Permit 71 '' r "I "i CITY OF TIGARD ELECTRICAL PERMIT
� n
c COMMUNITY DEVELOPMENT Permit #: ELC2010 -00226
Date Issued: 05/07/2010
T1GAFt.D, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
„ Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 450
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: ACE American Insurance
Project Description: (1) 200 amp service and (20) branch circuits for TI
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 1 ea Services or Feeders - 200 05/07/2010 $100.70
amps or less
PHONE: 503 - 624 -6300 20 crt Branch Circuits w /Purchase 05/07/2010 $148.40
Service or Feeder
1 ea 12% State Surcharge - 05/07/2010 $29.89
Contractor: Electrical
JOHANSEN ELECTRIC INC
10948 SE VALLEY VIEW TERR
HAPPY VALLEY, OR 97086
PHONE: 503 - 698 -3417
FAX: 503 - 698 -2486
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $278.99
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 -0100. 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: ( / ' / . .. Permittee Signature: ('t/ ('# .' ('r9 - /V
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 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.
Electrical Permit Application l rf-1) ",- i j I 1..(11; O1.1 1i 1: 1 'I•: O" l.v
114 City of Tigard MAY V �a � "°d S / 1111*. permit No.: QC�p /0 �e
13125 SW Hall Blvd., Tigard, OR 972 MA r - 6 20 1( Plan Review �w
I , Phone: 503.639.4171 Fax 503.598.1960� q Date/B : Other Ptror4 '/ ,( i/Q JO�Q
1. ., ,., i.. Inspection Line: 503.639.4175 o� 9 y /i6' - lfi 4 �,�) Date ReadyBy: Id See Page 2 for
Internet www tigarJ or gov s tl ' At) � � Supplemental S a H i Notified/Method:
E y .... e1. Infotmation
Ill; 'Al ° ir"Y Yt(is ulp 4%.4i -„ - 1 � N . .,_ . -IY7 ii h...., R II1 I p■ :i , .. ,,� p a
,.tl , " ter i`Yr Jl• t k .' n '4v,. i' .. qrS� - ' t. - ' - qa:; (i . 'A' .. i Y J? v' :!- 1J ' , i 1 r r . }. @1 UK ^ E [ 1 1 ,..1-,!:, � 5:- I , . ors q
❑ New construction A Addition/alteration/replacement Please check all that apply (submit j sets of plans w /items checked below).
❑ Demolition ❑ Other: 0 Service or feeder 400 amps or more C1 Building over three stories.
01 De ` + It, ll y i 1 ( rr' �i l JI l f la> where the available fault current ❑ Marinas and boatyards .
i, q e „;,,,: i 'xt,i ,1 _. g , Y exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial use agricultural
0 1- and 2-family dwelling pCommercial/industrial ❑ Accessory building amps for all other installations buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KV A or
)l, a , r-j. #,4 :' rr'' ''' ' y ,. a e " ; ❑ Eme new m larger separately derived system.
motor load of 1 brh _ r _� `�u � 1� F i :l ?vh �n �r 17 R7; ..�.! '
,- ,• ±�i. L,', . ❑ Additi000farw
Job no.: Job site address: 7 (�} ', \\ r -�l H more,
`� `-'N ` �� ❑Si or P m or xe residential arils. occupancy.
❑ Recreational vehicle parks.
City/State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal.
Suite/bldg. /apt. no.: Project name: / N e r \ I f tXii /ia ❑ Service or feeder 600 amps or more.
(Y� 91.'; *li 1T, , l{ :§ r:s9 El l ilri)i1kl:;`l' , !i.
Cross street/directions to job site:
Description 1 Qtr. { Fee. I coral 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea add'I 500 sq ft. or po rtion 33.92 l
Tax map /parcel no.:
-
ti i Limited energy, residential
{ (t f r " #ie�1 11 r 1 L' 1 �' ii e 67.84 2
CJ1,kt, t , F4.1i i:: a :Y q'F � if.11, �i:J ' ,�:! t : 1..: ' (with above sq. 8.)
Tr i _ __ _ j' Limis energy, (with b ' e s .l f 67.84 2
X1�Y1 1 e,�rv�� residential (with above sq. R)
Services or feeders iostallation,altfration, and/or relocation
h t 11 " Jl a . ( r t l I� r' 200 amps or less 1 100.70 �.io � 2
7
t ; r 1 t e!>_. 7,.• . . trt1� ry,,t, , „ -, ! . ,1 .a t . dra �'_;:',1 1 f 1 J + . 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: ( ) I Fax: ( ) 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 125.08 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, per panel
A. Fee for branch circuits with
r :.,...
` r ' y '`a.,.
5;t Ali ` l ,, ,,l fi, . �, ., tt 1 3, �i " b.: i t �. = a �,( " � I � above service or feeder fee, 7.42 l yg'Ya 2
each branch circuit
Business name: Johansen Electric Inc B. Fee for branch circuits
Contact name: Charlynn Leifsen
without service or feeder fee, 56.18 2
first branch circuit
Address: 10948 SE Valley View Terrace Each add'1 branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Happy Valley, OR 97086 Each rranufactured or modular
dwellir.R, service and/or feeder 67.84 2
Phone: (503) 698 -3417 I Fax: : (503) 698 -2486 Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
.. f4.6:14 -1 4 74 41114. k P9l. i.4ill , + „I, Itl1n, .t 1,1- +s f l,,,„ '7. Si or outline lighting 67.84 2
Business name: Johansen Electric Inc Signal circuit(s) or lim[ted
energy panel, alteration, or
Address: 10948 SE Valley View Terrace extension. Describe: Page 2 2
City/State /ZIP: Happy Valley, OR 97086 _ Each additional inspection over allowable in anyof the above
P : 503 698 -3417 Per inspection 66.25
, t om ( ) I f Fax: (503) 698 2486 Investigation per hour (1 hr min) 66.25
••• I. CCB Lic.: 51539 V Electrical Lic.: 3 -243 ` Su rv. Lic.: 2053S Industrial plant per how 78.18
a r ., `-',r,.,ey'�ala4rre {1 ,',Il i o,: t {, I t 4t. ,,,, ,(tl /
Suprv. Electrician signature, required: I Subtotal 2
Print name: Carl Johansen J Date: S 1 P i IlP� CJ an review (25% of permit fee):
l State surcharge (12% of permit fee): 24r
Authorized signature TOTAL PERMIT FEE: 21 g../9 0 ,,
,
Print name: Charlynn Leifsen Date: l _ 1 This p ermit appl catioi expires if a permit is sot obtained within 180 1 J-
1� days after it has been accepted as compkte. (l�(�
Number of inspections allowed per penult.
1 18uildineennisiaLC•PtnmtApp.doc 10/01/09 440.4615T(11 /D5 /COM/WBa
I •d xlrld 13C?I3SEll dH WdEI t2I 0 90 ReW