Permit '441,P V:4:14 CITY OF TIGARD ELECTRICAL PERMIT
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COMMUNITY DEVELOPMENT Permit #: ELC2010 -00275
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 06/09/2010
TIGARD` g Parcel: 2S112DA00700
Jurisdiction: Tigard
Site address: 15333 SW SEQUOIA PKWY, STE# 150
Subdivision: PACIFIC CORP CENTER Lot: 0
Project: OnOne Software
Project Description:
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 25 crt Branch Circuits 06/09/2010 $234.26
wo /Purchase Service or
PHONE: 503 - 624 -6300 Feeder
1 ea 12% State Surcharge - 06/09/2010 $28.11
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 $262.37
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 OAR 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.
t'
Issued By: /4/0 ` 95 Permittee Signature: 5 61. It• r cA r_ e'd/
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.
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 R
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...,()11. WI.: 151 : (1'.\ 1.)•
City of Tigard Received
`J Tigard ®� � DatclB : Permi tNo.: d r 27S
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
B Phone: 503.639.4171 Fax: 503.598.1960 Date/B ; Other Permit: a •
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1 . 1 ; :.` ,: 1., Inspection Line: 503.639.4175 CITY OF TIGARD Data Ready/By: Saris:
Internet: www.tigard-or.gov el otrtied,Method:
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❑ New construction g Addition/alteration /replacement Please check all that apply (submit 1 sets of plans w /items chocked below):
❑Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition CI Other:
r I _ � where the available fault current ❑ Marinas rind boatyards.
J,l - I n t x� r ` r r, t ""S• 1°' ' G
, I' 1 { �. x!,iftl .��iu exceeds 10,000 amps at 150 volts or ❑ Fl oat buildings.
�� •.; � i �,1„� �I p�1C1 {aria �'13r. . . �� ..�'`� r : :J� 1!{I �° Floating s. P
w less to ground, or exceeds 14.000 ❑ Commercial-use agricultural
❑ 1- and 2- family dwelling CCommercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑Multi- family Master builder ❑Other. 0 Fire pump. ❑ Installation of75KVAor
zrk, ya *.,s Ilan w „ n n ❑ Emergency system larger s eparate/ m.
l r . Ii $.t'"Illti i � . t. ' .,, .... , 1 s r r. c `ioifif r ;_.,,:'71 Y derived syste
❑ Addition of new motor load of ❑ "A" "E" "1.2" '1 -3"
Job no.: l Job site address: 15.3S 0%1 UDI 100M' or more. occupancy.
•
""� ❑ Six or more residential units. ❑ Recreational vehicle parka.
City /State /ZIP: ❑ Health-care facilities. ❑ Supply voltage far more than
❑ Hazardous locations. 600 volts nominal
Suite/bldg. /apt no.: I 50 1 Project name: )in oat. ❑ Sery ice or fader 600 amps or more.
II
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Cross street/directions to job site: Description I Dry. I yea ' 1 Total '
New residential single- or multi - family dwelling unit.
Includes attached garage. _
Subdivision: I 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
� 1 , ,,, Limited energy, residential
��s;yl � u �'�Ill 1k . t { It'd ,'a. - 1V p �, rt a ,r t t ritlt , u+, i '�
mill °rS .! ... 3,fi�„ "° �#a �!!4�, •."4RCr �'.1 �.c ,fr:r r (with above sq. fl.) 67.84 2
l , 1, in p t1n l Limited energy, multi - family 67.84 2
St Y 1 Y r Q.1 r t.Q�s It residential (with above sq. R.)
Services or feeders installation and /or relocation
: = err 200 amps or less 100.70 2
•
�,7} laiut3l,' ,'l. V1'.alris i t `' ;i it : r;+,Gs °4,,: t 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 552.26 2
City /State/ZIP; Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 1 Fax: ( ) 200 amps or less 59,36 1
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, tent, 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
A. Fee for branch circuits with
' , ;, v t ` a s t . 1,I r : a ' ' l kl'„ Iw above service or feeder fee, 7,42 2
iR "a . eu.. .'. . i ti, ri ,.
each branch circuit
Business name: Johansen Electric Inc B. Fee for branch circuits -
without service or feeder fee,
Contact name: Charlynn Leifsen first branch circuit 56.18 54.,1$ 2
Address: 10948 SE Valley View Terrace Each add'/ branch circuit 1 4 7.42 f ig.aj{ 2
City/State/ZIP: Happy Valley, OR 97086
Miscellaneous (service or feeder not included)
)+ Each manufactured or modular
67.84 2
dwelling, service and/or feeder
Phone: (503) 698 -3417 I Fax: : (503) 698 -2486 Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
I' t t T i, lr" '. t7 :. ' !4 ' r1 w Y 5 n i'4 arl '''f i
�� � `, fE Y ; ��1. l.il � ..; � I. ., , t,,.,.;,i,. Si or outline lighting 67.84 2
. It #e�a+YY ,.It ,,. ° .ltl�1FI•i1�t, ;� it. �' u 10 l lll�l>'i - . !,
Business name: Johansen Electric Inc Signal eircuit(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 66.25
Phone: (503) 698 -3417 I Fax: (503) 698 -2486 Investigation per hour (1 hr min) 66.25
CCB Lic.; 51539 , Electrical Lic.: 3 -243C I Suprv. Lic.: 2053S Industrial •Iant per hour 78.18
/! J � /� .''...f;:. : I ' , : :: tie ; "irrr �, ; , 14 ..',
Suprv. Electrician signature, required: L ,i t I $- „14,.� Subtotal: _ 2.3y 22.4
Print name: Carl Johansen 1 Date: /4110 Plan review (25% of permit fee):
f, , r� State surcharge (12% of permit fee): _ 2(?
Authorized signattue: O IA !1 I 1 TOTAL PERMIT FEE: 2 . 37
�lAl �� tRl MM ,1
Print name: Charlynn Leifsen ' / Date: This permit application expires if • permit is not obtained within ISO
♦� days after it has been accepted as complete.
• Number of inspections allowed per permit
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