Permit (2) CITY OF TIGARD ELECTRICAL PERMIT
1"11 COMMUNITY DEVELOPMENT Permit#: ELC2023-00305
Date Issued: 6/15/2023
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S113AB01201
Jurisdiction: Tigard
Site address: 16250 SW UPPER BOONES FERRY RD
Project: NW Regenerative Orthopedics Subdivision: None Lot: None
Project Description: Electrical work for remodel of 4,090 sq.ft.of existing office space.
Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES LP
16869 SW 65TH AVE, SUITE 311 ATTN: N PIVEN
LAKE OSWEGO, OR 97035 15350 SE 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 06/15/2023 $100.70
Specifics: amps or less
20 crt Branch Circuits w/Purchase 06/15/2023 $148.40
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea Plan Review Electricial 06/15/2023 $62.28
Type of Const: 1 ea 12%State Surcharge- 06/15/2023 $29.89
Occupancy Grp: Electrical
Total $341.27
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 require you to folio the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 throuah 0 952-00 . Yo av btai he rules or direct auestions to OUNC by callina 503. 2. 87 or 1.800.332.2344.
Issued By: Permittee Signature: �4
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.
LCEI
Electrical Permit Application s l'OR c)FF►c l: I sr()NIA
r Received /r , _
City o Tigard ��`) - /� 3/'/--
13125 SW Ha11 Blvd.,Tigard,OR 97223 eview `�2 ' r ►i 'l�sri U UV�(/J
°: ® Phone: 503.718.2439 Fax: 503.598.1960 1 Date/By: Q( I(Z 7 4 4 Related Permit#:
Inspection Line: 503.639.4175 Cr�`Y OF T;^ ate Sy: Sum: 0 See Page 2 for
i l"")l (') Internet: www.tigard-or.gov B 1�,r ill i., �" l , 1 ethod,(/ /G��z�/�i Supplemental Information
TYPE OF WORK �--�7�T77`✓ PLAN REVIEW
❑New construction Z Addition/alteration/replacement Pleas:check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
El1-and 2-family dwelling El Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 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#:
16250 SW Upper Boones Fy Rd 100HP or more. ❑"A","E",°'1-2° "1-3'
City/State/ZIP:/State/ZIP: ❑Six or more residential units. occupancy.
Tigard,OR 97224 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: NW Regenerative Orthopedics 0 Hazardous locations. 0 Supply voltage for more than
p 0 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: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'►500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
Electrical for remodel work to 4,090 SF of existing office space Limited energy,multi-family 75.00 2
residential(with above sq.ft.) ,
Renewable Energy 0 See Page 2
0 PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 1 100.70 100.70 2
Address: 201 amps to 400 amps 133.56 2
— 401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) 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
Branch circuits—new,alteration,or extension,per panel
] APPLICANT 0 CONTACT PERSON
A.Fee for branch circuits with
Business name: above service or feeder fee,
Johansen Electric.inc. each branch circuit 20 7.42 148.40 2
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
Miscellaneous(service or feeder not included)
Phone:(503 )747-2503 Fax: :(503 )972-1861 Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: 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 0 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 ' '_43C Suprv.Lic.: 53785 specifically listed(%hr min)
irA ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:iv a, Subtotal 249.10
Print name: Jonathan Johansen Date: S I 1 s 1 26z3 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 29.89
Authorized signature: C TOTAL PERMIT FEE: 278.99
This permit application expires if a permit is not obtained within 180
Print name: Charlynn Leifsen
Date: S /6/03 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB