Permit ,r; tt `" CITY OF TIGARD
ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 00147
T I G ARID 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/31/2010
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 460
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: AM Trust North America
Project Description: Install (1) 200 amp or less service /feeder, and add /alter (15) branch circuits.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 1 ea Services or Feeders - 200 03/31/2010 $100.70
amps or less
PHONE: 503- 624 -6300 1 ea 12% State Surcharge - 03/31/2010 $31.29
Electrical
15 crt Branch Circuits w /Purchase 03/31/2010 $111.30
Contractor: Service or Feeder
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 $243.29
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. At 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 AR 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.
l
Issued By: C_SVO L LA 0.9,... Perm ittee 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' Q
/1 Sp() 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. � ` 1 A t � k, l a e- Fr- ` ,, >r 4 . �' , t ; A 4 • -
.1 T !g 1 p lyl () 1;: (til f) \1�1 t
! 11 � t,_ : ' S. r ' - .. a ,rk . ,, ik Rec
III City of Tigard DateBy: Permit 7 �ojc ig(� I t f
G .
13125 SW Hall Blvd., Tigard, OR 9722 31 2010 p Re view ) ! z - V m `{7
Phone: 503 Fax: 503.598.1960
Other Permit:
, . D ett Bv:
,,....1� Inspection L ine: 503.639.4175 -.
k:�C: I�, I� n - • i. � Date Ready/By: luris:
tsar g nv l,S t Od I iG> RD T Supplemental Sae fo�
Internet www ngard -or Noafied/klethod.
i, t v k/ 1101 ll A l G Information
t
t l� � �'it 1 tM 1 If A ° "k 1 1 , t ' aI • li ., €I 1, l ior r.,,,, t o ,,,, It , ,,,,, I tx a , ,, , .,G , , q� ,
ptrer,:..•,; 'tl Q. 4..ta1L.: ,i , _ iiT 1�i1 l,, 41:•11 l 7.r ., - : ,d 41Ytx, „ cirt z',,:;(; ., r. l kba lti a l lti h'��� '���'.°
❑ New construction IN ' dditionlalterationlrepldeement Please check all that apply (submit 1 sets of plans w/items checked below):
ID Demolition ❑ Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
•' t 1 r. ti a ;rte? A - where the available fault current ❑ Mar and boatyards.
'' 1 1...l
. `I � r r'r Il ' .ilr. ql It 1 : - _. 1 y t r: ` ,,�} X11 t $(� , v u 'x •, . �� 1, t a.a I, , I 1 ." it t w i ;`�P ❑ Floating buildings.
exceeds 10,000 amps at 150 volts or Fl
�.aa:>! �.. �'` Lj ., :ri' �
❑ 1 - and 2 - family dwelling '% ommercial/industrial 0 Accessory building less to ground. or exceeds 14,000 ❑ Commercial -use agricultural
amps for all other installations. buildings.
❑ Multi - family ❑ Master builder 0 Other: ❑ Fire pump.
❑ Installation of 75 K V q or
a ;11 i -'a` ^ r i ih Pr q l !:9NeT' a1r er rq f , .4.- Emerg cy system. 1 separately derived
1 i ; 'i> r :' l , lit r ya f., t.:iI, I ti' sit " a1s ' i ' ° ' pia! +( 4 i ' 141A' 1 'f ' ❑ Addition of new motor load of
Ea larger P Y system. t .... ,,i, ❑ "A" "E" "I - "1 -
Job no,: Job site address: Z-6119,Y:i G\k,) t Q S} 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State!L IF: ❑ Health -care facilities. ❑ Supply voltage for more than
COD ❑ Hazardous locations. 600 volta nominal
Suite/bldgJapt- no.: It \lam l l Project name: ArbryiTIFOSt ❑ Service or fetter 600 amps or more
1 Ct � i N c 1;�4 n. .
Cross street/directions to job site: a :1�' U F [ t ;111St :. II I + ^ �i3 + x' �, t i �
+.•_
Description I OM 1 Fa, 1 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
Tax map/parcel no.: Ea. add'] 500 sq. ft. or portion 33.92 1
�}�pp ., Limited energy, residential 67.84 2
1 'Yik 1 { n,M;xrtlx. { vt 4 `. °rp c°� ? 4? . " Ftl i•1ui tr f { sy a 1 Y: � M. 1
: taYUUal .lmi of i . e t. 1 @fi t. ' .. .fl i) EN,.,... &M P (with above F..
Limited energy, multi - family 67.84 2
residential (with above sq. 6.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 100.70 10 40 2
r2X1 ' 1 'Ti ' gis : ' ;i rtpil , ?� t5 IF '.:R., P 1 20 amps to 400 amps 133.56 2
w yt se-.- .mos'liersesimm aal.•+_t to s::'1.. Allk Ma t r ? 3I .fit. �. s'i• 1. 1i> :' .. ,
Name: l e4 1 401 amps to 600 amps 200.34 2
Address:
601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 1 Fax: ( ) 200 amps or less 1 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 I 168.54 2 _
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
: I �u,• r nerve! tl 1� per! 1; • � { , A. Fee for branch circuits with
. e.11 .e t> e�.mst '' ` { (,a ' ire p , - ai rMaDli ..: i.:1 1 11 ' ,,, . n .' ,, above service or feeder fee,
each branch circuit i t 7'42 111,3c, 2
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'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Happy Valley, OR 97086 Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: (503) 698 -3417 1 Fax: : (503) 698 -2486 Reconnect only 67.84 2
E -mail:
� l ! r r' 'it]' , Iv t A � ' �, tit Pump or irrigation circle 67.84 2
l ,Sdgly., :: : , �( y,,•' illy 11, � ' M1 m 9 idr 1 )l ` if;f E , 1 S ign or outline lighting 1 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 in an ' of the above
Phone: 503 698 -3417 Per inspection 66.25
( ) Fax: (503) 698 -2486 Investigation per hour ( 1 hr min) 6625
CCB Lic.: 51539 Electrical Lic.: 3 -243C Suprv. Lic.: 2053S Industrial plant per hour Ti° t 118
t � ad
- " � ` iii r ;:, •,; r't iii! •: Mili r'e /lt;;;., 71
Suprv. Electrician signature, required: ( k' I Subtotal: 2,17.— Print name: Carl Johansen Date: 3l ' ` 1 o Plan review (25% of permit fee):
r Stale surcharge (12% of permit fee): ZS • ti q
Authorized signature: TOTAL PERMIT FEE: 231
Print name: Charlynn Leifsen Date: 3 ( - 110 This permit application ecpires if a permit is not obtained within 180
days after it huts bees accepted as complete.
• Number of inspections allowed per permit.
1:1 Buildioglpennits , ELC.PtratitApp.doc 10/01/09 440.4615T(1I/05/COA<N,'
0 ki 6V'liA i • U I ) et V \
i sq
T' Xdd 13C213SIF3 dH Wd6S:E OTOZ TE -reW