Permit kaj CITY OF TIGARD ELECTRICAL PERMIT
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COMMUNITY DEVELOPMENT Permit #: ELC2010 -00117
TIGARD, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 03/11/2010
Parcel: 2S113AB00101
Jurisdiction: TIGARD
Site address: 16101 SW 72ND AVE 140
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: Trinity University
Project Description: Add /alter (6) branch circuits.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 6 crt Branch Circuits 03/11/2010 $93.28
wo /Purchase Service or
PHONE: 503 - 624 -6300 Feeder
1 ea 12% State Surcharge - 03/11/2010 $11.19
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 $104.47
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within ' 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through O 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: Z22-0—
OWNER INSTALLATION ONLY
The installation is being made on property 1 own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Cali 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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Electrical Permit Applicat' C 0 � j a ,� ,t 4, ' �� t i,lzi()1.1,Itlil 1 : , µ l �Ix ` , _ "
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C I o4 Tigard MAR Received P erm i t No.: 0 0 • c
eh , - 13125 SW Hall Blvd., Tigard, OR 972Z3 1 2013 Phan Review • � e2 l r f �y C . ,0 Phone: 503.639.4171 Fax: 503.59$.1260 Date/By. Other Permit: IAp?0t0. � g
�' 'S� Inspection Line: 503.639.4175 (.I `` {'i ` IGAR nape Ren R iB 0 See Page 2 for
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1 1 tvonfiedlv,ethod: Supplemental .t 78 Internet wvnc.tigard�r.gov o . i n ( pplemeamlInformadon
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❑ New construction Addition/alteration/replacernent Please check all that apply (submit 3 sets of plans w/items checked below};
❑ Service or feeder 400 amps or more ❑ Building over three stories.
['Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
i " t rw i, ,i I ., 'ar , , i ii t . : ' "...''ca I exceeds 10.000 amps at 150 volts or ❑ Floating btsildmgs
t 1�r�i i !i, .l N t t d 4 -eiall tali.' 1 ....:� ievwi del i t
less to ground, or exceeds 14.000 ❑ Commercial -use agricultural
❑ L- and 2- family dwelling ►': Conunerciallindustrial ❑ Accessory building amps for all alter installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
, 1 I t. . ' IO�j� r.W. gt Vr 'j'rr �e4s(lr lu . 1�i 7'i` li 1 H. , 1 91 net ,11 ❑ Emergency system. larger separately derived system.
.anal.,. 3d . t itil �al
N arih,tilsitial t lain ,, n
-W n'.- +l' W:. ,. ❑ Addition of new motor load of ❑ "A" "E" "1.2" "1.3'
+ r' Will 100HP or more. occupancy
Job no.: Job site address: `(J
❑ Six or more residential waits . ❑ Recreational vehicle parks.
City /State;Z1P: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: l t} () Project name: 1 r \ f . \ , 0 VS0, I ❑ Service or feeder 600 turps or more.
till r .`. r ' l r Ba Ali ,,,.. iAt,
Cross street / directions to job site: Nuristan Oty. Fie. Total
New residential single- or multi- family dwelling unit.
Includes attached garage. •
Subdivision: Lot no.: 1.000 sq. ft. or less 168.54 4
Ea. addl 500 sq. ft m portion 33.92 1
Tax map /parcel no.: Limited energy, residential
��i1ggll ::� m c ,. .rte m+ t qurr� u 1 �rU 9 ; 1 67.84 2
.:1.; r ' .. hunt I'.: 1xI:Li Ii ' i>a ' 11173M i`mi t I1','Ai "71 : � .-; s:. (with above sq. fl.)
l l 1 I 1 /l d
Limited energy, tial (with th above sq. multi-family
b
residential (with about sq. fr.) 67.84 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
y � gp �� - � k m }
�I" I z LGiYlr7wNaa snd'ffiti IIY91a a� '' r 1k 11tH %` = : 4 u a { 201 amps to 400 1 1 ,t =,�� ;< t r 1' t �d _ `r r r� "i . P 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 wbich 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 turps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel Fee for branch circuits with
Owner signature: Date:
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1 �.' �t " c1,1�10�l i ® ' t c1 . L 1., G r r r i
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1 1Si 0i s d }' t,,, . ig` b'n: x , ;,r t JI, r' s.. i �� u t ; . -. t s',,tn ltr'i above service or feeder fee, 7.42 2
each branch circuit
Business name: Johansen Electric Inc B. Fee for branch circuits
Contact name: Char n n Lettsen f irst b ranc circuit
service or feeder fee, 56.18 ,It 2
ly fir bh iit
Address: 10948 SE Valley View Terrace Each add'! branch circuit 1 7 7.42 5r1, t D 1 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Happy Valley, OR 97086 Each manufactured or modular I
dwelling, service and/or feeder 67.84
Phone: (503) 698 -3417 I Fax: : (503) 698 -2486 Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
•,;'o E E °, , ly ;:, ,1 ,;,' : "4'1, t. r.. ', , r „ a i sign or outline lighting 6784 2
Signal panel, or limited-
Business name: Johansen Electric Inc
energy p 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 any of the above
Per inspection 66.25
Phone: (503) 698 -3417 I Fax: (503) 698 -2486 Investigation per hour (t hr min) 66.25
CCB Lic.: 51539 I Electrical Lic.: 3 - 243C Suprv. Lic.: 2053S Industrial pl hour ,t 78.18
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Suprv. Electrician signature, required: ,� �s� J -e k Subtotal: 4r .2g
Print name: Carl Johansen 1— Date: b 1 I Plan review (25% of pen[[[t fee):
State surcharge (12% of permit fee): 1 1 . 11
Authorized signature:
e,,,,,t,l - TOTAL PERMIT FEE; 10 ti, Lf 1
Print name: Char) Y nn Leifsen Date: I o This permit application expires if a permit is not obtained within 180
days alter it has been accepted as complete.
• Number of inspections allowed per permit.
t:l nuilding 'Pdrnits\ELC- PenutApp.d°c 10,01109 440.4615T(11 /05 /COM/WEB
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