Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2021-00730
Date Issued: 1/20/2022
T j G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718,2439 Parcel: 2S 112DA00700
Jurisdiction: Tigard
Site address: 15333 SW SEQUOIA PKWY, STE# 100
Project: Bridgetown ER and Veterinary Subdivision: PACIFIC CORPORATE CENTER Lot: 3
Project Description: Electrical for TI: Replacing (1)400 amp main breaker panelboard, (1)200 amp feeder for transformer pad
conduit,and(35)branch circuits.
Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES LP
16869 SW 65TH AVE, SUITE 311 ATTN: N PIVEN
LAKE OSWEGO, OR 97035 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-747-2503 PHONE:
FAX: 503-972-1861
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 01/17/2022 $100.70
Specifics:
amps or less
1 ea Services or Feeders-401 to 01/17/2022 $200.34
Type of Use: COM 600 amps
Class of Work: ALT 35 crt Branch Circuits w/Purchase 01/17/2022 $259.70
Type of Const: Service or Feeder
Occupancy Grp: 1 ea Plan Review Electricial 01/17/2022 $140.19
1 ea 12%State Surcharge- 01/17/2022 $67.29
Electrical
Total $768.22
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 952-001-0090 You may obtain a coov of the rules or direct auestions to OUNC by callina 503.232.1987 or 1.800.332.2344.
Issued By: Hn-LLy Vrt,vr,Dv,We.ge, Permittee Signature: Ow A
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.
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.
... _.. .0
RECEIVED 5
Electrical Permit Application DEC 2 2 2021 • FOR OFFI( I: I Sl'.OyI,l
City of Tigard Received �// �/� J
Date/By:/ 202/ I ermit#: L C2d2l-cO 30
13125 SW Hall Blvd.,Tigard,OR 9722�11 Y OF (1uNHLJ
2 Phone: 503.718.2439 Fax: 503.598.JDING OIVISIGP Plan Review,Date/By: Z/7 /2( Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By '"`7uris:.�y H See Page 2 for
1 1 C A R D Internet: www.tigard-or.gov Notified/Method: iL(� I I�, Supplemental Information
`
TYPE OF WORK ` /
110
r-r'�I`� 4ow PLAN REVIEW
0 New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
Ve Service or feeder 400 amps or more ❑Building over three stories.
El Demolition El Other:
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
0 1-and 2-family dwelling Q Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job site address: ❑Addition of new motor load of system.
Job#:
15333 SW Sequoia Pkwy PO 100HP or more. ❑"A","E","l-r', `1-3",
City/State/zIP: Tigard, OR0
x or more residential units. occupancy.ealth-care facilities. ❑Recreational vehicle parks.
Suite/bld /a t.#: Project name: azardous locations. ❑Supply voltage for more than
g p j Bridgetown yet �Re✓n-.•service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
change out existing electrical panel,Tenant improvement, Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
0 PROPERTY OWNER I ❑ TENANT Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less ) 100.70 100*7D 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 1 200.34 200.3y 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) I Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 _ 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
APPLICANT I 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: JOhansen Electric,Inc. above service or feeder fee, 2 7 42 2
each branch circuit 3b` 2�f.°7
Contact name: Charlynn Leifsen B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
16869 SW 65th Ave#311 branch circuit
City/State/ZIP: Lake Oswego,OR 97035 Each add'l branch circuit 7.42 2
Phone: Miscellaneous(service or feeder not included)
(503)747-2503 Fax: :( 503) 972-1861 Each manufactured or modular 67.84 2
dwelling,service and/or feeder office@johansenelectric.com Reconnect only
67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: SAME AS APPLICANT Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy ❑ See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 51539 Electrical 4 . 3-243C Suprv.Lic.: 5378S specifically listed(1 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,require* l
l�r�V Subtotal: 5 0,1t
Print name: Jonathan Jo Seri Date: t'L' Zd I J(��Z' 0 Plan Review Required(25%of permit fee): I ib* I Cj
State surcharge(12%of permit fee): ( ' ,Zq
Authorized signature: TOTAL PERMIT FEE: t ( .2.2.
This permit application expires if a permit is not obtained within 180
Print name: Charlynn Leifsen Date: ( 7 wD / days after it has been accepted as complete.
Lam{ * Number of inspections allowed per permit.
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(I I/05/COM/WEB