Permit V;, CITY OF TIGARD ELECTRICAL PERMIT
ipi .,Y COMMUNITY DEVELOPMENT Permit #: ELC2009 00677
T R
[GAD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 . Date Issued: 12/29/2009
Parcel: 2S102CB06801
Jurisdiction: Tigard
Site address: 10475 SW PARK ST
Subdivision: Lot: 0
Project: Solis
Project Description: Reconnect, and correcting wiring done without permit.
Owner: FEES
SOLIS, EDGAR Quantity Description Date Amount
C/O 2645 SW 153RD DR.
BEAVERTON, OR 97006 1 ea Per Inspection 12/29/2009 $66.25
PHONE: 503 641 -3309 1 ea 12% State Surcharge - 12/29/2009 $7.95
Electrical
Contractor:
MONTI ELECTRIC INC
PO BOX 30478
PORTLAND, OR 97294
PHONE: 503 - 491 -4909
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $74.20
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 OAR 952 - 000100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: �� 4�% 4' • f ` `1_ ! ..L1 Permittee Signature:
Ntia
OWNER INSTALLATION ONLY
The installation is being made on property 1 own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' i 'L l APP ' 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.
Dec 29 2009 3:17PM HP LASERJET FAX page 1
Electrical Permit Application ICJ eM s ,,' l I c ) I L {► f I+ .l ti �'(l l - • ` 4. .,
ty Tigard Received (0_200143W 7
?- I>raosBy: .) Permit No 13125 S W Hall Blvd., Tigard, OR 97223 ( . 30.0 Plea Review `Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
i , , ., 1 � Inspection Line: 503.639.4175 Date Ready/By: r: &I See Page 2 fir
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
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❑ New construction ❑ Addition/alteration/replacement Please check all that apply (submit 1 sets of plans w,items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition 0
r ,
�! where the available fault current ❑ Marinas and boatyards.
' (� T4 'ca >�. fit. u F 44 r 41 si r , r , k exceeds 10,000 a at 150 volts or s.
%. ,, : t I, `- f Y.. i .e.` is a, , tt t t: u I `¢ x ai:'s . , , -' ,, $ �x �, Dating buildings.
ecru -.,r 9dlr>r rs � �e+ > 1e-• � 1m � �� a'`f �? '� ❑ Fl boil s
❑ ] - and 2 dwelling ❑ COmmerciaUindustrial less to gro'md• or exceeds 14,000 ❑ Commercial - use agricultural
❑ Accessory building amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: s }, , ar V R ?,-• 11eC ❑ Fire pump, ❑ Installation of 75 KVA or
.j { a" t t m 6 T l r a I ' ' 1 h 0 + I r e- i � R ❑ Em er gency syst larger separately derived system.
r i
z ,, s;, ., k ,„ - ,.. N t r ' ' G 1 I r . i ,::7 1 `: ,,,,Y.. ❑ Addition of new motor load of ❑ "A" "E" °1.2 ", °1.3 ",
Job no.: 2921 Job site address: 10475 SW Park Street 10011P or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97223 ❑ Health -care facilities. O Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg_ /apt, no.: Project name: NW House Doctors - 2921 ❑ Service or feeder 600 amps or more.
■ �
Cross street/directions t0 job site: — r . -3' ' , SI 4Y ` 'rte- 11 " ; r }� I
" xl : i I n t ifit �T i . ;
Description OM Fee. 7 bnt •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map/parcel no.: Ea. add] 500 sq. R. or portion 33.92 I
a tr , ; L r s Limited energy, residential
?9a n .t I t,.f } Q x I �:: i �ai i 4:a i5 ; h t +a r. ! 67.84 2
i ' �riru' .>rc .1. , .i z k, u o ' (with above sq. ft.)
Goes with ELC2009 -00582 Limited energy, multi- Family b7 84 2
residential (with above sq. R.)
Services or feeders installation and/or relocation
}, i i� � s aruM1 raxs �,vaercct3l! S / ! - . • f ; t „ 1 : 4b ". " 1 200 amps or less 100.70 2
.r. ,..?. „)R71, ::.� al eta } . ,,',A 11� _s,.? , 't d'1' .,, ,,4 b> w; - ...1 4i ii .4. v l ' 1 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) r Fax: ( ) 200 amps or less 59.36 I 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 1 1 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits — new, alteration, or extension, r panel
K r „�, „ A. Fee for branch circuits with
4 1t' ii+i "7' 1' , ejt [ l ,. ' rt�y�a rF, laps *•?g'
iii rtiu.. > t 1 , to * E 41 R ,a 3 ` lil aft T N aaat: y ' r e
•1 t *f i above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee,
first branch circuit 56.18 2
Address: Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Each n nufactured or modular
dwelling, service and/or feeder
Phone:( ) Fax: : ( ) 67 2
E -mail: Reconnect only 67.84 2
I : ;" ; sir ; I . j�tI f Bs'i IT t
,r ="• = x =.eia. ' )"..V.V h:.'.. i T c z ' " I 7'i ' K Pump or of mike lighting n le 67.84 2
„ ait']t.wli a, S Sign 61,84 2
Business name: Monti Electric, Inc. signal circuits) or limited -
energy panel, alteration, or
Address: PO Box 220 extension. Describe: Page 2 2
City/State/ZIP: Troutdale, OR 97060 Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: (303) 49111909 Fax: (503) 665 4200 Investigation per hour (1 br min) 66.25
CCB Lic.: 135326 Electrical Lie.: 26 -1018C Suprv. Lic.: 4591S Industrial plant . r hour 1 78.18
\\ S \ � . alum ,:1� EIN h":.' t= , , *i ;iii
Suprv. Electrician signature, required: `•\
�. \1��. _ Subtotal:
Print name: Stan Monti Date: 12/28/09 Plat review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: \, ..- \ �\ _ TOTAL PERMIT FEE: 74.E
a �
Print name: Stan Monti Date: 12/28/09 This permit application expires if a permit not *tailed within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:1Building1Perr hs1ELC- PermitAppdoc 10/01/09 440.4615T(t l /05/CCM/WES