Permit CITY OF TIGARD ELECTRICAL PERMIT
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?:Q COMMUNITY DEVELOPMENT Permit #: ELC2010 -00118
T 1 Gi1RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 03/11/2010
Parcel: 2S112DA00700
Jurisdiction: Tigard
Site address: 15333 SW SEQUOIA PKWY, STE# 100
Subdivision: PACIFIC CORP CENTER Lot: 0
Project: Coca Cola
Project Description: Add /alter (30) branch circuits.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 30 crt Branch Circuits 03/11/2010 $271.36
wo /Purchase Service or
PHONE: 503 - 624 -6300 Feeder
1 ea 12% State Surcharge - 03/11/2010 $32.56
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 $303.92
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 rough •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.
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Issued By: � Permittee 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.
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.
l k { ® RECEIVED
Electrical Permit Application � r 4 _ , a�. . �.:
M AR 11 1 2 010 Rx eivad st- I. Jilt 041...1 to lit, Si ,t ei t)j� nr %'.
' tr ; a C i ty of Tigard &C2OO. 00
{ s " ' a 13125 S W Hall Blvd., Tigard, OR 9 Dare/By Permit No
K..;- ' ' . ` Phone: 503.639 4171 Fax: 503.5&IAi OF TIGARD Plan Review
Date/B Other Permit. r , . ` , "
F t sRx Inspection Line: 503.639.4175
BUILDING DIVISION Dato ReadyBy: Iu ra s« e2for
"afia 5 kA Internet www.tigard-or.gov Non6ed/Merhod. l 4 I C Supplemental Information
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w1C, Ttl(fi .1s 4Pr, t � � } t ."It. ,i tir't ?: ;�. �f '4°.trt �::,��a. 1 ';. >7;..,1�x:;, 3Yt..Jl�w:' r 1. ,'Sf. -1 n ,4�i: t'4 1 , a, ,9 r��ltg %a l
❑ New construction • ddition/alteration/replacement Please check all than apply (submit J of plaos w /items checked below):
❑ Demolition ❑ Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault currant ❑ Marinas and boatyards.
,� '' i S 1 ; ti 9 ru `�t �,_ I a � 1. I' fi t*"'# i 1 2 excee 10,090 s a' 150 volts or ❑ Floating 1�ot1Ja � i . h t,�.CYt 4s ,i, , r 1 } ,�.. : r��L' ' tdts�- "tom �,x � "n1�. '"iu4 ;il '�^ ( 1 4r:,�:}� �'. �'p n8 buildings.
❑ 1- and 2- family dwelling t; ommercial/industrial ❑ Accessory building less s o ground, or exceeds onsn. ❑ Commercial-use agricultural
atvpsforall otherinstallations. buildings.
❑ Multi- family { r ❑ Master builder �St ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
t
� d °i=7= iii.:`- all l ' t .. i •t . fly i '�t• ,� ,i ,1. I t i yi i _ ❑ Et n7Benc , stern.
iii 1 I� y,, � ., �e a ' sy larger separately derived system.
7 •,t n: , ' iaee,ltx. 1B8 (i•:a . , , ❑Additionof new motorloadof ❑ "A_ ••E "1.2 ,. l_9 ,.
Job no.: Job site address: 1 5 •j33 /� (A ri A IOOHP or more. occupancy. � � i/`^' ❑ Six or more residential units. ❑ Recreational vehicle parks.
C ity /Statei'Z IP: ❑ Heatth -care facilities, ❑ Supply voltage for more than
` C , , L -�J ek ❑ Hazardous locations. 600 volts nominal. .
Suite/bldg./apt. no.: t Op I Project name: (�, ❑ Service yy or feeder 600 amps or mare
:'-:04 ,ilril{t -4, TO ii; ffin"�i w'„u�.. tt 7M - . 4,' s•' f If. 7,1
Cross street/directions to job site: oesenation tm. Fee. Told 1 -
New residential single- or multi- family dwelling unit,
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft or less 168.54 4
Tao map /parcel no.:
Ea. add'I 500 sq. ft. or ponion 33.92 1
Erat i+ o a ,salt � ffit �� Limited energy, residential
I iJ : J'I I t ziu r�xc i't M li 4 ,, �s ' t � .... :'. .., l te ,`, (with above sq. fr.) 67.84 2
l n ,�- ,, , L energy, multi - family
-- Ire A i 1
IC7i �.I 1� f [ L residential (with above lick ft.) 67.84 2
Services or feeders installation, alteration, and/or relocation
� s� 4 200 amps or less 100.70 2
nYt S o t t p, „; ;� �i, ' v •' t PJuifi(t,+ _2 to 400 amps 133.56 2
.r ,a:'. �t�, �� ,r rr : amps P
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: ( ) f Fax: ( ) 200 amps 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
Owner signature p Branch circuits - new, alteration, or extension, Der panel
1
A. Fee for branch circuits with
BM i Er t h ;,, ur. � { {r (E , ]D wtMi l • ; ; ' above service or feeder fee, 7. 2
r each branch circuit _
Business name: Johansen Electric Inc
B. Fee for branch circuits
Contact name: Charlynn Leifsen f bra service or feeder fee, ' 56.18 `>(p , Ig 2
first broach circuit
Address: 10948 SE Valley View Terrace Each add'l branch circuit 2A 7.42 216.1$ 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 f Fax:: (503) 698 -2486 Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
l ' t ; r , . s 9 „ ' O . 1 3 1 , h , t : r1 M1117 a.,;'L i ' = is ' s5.' i ti 4 ,T,^, 4 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 anv of the above
Per inspection 66.25
Phone: (503) 698 -3417 Fax: (503) 698 -2486 Investigation per hour (1 hr min) 66.25
CCB Lic.: 51539 Electrical Lic.: 3 -243C Suprv. Lic.: 2053S Industrial plant per hour 78.18
Suprv. Electrician 1 )' +'', 4i If?, _l. ,'. _, ^ Ei
an signature, required: J � � ; ,��� �.`c �`�1�'�
_ e A- l= / :., ., Subtotal: 211 , 31,0
Print name: Carl Johansen / Date: t ( f T Plan review (25% of permit fee):
U State surcharge (12% of permit fee): 32 - (o
Authorized signature: 1 ' ljh '� TOTAL PERMIT FEE: 3b3.' 2
Print name: Charlynn Leifsen Date: TT This permit application expires if a permit is not obtained within 180
ti �V days after it has been accepted as complete.
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• Number of inspections allowedperpetmit.
I:\ Building lPenaits'ELC- PerrntitApp.dos i 0l0i!09 440- 4615T(] Id05/COMAVEB
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: -
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other: -
COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
• ❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other -
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 10/01/09