Permit , T ® ELECTRICAL PERMIT
r CITY OF TIGARD li
rt Permit #: ELC2010 -00207
= 4 COMMUNITY DEVELOPMENT Date Issued: 04/30/2010
T1GARD, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S112DD01600
Jurisdiction: Tigard
Site address: 15575 SW SEQUOIA PKWY 140
Subdivision: Lot: 0
Project: Winzler Kelly
Project Description: (25) branch circuits for TI
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300 25 crt Branch Circuits 04/30/2010 $234.26
PORTLAND, OR 97224 wo /Purchase Service or
PHONE: 503 - 624 -6300 Feeder
1 ea 12% State Surcharge - 04/30/2010 $28.11
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 $262.37
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. / //I
Issued By:
Pertnittee Signature: ®Ar /'G / e �- " "
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.
71- s
RECEIVED
Electrical Permit Application 1 ) : (l : t i : O\ l .\
City of Tigard APR 27 ;::::.• Received 7 iar= Permit No.�C� 1/0 .-0' • ,_ 0 DatGB : 3d / �,
-. 13125 SW Hall Blvd., Tigard, OR 97223 non Plan Revie p �1D -00069
9
Phone: 503.639.4171 Fax: 5°3. 0FTIGARD DateB - : � P° V
Tic: !: ['l Inspection Line: 503 6394175 BUILDING DIVISI ®N Date Ready/By: 3una: �/ !a See Page 2 for
Internet: www.ti d - or. 8 ov Notified/Method: C) Supplemental Information
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❑ New construction 1 Addition /alteration/replacement Please check all that apply (submit 2 sets of plain wlitems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stones.
❑ Demolition ❑ Other: current ° t c'Ttp It , J s exceeds s l0,OD0 a ampa at 0 volts or ❑ saunas and boatyards.
W i ltltl ll. •P , .',OF3 is v t?; . ,.: ; ❑ Floating dings.
.. 1 r sr • .: ' !* less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling 'Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
ry1w t ¢ a J c, j �1� � �! . �1 , ,,, ! ❑ Addition system. larger separately derived system. i . *t, n y s iik1ra " lt •1 „c ' ❑ Additi ❑ fo of new motor load of ❑ `:4 - , "E', "] -2 ", - 1 -3 ".
Job no.: I Job site address: 1% F 9 9,, 1 1 I0OHP or more. occupancy.
El or mare residential units. ❑ Recreational vehicle parks.
City /State /ZIP: VVVV ❑ Health-care facilities, ❑ Supply voltage far more than
❑ Haardous locations. 600 volts nominal
Suite /bldg. /apt. no.: LI O I Project name: Y�f tt W l nz_Q ❑ Service or feeder 600 amps or more. �F+�a
. , 1 ,.` i Ft; °wR' :t'► a 'x '18 1°! fr+ .I lif D,1,
Cross street'directions to job site: Deur,ption 1 4t,. 1 Fee. I Total 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 portion 33.92 1
Tax map /parcel no.: Limited energy, residential
3l tANttBa "k , .i ? , 1t Y. ' 1 !l 6 .. 1 67.84 2
s, atTCit itjl( tie( pe,i.,.. tr�4 tS,r,r , r .. - .. s P 1 1;:; (with above sq. ft.)
/] r Limited energy, multi - family
-(/► i- } y�pi'r residential (with above sq. ft.)
67.84 2
l Services or feeders installation, alteration, and /or relocation
i FY 'J r�r'�•x�p�
'p * �p It 'I ; :: i.,, ,, 200 amps or less 100.70 2 _
1 c , ,k , ; k i `- � ^ . ,,71 , sli,s tl - lt 1 I l ixli` # '_ , .e .. 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
relocatio o _
Phone: ( ) Fax: ( ) 200 zmps or less 59.36 1
Owner installation: This installation is being made on property that 1 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
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. F� for branch circuits with
4 + l a, 71 1 ,; F 4" ,4li,l t 1 ,Iris z , above service or feeder fee,
�. . , t �i+ I ...11 .AI ::!�av11. 7.42 2
Business name: Johansen Electric Inc a branch circuit
B. Fee h for branch circuits
without service or feeder fee,
Contact name: Charlynn Leifsen first blanch circuit i 56.18 5 (, ,1 D 2
Address: 10948 SE Valley View Terrace Each add'I branch circuit 9 _4 7,42 11 g/ 031 2
City /State /ZIP: Happy Valley, OR 97086 Miscellaneous (service or feeder not included)
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
r t*a 46? »' 1 .4. rl °I'lii4i;i1l(!1 t1' ,.!1 r7 i s 'ice i , .;; sign or outline lighting 67.84 2
Business name: Johansen Electric Inc Signal circuits) or limited-
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
Per inspection 66.25
ne: (503) 698-3417 Fax: (503) 698 -2486
/ / Investigation per hour 0 hr min) 66.25
CCB Lic.: 51539 ,/ I Electrical Lic.: 3-243C e/ Suprv. Lio.: 2053S Industrial plant per hots 78.I8
i' IlRo7'`. +':1 .)18 AL • i Ht_ ;J IA r4,
Suprv. Electrician signature, required: 0r4 �/ � � ��� Subtotal: �+{ ,2,(
Print name: Carl Johansen Dom: 4 27 Plan review (25% of permit fee):
O I `� State surcharge (12 %of permit fee): 2- . (1
Authorized signature: . TOTAL PERMIT FEE: 2 . 1,2 .3/ /����"" """11 This permit application expires if a permit is not obtained within 180
L-1 "Z
Print name: Charlynn Leifsen Date: i ID days after it has been accepted as complete.
• Number of inspections allowed per permit. A •
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