Permit . CITY OF TIGARD ELECTRICAL PERMIT
c ri Permit #: ELC2010 00206
, COMMUNITY DEVELOPMENT Date Issued: 2010
04/30/
T1G'AFtDi 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel 04/ 2S103DA05700
Jurisdiction: Tigard
Site address: 10634 SW COOK LN
Subdivision: FANTASY HILL Lot: 11
Project: Scholes
Project Description: (2) branch circuits
Owner: FEES
SHOLES, LANCE M & KRISTIN A Quantity Description Date Amount
10634 SW COOK LN 2 crt Branch Circuits 04/30/2010 $63.60
TIGARD, OR 97223 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 04/30/2010 $7.63
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: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $71.23
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 952 -101 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 oorr 1.800.332.2344.
- 444113 Issued By: P ermittee Signature:
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.
CaII 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 :Attie time of each inspection.
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Electrical Permit Applicati • 4 I. � C E1 i iii I ►ri It t. I Si. <►N1.1
City of Tigard Received 'J nn Da[e1B : �� �� I�i'r Permit No. %., //D -,O 2�
13125 SW Hall Blvd., Tigard, OR 9722 21 20 \U Plan Revie
>0 Phone: 503.639.4171 Fax: 503.598.1 9 � D ,g ;
Caber Permit:
Inspection Line: 503.639.4175 ,���! ®R Dam Ready/By: ® See Page 2 for
cyo Internet: W4vw tigard -or gov �'` 'UL " -
Notified/Method: � Supplemental Information
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❑ New construction s Addition/alteration/replacement Please check all that apply (submit j sets of plans w /items checked below):
D ❑ Demolition ❑ Other: ❑ Service or feeder 100 amps or more ❑ Building over three stories.
D� s ! 1 l i { 4xt+ 11 !t rl� where the available fault wrrent ID Marinas and boatyards.
11-0„ , PlG,ll' ll,d+ 7 :.= t - ? it 1 ivn. I ll,!hit . ri 1 'JiS , T- exceeds 10.000 amps at 150 volts or ❑floating buildings. tnil dwelling less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
1 - and 2- fa
y g ❑ Commercial /industrial ❑ Accessory building amps for all other installations buildings.
❑ Multi- family ❑ Master builder ❑ Other: ['Fire pump. ❑ Installation of 75 KVA or
1 71k k >4+ yp it v41.trl tw i*r . 1 t ° • y ' !� i u y : , ❑ Emergency system. larger separately derived system.
; , c...i ..�:.,r ,... - ,' :� s. I • - , e ! , 4r ,,,hi 1 1 ii' . �i , I ,i l (,3 . . Ai I ❑ Addiionof new motor load of ❑.. ,.
Job no.: Job site address: ,, � J C upk • F' or more
occupancy.
t./t!/3� iJt� lMlr"�N• 1001
❑ Six or more residential units. ❑ 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: `^ t n ❑ Servece or feeder 600 amps or mote.
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job site: " "
Cross street/directions to
J Description 1 Qty. l Fee. 1 "Cot! 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
}TS }} �1'6 ? ° i' 10 3r. is +h l � ! 3 o- 67.84 2
11 ��{0,� [ r , '...T ,,, i'07;''' . 1' ,i Tl 1 I { + ,. , ' 5 , i u! #! 1 t ; 1 1 ' i t b i r: (with above al. R.)
Q/ ///�tl�'�� � nI t r 1� p7 / �,�vv Limited energy, multi - family 67.84 2
y(/1 �� (�LZ I "' Clr� l-�' t/ 1 rQQ I l v • f!/OQS' residential (with above sq. f1.)
t r Services or feeders installation, alteration, and/or relocation
g 200 amps or less 100.70 ' 2
agiiii:.lr. !Fnt' i N' 4 17 1 . iid1u`.s f� 1.: r..., 201 a uras 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 1,300 amps or volts 552.26 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 1 59.36 I 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
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
r1 A. Fee for branch circuits with
, emu' b ` 4 1 ' it' t Li , ,illtit tr ! 11 :4rl,„ -Il . _ ,� e0N ' 114 above service or feeder fee, 742 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 54, IQ 2
first branch circuit
Address: 10948 SE Valley View Terrace Each add'I branch circuit 4 7.42 7.42, 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Happy Valley, OR 97086 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 698 -3417 Fax: : (503) 698 -24S6 Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
1 11- 1 41,.tk11 n rte li X5.0 1ti 1111 ':l , 1, 060 0ri i iCrl ?i,.1i ., i , . ` L 0∎?7, (:ET Sign or outline lighting 67.84 , 2
Business name: Johansen Electric Inc Signal circuit(s) 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 i■ any of the above
tae: (503) 698 -3417 x: (503) 618 - 2486 / Per inspection 66.25
/ ,� rJ Investigazlonper hour (1hrmin) 66.25
CCB Lic.: 51539 c Electrical Lie.: 3 - 243C Fa Suprv. Lic.: 2053S Industrial plant per hour 78.18
lr'_. t Viii 1 .ar' ., Iii 1;.3111,'1
Suprv. Electrician signature, require��J k �/
Subtotal: 0 3. to
Print name: Cats Johansen Date:
4 ( to Plan review (25% of permit fee):
State surcharge (12% of permit fee): 2 + 6
} 7/
Authorized signature: TOTAL PERMIT FEE: v ,
Print name: Charlynn Leifsen Date: (.41 T permit application pins ifs permit is not obtained within 780
I V This a :
days after it has been accepted as compote.
• Number of inspections allowed per pcnnit
1 .1&rilding\Permit31ELC- PermitApp doc 10/0t/09 440- 4615T111 /05ICO,M/WEB
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