Permit CITY OF TIGARD ELECTRICAL PERMIT
•
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00666
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/30/2010
TIGARD Parcel: 1S135CB00200
Jurisdiction: Tigard
Site address: 10250 SW NORTH DAKOTA ST
Project: Clear Wire LLC Subdivision: Lot: 0
Project Description: (1) service and (1) branch circuit
Contractor: MONTI ELECTRIC Owner: PASCUZZI INVESTMENT LLC
PO BOX 220 10250 SW NORTH DAKOTA
TROUTDALE, OR 970660 TIGARD, OR 97223
PHONE: 503 - 491 -4909 PHONE.
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 11/30/2010 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 11/30/2010 $7.42
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 11/30/2010 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121.09
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 OA' •52- 001 -0090. You .. •. a copy of t - questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
s
Issued By: �.� _ Permittee Signature: -
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.
Call 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.
Nov 29 2010 2:27PM Monti Electric Inc. 503 page 2
Electrical Permit Application • , mild ()Hi( 1.1 'F, ON 1.1 ,
' City of Tigard • l C� . � I Received /
13125 SW HaII Blvd., Tigard, OR 97223 �L t ' ' �r 1 /i DatelBy: III�� 14 d '� Permit No.; C— jjr) _ � (nr i
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
i r A/
Inspection Line: 503.639.4175 I y O V 3 Date Re Other Permit
i I t tot D ate Read iB t r.
lntemet ®��' U y Y I Su See Paget for
www.tigard or.gov , . e . ethod:
J ,9 �rr m � � Suppl f rsformat i oa
7�1 �" �+]� .�'� � � ;�g xxrs�.o �tegn.�I��).t {,ag�p 1 € e r a , a1,tl�r t 1 "7 1.•. a M t,
lif i €�f $ i t,� d'ri { q, fit i ` '�:j tl,. 31 � 1��t , I N, r itig. j ja• t{ e r ys?�p rzi ,eul'c rr x �
- � ���P�9�84ad�lu ,��'. z r�,rl�� �� / �'' �'� °��i'�� ¢�;� SM1�lI {) � � ri 8tw +1�� ��17�K�'����.,y
.��a.i:, 11° 1:t� n. � +� r �t ilr. a?ai adJ�..,ilit�€ �f. tl . . ��1�� i�:i11i:
P I NeW construction ❑ Addition/atterati on/rep1. n '�. ISJON Please check all that apply (submit a sets of plans wiitems checked below):
O Service or feeder 400 amps or more ❑ Building over three stun des.
❑ Demolition ED Other
El where the available fault current ❑ Marinas and boatyards,
' I E a" rx'P� a
;r ( fst!xt s€a+r r+ ase l y s 5:0161112 qrI t ex c eeds 10 150 wit er
�� i R' {G'"ii�xaa �raYv�e l� ]ntu�raai�r�rrr ��°��`� P 000 amps a ❑Floating buildings.
❑ 1 and 2- family dwelling Tai ommereial / industrial 0 Accessory building amps for all other insta llations. less; to ground, or exceeds 14,000 ID Commercial -use agricultural
ID 1Vlulti -finstallations. huildiags. gric
y ❑ M aster builder ❑ O ther: ❑ Fire pump. ❑ Installation of 75 KVA or
x q u vwA ,r tin rgnturns5z t�{.1 Yir ar e ( ❑ Emer ea system . ger separa d erive
Pin, . 1 a i1i ':t � ikl�t Q$'sknl a�r i..r rqu:Wart:i iii lft3 i ,1 a y f B eY tar
i. ❑Addition of new motor load of Cl "A ", "E ", "1 -2 " tely , "1 -3 ", d system.
Job no.. 3( 5Cp Job site address: ,paces IJv►C,t k c:ta ix orns more occupancy.
r ❑S i or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: T 1 (� �a t � R ❑ Health - care facilities. CI Supply voltage for more than
v ❑ Hazardous locations. 600 volts nominal.
Su ite/bldgiapt. no.: Project name: 4) / - ry o a feeder 600 mps o more
� .'tld �• � n � ❑Se i� F ' n �:t t, .u� r : nn ,r, f K let rot l t
t. ice � � ` y A.` ixli 1T
Cross street/directions to job site:
Description Pty. roe. Total •
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. ft. or portion 33.92 1
tir q ., a ra a e aesa t ., Limited energy, residential
gnilli iffi 3� sErin aiding s�i i .:rlED ' ? i i i : (with above sq. fl.) 75.00 2
Limited energy, multi - family
v V T c & + (1 1 ( j , (,uC residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
{ 200 amps or less 1 100.70 00,'.f O 2 .. d »
r��ll yjl'uR tag b z�asI N rt r. � P r ` � 201 amps to 400 amps • 13356
�ke,r�a'tr;� � e Ntcssr4i�. � n fd t ' � r � , 2
s �� � Je''�br hs.,.0 ..: f� � 1
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/Z1P: Temporary services or feeders Installation, alteration, and /or
relocation
Phone: ( ) I F ax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125 2
intended for sale, lease, rent, or exchange, according to ORS 447, 4 670, and 701, .01 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, er panel
Owner signature: Date: A. Fee for branch circuits with
1 r ' tr tipntu l pk9i' lid fr'`lrts� a'tu � abo
j v r eder fee, `
7
a, . r�tl l Q,r l u '. r M t r I� x i t u, n` Medea l 1 .42 1,`P. 2
�' � � °�'�`���'+`�t ��.nri each e b circuit ofe
Business name: B. Fee for branch circuits without
service or feeder fee, first
Contact name: branch circuit 56.18 2
Address:
Each add'/ branch circuit 7.42 2
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
E -mail:
Pump or irrigation circle 67.84 2
IMI 3�u ,r I r . s amm�mr , t Y Signor outline lighting 67.84 2
t MTSSEY EEIIEII EEZ ITM )� ' N ' Signal circuit(s) or limited- energy
Business name: \ is--„,..*--‘ 1....A �� 1E4-1C panel, alteration, or extension_ P age 2 2
Each additional inspection over allowable in any of the above
Address: p 6i a'2r.0 _ Additional inspection (I hr min) 66.25/ hr
City /State/ZIP: &C3,31.12.. t � 74 _ 0 / \ investigation (l hr min) 66,25/ hr
[lp (A T L3lP Industrial plant (1 hr min) 78.18/ hr
Phone: ( — 1 - L t — Licit 01 Fax: ( 3) L c _t ($ fo
2 s Inspections lficall Itor stcd % which hr n fee is
nvn 90 00 hr
CCB 'lc': k ; J C 3 3 Electrical Lie.: a - �(1 $ Suprv. Lie.: - j 1 ' l + ;c t� t t i a R i,'ita 41 ROs
�o _ ��,�.� � .�h����:.a�xHL.,. »,1�.� .,�..�» �,�1= »,� � t�iat�..:.d'��1
Suprv. Electrician signature, required: Subtotal: k>� t k
. 4 v a, 1.1h. Plan review (25% of permit fee):
�`'
Print name: e v6 ' 'y3T-1 ` Date: L\ ep, • . State surcharge (12 %ofpermit fee): 1 ' a ,
TOTAL PERMIT FEE:
Authorized signature: \ , � _ r iq
ca... • , • ...a. ii, This permit application expires if a permit is not obtained within 180
Print name: S \- A Date: �� vD.�,1 days after It has been accepted as complete.
ilri r^} ! Nnntber of inspections allowed per permit.
I:o: wilding TermitskeLc.Permitapp.doc 07/01! 440- 461571 1/05/COAt/WRB
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