Permit lire CITY OF TIGARD
ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00597
`T GARD'' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 11/04/2009
a }4y Parcel: 2S112DC00500
Jurisdiction: TIGARD
Site address: 15895 SW 72ND AVE
Subdivision: OREGON BUSINESS PARK III Lot: 40
Project: Building 215
Project Description: Reconnect service after fire.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 1 ea Services or Feeders - 200 11/04/2009 $100.70
amps or less
PHONE: 503 - 624 -6300 1 ea Services or Feeders - Over 11/04/2009 $552.26
1000 amps or volts
1 ea 12% State Surcharge - 11/04/2009 $78.36
Contractor: Electrical
JOHANSEN ELECTRIC INC
10984 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 $731.32
Required Items and Reports (Conditions)
This permit • - • • • - t to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be dor in accordance with ap• oved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
day-. ATTENTION: Oregon law -• ires you to follow the rules adopted by the Oregon Utilit it on Center. Those rules are set forth in OAR
95 through OAR 95 101 -r 10 You may obtain a copy of the rules or direct questions to OU • • •.6699 or 1.800.332. -44. w
4
I ued By: /r � Permittee Signa �r — : Ao" (C�l
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' �� / r ) <ii ! -- Date: / /�O
r /�
/J Z /
LICENSE NO. q J S
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.
4 onno,e_eiN Cy A* s J y✓ •N M 3)
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Electrical Permit Application �,,,, _ 1.,p,1 ()1 (ll I ` 1 0„.
1 - A ..
a t Cit ofTi Received and 'a: 7
Y g DateiBy': I Q m t so
7 �v / tiC/
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
0 Phone: 503.639.4171 Fax: 503.598.1960 Dare /8y: Other Permit:
,`4 ' Inspection Line: 503.639.4175 Date Ready/Fly: fur 6d See Page 2 for
gt5;gc {g;± +y°tf7i Internet: www.tigard- or.gov Notified/Method. , Supplemental Information
'''' TYPE OF WORK 1 PLAN REVIEW t-," -.>
❑ New construction Xgddition/alteration/replacement Please check all that apply (submit j sets of plans wntems checked below/:
❑ Service or feeder 400 amps or more ❑ Building ovet three stones.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION 1 exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
1 Tess to grotmd, or exceeds 14,000 ❑ Commercial-use agncultural
❑ I- and 2- family dwelling ommercial/industrial ❑ Accessory building amps for all other installations buildings.
❑Multi- family �❑Masterbuilder ❑Other: CI Fire pump. ❑ Installation of75KVAor
❑ Emergency system. larger separately derived system.
' ' JOB SITE INFORMATION AND LOCATION . ❑ Addition of new motor load of
Job no.: Job site address: �� F Ct o 9+ J� I00HP or more. occupancy.
V - J W /` —� ❑ Six or more residential units ❑Recreational cchicic parks.
City /State /Z.IP: ,, ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal
Suite/bldg. /apt. no.: Project name: 6161,4 26 _ ❑ Service or feeder 600 amps or more.
FEE SCHEDULE `
Cross street/directions to job site: nix Wlion - I
I ty. 1 Q F I ee- "rotW •
' 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'I 500 sq. ft. or portion 33.92 I
Limited energy. residential 67 64
DESCRIPTION OF "WORK (with above sq. ft.) 1
Limited energy, multi - family
i (o 'uud 9_,N U. rtf-te. . - i e \ ilS1ciI 'j oA � n residential (with above sq. ft.) 67.84 2
- 1 Services or feeders installation, alteration, and /or relocation
200 amps or less ( '- 100.70 1 W: la 2
❑ PROPERTY OWNER ❑ TENANT , 1 201 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 I 552.26 X2 24, 2
City /State /Z1P: Temporary services or feeders installation, alteration, and/or
relocation
•
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
Owner installation: This installation is being made on property that I 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 16X.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A Fee for branch circuits with
-• . APPLICANT 1 ❑ CONTACT PERSON y above service or feeder fee,
7.4_ 2 2
I each branch circuit
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'l branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Happy Valley, OR 97086 Each manufactured or modular 67.X4 2
dwelling. service and/or feeder
Phone: (503) 698 -3417 Fax: : (503) 698 -2486 Reconnect only 67 84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR 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 in an of the above
Per inspection i 66.25
Phone: (503) 698 - 3417 Fax: (503) 698 -2486 Investigation per hour (I hr min) 6625
CCB Lic.: 51539 Electrical Lic.: 3 -243C Suprv. Lie.: 2053S Industrial plant per hour L 78.18 t
/�, Q �/ ELECTRICAL - PERMTT FEES: '
Suprv. Electrician signature. required: eevic f�, - ... /.r,,.•.,,/ Subtotal, Co 52 ' k,
Print name: Carl Johansen ' Date: 1 1 Plan review (25% of permit fee):
f t . 4 l v l State surcharge ( 12% of permit fee): 1i5• ((,
Authorized signature: _.---------- --------- TOTAL PERMIT FEE: '] 31 , 3Z
Print name: Charlynn Leifsen Date: I t This permit application expires if a permit is not obtained within Igo
�� �Qq days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:% Bu ild, ngrPermus'ELC- PemutApp.doc I0 /U1 /09 440- 4515T(I I /55 /COM/WEB
Aug, 14. 2049 6:33PM PGE REPAIR DISPATCH No, 0965 P. 1
Request to Energize an Electrical Installation RECEIVED
,� jurisdiction address: NOV 0 5 2009
CITY OF TIGARD
BUILDING DIVISION
04g
Name of supervising electrician: cc nc-t ... G. "Tc >Inc:.tn y v Date of request: l 1 /3 / 7tf
Supervising electrician's license number: 5 3 7g 5 Date installation was completed: I 1 / i / Zc
Electrical permit no.: EILZ{ci - WW1 If a temporary permit is posted at the jot) Sire, please include a ccpy cif it with this form.
; 4 0 : 5 I y R t O Y I rOnE.CT - 1',A.'040 N . V , i Q NFORTVINTIO : .
Name of electrical contractor: i o Inc: vt 5{ v, E I k C f r L License no.: 9 -2 -I 3C
Business address: I U 1 Q SE 1
City: \ k el State: 0 R ZIP: 9 70 $ G •
Phone: 503 .69- 'i< 1 1 Eax:S03 U- 2 � $G E-mail: J v Lc 4ASt r1 e-1 cc,4 @ tttS cc
Customer's name: 6 0 - C,} (kJ S
Customer's address:
City: State: ZIP:
Address of installation if different than customer's address:
City: 1 5g i E S' J 1 "•-•-• State: ZIP:
'F c tit /1 /� + R t�r S �' q' Y rb! w��r g . 1 Y R ••.
P5 i
Authority having jurisdiction to inspect: 4 � c V ` , 3 e Phone: 5:0 -(3 -L} 11 1
Address: 1312-5 S L.O Hail 071v<1 •
City State; p R ZIP: °1223
•
Name of electric utility receiving request: Phone: 503 134- 545 b
Address; 111 SL,&) Seintion S ,„4-
City: State: UR ZIP: C172O
�. ., �! • ' , :.is � ;• ':;1 ;Y'y, f`•N. ? ' ) ,'.• ,. �i.i r &ti1�+r,`' •5'',EA QW; STT r,: f n v', %H', `',f?!o 'J �n[�y„ ,�` i / .`r..' <r:: 3"t'.�\ r.
A. Restoring electrical service that was interrupted or disconnected because of either a:
❑ Service change or KUncoutrollable event, such as fire, flood, or severe weather;
Or
B. Electrical service at a remote location needs to be:
E Initialized ❑ Restored
;Li A.L-E:T ON.i; STRU0119 GNA ,11R»~r:� . '' }.
Supervising electrician Electrical contractor
Please note — After sending this form to the electric Please note — By close of business on the first business
utility named above, you must send a copy of this form to: clay, following energizing of a completed installation in
(1) the electrical contractor, (2) the customer, and (3) the response to the above request, you must: (1) notify the
authority. authority having jurisdiction that the installation has been
j energized, and (2) request that the authority inspect the
����� i I 1 �� completed installation.
super' electrlclnn's signature Ilnte
440 -094 B -001A (9/08/COM
T ' d Xdd 13C213Sd1 dH WFJL T :6 6002 SO now