Signature: OM- I PC 1 L1 C 0-7170
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' Date:
LICENSE NO.
can 503.639.4175 by 7:00 a.m. for the next available Inspection date. ,
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.
01/09/2013 12'54PM FAX 5036657200 MONTI ELECTRIC Z0001 /0002
Electrical' Perm it Application CLIV L �. I tali (iF1:1t::1 Iltif•_ p;NL)
City of Tigard Permit Na y ,� vii 3 - U Da _1
Other Permit:
at 13125 SW Hall Blvd., Tigard, OR 97223 Plan Roviaw
� : Phone: 503.718.2439 Fax: 503.598 1960 J Q 9 2013 r
T I .1 I; I Inspection Line: 503.639 4175 Date Rr iy)iiiy: ruri • 65 See Page 2 ter
Internet www ligord -or goy CITY OFTIG' s ) Notilled/Matliod' 111 Supplemental Information
TYPE OF wo ILDING DIVISION PLAN REVIEW i
❑ New construction E Addition /alteration/replacement Please check all that apply (submit I sew of plans w /,isms checked below):
❑ Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other: - where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO veils or ❑ Flailing buildings. ,
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
® I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building nlnpa for all other installations. buildings
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. 0 Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMA ION ND LOCATION ION ❑ Addition of new molar laud of 0"A", "E", "1 -I ", "I -3",
Job no.: ( Job site address: SW Tangelo Ct. 114-(p 3 inaiIP occupancy
❑ Six or more residential units ❑ Recreational vehicle parks.
City /Slate /ZIP: Tigard OR ❑ Health -care facilities ❑ Supply voltage for more than
❑ Hazardous Iocntinns. 600 volts nominal
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directionS to job site: Derr 1 Qty_ I FCC. I Total: I •
Ncw residential single- or multi- Ihmlly dwelling unit.
Includes attached garage.
Subdivision: f Lot no.: 1,000 sq. ft. or less 16854 4
Fa. add'l 500 sq. ft. or portion 33 92 1
Tax mop /parcel no,: Limited energy, residential
DESCRIPTION OF WORK
-- (with above sq. fL) 75,00 2
Limited energy, multi- family '
7500 2
Panel Replacement residential (with ahovo sq. R )
- -- Services or feeder! lnstallallon, alteratlgn relocation _
200 amps or less 1 100.70 100.70 2
0 PROPERTY OWNER L ❑ TENANT • 201 amps to 400 amps 133 56 2
401 amps to 600 amps 2 00.34 2
Name: _..� - . ,
601 amps to 1,000 amps 301.04 2 ,
Address: Over 1,000 amps nr voltsI 552,26 2
City /StalC /l1P: Temporary cervices or feedera inatollatlon, alteration, and /or
rclocatlutt ��-
Phone; ( ) Fa ( ) 200 amps or less S9 36 1
201 amps to 400 amps _ 125 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for salt, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits -- new, alteration, or extension, per panel
Owner signature: - Date: . _ A. Fee for branch circuits with
0 APPLICANT ❑ CONTACT PERSON above service or feeder rec. 7 42 2
--- cuch brunch circuit
Business name: B Fee for branch circuits w ithout
service or feeder fee, first
Contact name: branch circuit 56.18 2
-- Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67 84 2
dwelling, service and/or feeder
Phone: ( ) I Fax: ; ( ) Reconnect only 67.84 2
— 1 — Fax:
or irrigation circle 67,84 2
E-mail:
Sign or outline lighting 67 R4 2
CONTRACTOR Signal circuit(s) or limited. energy
Business name: Monti Electric panel, alteration, or extension. Page 2 2
Each additional inspection over allow hie in any of the above
Address: 845 NW Dunbar Rd - Additional inspection (I hr min) [ 66.25/ hr
City /Statc/ZIP: 'Troutdale, Oregon 97060 investigation (1 hr mm) 66.25/ hr
--- - Industrial plant (1 hr min) 78.18/ hr
Phone: (303) 4914909 Fax: ( ) Inspections for which no fee is 90 00/ hr
specifically listed (% hr mm)
CCB Lic -: 1 3c 3 Electrical Lic.: 26 -101RT7 Suprv. Lic.G�q/ S ELECTRICAL PERMIT ,FEES ; .
l Subtotal; 100.70
Suprv, Electrician signature, requ , ■ A
.. . n11 - .r Plan review (25 %of milli fee):
Print name: Stan Monti /I Date: 1/4/2012 Stale surcharge (12% of permit fee): 12.08
Authorized signature:
TO'I'AI. PER MI f FEE 112.78
Thin permit applkal(on en(dres If a permit Is not obtained within 180
•
Print name: Date: days after it has been accepted as complete.
' Number of inspections allowed per permit.
I, UWadiagTormasktl.C•ParmtiAppdec 07101/10 4404011T(