Permit ' , ' :.5' CITY OF TIGARD ELECTRICAL PERMIT
n
` a COMMUNITY DEVELOPMENT Permit #: ELC2010 -00173
r 1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/15/2010
T1G'AAD; Parcel: 2S112AD01000
Jurisdiction: Tigard
Site address: 7007 SW CARDINAL LN 105
Subdivision: Lot: 0
Project: Fax Back
Project Description: (10) branch circuits for TI
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 10 crt Branch Circuits 04/15/2010 $122.96
wo /Purchase Service or
PHONE: 503 - 624 -6300 Feeder
1 ea 12% State Surcharge - 04/15/2010 $14.76
Electrical
Contractor:
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 $137.72
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 0 R 95 -101 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Y
Issued By: / ® I, P / - Permittee Signature: 4 4 / 9//' (---/ C6
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 603.639.4176 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.
RECEIVED
Electrical Permit Application APR 1 5 2010 I ()t; 011:1(-1. 1 1. ()\I 1
I ....... City ofTipa ra ved q IN1111111111 PemitNo.:G`L 2O /0 Q// _,
13125 SW hall Blvd., Tigard, OR 97223 CITY OF TIGARD •
Phone: 503. 639.4171 Fax: 503.598.1 jILDING DIVISIO' "` °'‚ I , 4
(.. I i , Inspection Line: 503.639.4175 Date Ready'Ry: to gee Page 2 for
Internet: www.tigard- or.gov Notified' Ctfiod: IBMI Supplemental Whet moan
1 15, J �. t r "rT ti :.. , ^ >ry 1 S ,, _ 1) a ,
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44. : ;. h rl�, ti? ,' , 1 . . >'irA rf ;r i F A �` N f S ,< :, 5:.;.� I E,. .;` ) R Y'!/, s. ?� :f, ai.s ., , ! } .5� - c
❑ New construction Addition /aIterationhepIacement Please check all that apply (submit 2 sets of plena v7ilems checked below):
0 Service or feeder 400 amps or more ❑ Building over three stories -
0 Demolition 101 Other: where the available fault clareot ❑ Marinas and boleya l$.
1 " 1 1�}6 r h M .7eka - i � 'r t exceeds 10,000 amps at 150 volts or ❑ FlOadag buildings.
1
/ t ii,M "'„ t + -G t ..: �:I �+' - ,, ,es, , . - , , . ` ,i i 'r . 'M''' lase to ground, or exceeds 14.000 ❑ commercial-use agricultural
❑ 1- and 2- family dwelling 42 Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other ['Fire pump. ❑ Installation of 75 KV A or
t v y j F, £ 11 r M ,r ' + - Ir .?" ❑ Elm/80=Y system- larger separately derived system.
, i ' "r i c .i t ' 4th ; s ¢ , A , r ; , . . ..1, +.. 1, ; a ❑ Addition of new mote Toad of ❑ "A" "E "1.2 ", "1 - 3"
1.,. 4,�,,,::r, . ?� s , ,.,. , . ssr" tJV�I/�i"'tr'�a�l
Job no.. Job site address: 1 + Six or or mere. occupancy.
I 1 001 J ,k ❑ Six or more ore. residential lair. ❑ Recreational vehicle parks.
In Health-care facilities. ❑ Supply voltage for more than
'��z�' ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: (0 5 Project name :) - RX -IXCR ❑ Service or feeder 600 am12p��s or m
Cross street/directions to job site: Fib( .B/rC*- Da.viption I Q. eve. I Total 1
New residential single or multi family dwelling unit.
f Includes attached garage.
Subdivision: 1 Lot no 1,000 sq. ft. or Less 168.54 4
Ea. add'1 500 sq. ft. or portion 33.92 1
Tax Wrap /parcel no.: Limited energy, residential
a E ::,Y E`,; ::;,. ,r , .1i R .. " "W , .' .. k e r „ , -. `, _ (with above s4. ft.) 67.84 2
¶ F- L imited energy, multi-family 67.84 I 1 2
residential (with above sq. it.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
;'.r r r 7 ,�. ,,.,a, ' � ' ,',.; k < . } ::; 0':'S; 201 amps to 400 amps 133,56 2
rJ '� , ,Sri .•.-„ l• _ . ,r „n , %,.,
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
C /State/ZIP Temporary services or feeders installation, alteration, and/or
City/State/ZIP: : relocation
Phone: ( ) I Fax: ( ) - 200 maps 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, tease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps _ 168.54 2
Branch circuits - new, alteration, or extension, gar panel
Owner signature: Date: A. Fee for branch circuits with
+. i Y' + d � V +td 4 ? c " y e t , , 00 , '. ry0 y �� :' above service or feeds fee,
ir, :.�•+. jt i;. �,i•',. "?? fYi . .<r shC { �. ! „t " ?y6ii,�W!��,w�i "t°1p"v"t' 7.42 2
each blanch circuit _
Business name: Johnsen Electric Inc B. Fee for branch circuits
without service or Contact name: Charlynn Leifsen circuit
fee, I 56.18 54„1E, 2 •
Address: 10948 SE Valley View Terrace Each add'l branch circuit 7.42 (o%.,'y,S 2
Miscellaneous (service or feeder not included)
City/StatcfZl P: Sappy Valley, OR 97086 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 698 - 3417 1 Fax: : (503) 698 - 2486 Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
w x �. x , . • I r t+I u A , ;! Sign or outline ltghtmg 67.84 2
t i� „� _�.r,. 4,e ,r ,t r,. t ... J ,r `' d4..,a,: C:, � !% ...�. . -, - , 1 . . _... , ,
Sight circui(s) or limited -
Business name: Johansen Electric Inc
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 aa,v of the above
Pet inspection 66.25
hone: (503) 698.3417 1 Fax: (303) 698 6 / investigation per hour (1 hr min) 66.25
CCB Lic.: 51539 1 Electrical Lic.: 3 - 243C Suprv. Lie.: 2053S V Industrial P� per hour' 78.18
:,
Suprv. Electrician signature, required: c e ,, 4 Subtotal: 7 VL q`
Print name: Carl Johansen ( Date: Plan review (25% of permit fee):
_ 141 ' d
� State surcharge (12% of permit fee): / c/, 7 6 ,
Authorized signature: - TOTAL PERMIT FEE: /37, 72, V
Print name: Cher1
Y» Leifsen Date: l +I 1 S ✓ 1 ( o Das pen& application expires if a wail la not obtained within 180
days after it :us been accepted as complete.
• Number of inspections allowed per permit.
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