Permit wl q CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00508
TIGARD; 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 09/30/2009
Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 150
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: Schuller Financial
Project Description: Install (1) 201 -400 amp panel, and (20) branch circuits.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 1 ea Services or Feeders - 201 to 09/30/2009 $106.85
400 amps
PHONE: 503 - 624 -6300 20 crt Branch Circuits w /Purchase 09/30/2009 $133.00
Service or Feeder
1 ea 12% State Surcharge - 09/30/2009 $28.78
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 $268.63
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 •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.
Issued By: C - A 1 _ _1 ∎ A �_ I • — Permittee Signature: nLQ �
OWNER INSTALLATION ONLY 1
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.
Electrical Permit Applicati
i �i l e r
0 ECEV\I ED
2 8 20 n .; l <)12OI I 1( I' r,; I r) \I 1 a
City SEP O � -::+
of Tigard
� � ' Received
a : - 13125 SW Hall Blvd., Tigard, OR 97223
7223 DawB . A Permit No.: ~!:
Plane: 503.639.4171 Fax: 503.598.yQ�� - T inASO "' Z r� Q - �! ,
Inspection Line: 503.639.4175 l_t t E n funs: r UM 449,001.7(0 Page
`" Internet rINEGI\ ..
r �h �: Re
www.tigard_or.gov ■ �.Nfi�1� ��Na Noo ed/Metllod:
tuns { 1� (a Supplemental Information
2 for
°s 1 0. Supplem
salz,ia ■ LA . WARM= Mit (e', ¢ ) r ` r aa- tri '>! effi
❑ New construction ® Addition/alteration/replacement Pkase check all that t bn � V rod
❑ Demolition app Y (submit seta of an plam wlitems checked below);
❑ Othei' ❑ Service or feeder 400 amps or more ❑ Building over three stories.
I <':' 1 y F 1, � a�xsst� t t }H r P . where the available fault current ❑ Marinas and boatyards.
rr:srt, tinCala�3aaG�atA'� u:ti l • f, , r�` / 4 1W ''d „7 1 1' 1 exceeds 10.000 amps at l50 volts or ❑ Floating buildings.
Q 1 and 2 family dwelling ® Commercia]/industrial 0 Accessory building gr°un or exceeds 14,000 ❑ Commercial - use agricultural
less to
❑ ❑Master builder Otber amps for all other installations. buildings.
nPr• rL ^r
j l c It 1, r, a * et n s yip" Yaerrrk ax a Fire pump, i:3 Installation of 75 KVA or
'C ��u al ur� ,t s 1 y 'e `t i lir ,¢' 1 a 4 i c t∎i 1 r 1Afi ❑ Emergency syacm larger separate ys he
j 1 "� ■i ' ' ' ❑ of new motor load of Y derived s m
Job no.: Job site address: 12909 SW 68th Pkwy ❑ occupancy.
sac "1-z ' 't -s
r0 0HP or man. occupancy.
City /State /ZIP: El Six or more residential units ❑ Recreational vehicle parks
❑ Health-care facilities. ❑ Supply voltage for more than
Suite/bldg. /apt. no.: 150 Project name: Schf�ller Financial Q e�eor feeder location 600 volts nominal.
amps or n1°rt,
Cross street/directions to job site:
Deseriatios a 1 M; - l
ty mLIli € y , � MIN
r
•'•`i
New residential single- or multi - family dwelling unit. erg •
Subdivision: Includes attached garage.
I Lot no": 1,000 sq. ft. or less 145.15 1 4
1
Tax map /parcel no_: Ea. add'] 500 sq. ft. or portion 1
?ippyy 33.40 1
- "t$' 1 `' - aq�rwan Limited energy,
r r IELT atd'�. .,E.'*_. w-.. ti ,' fa ''0' 4 •�1,,,' At-3..7,71 i (with above ' 75.00 2
Tenant Im. rovement Limited energy, multi - family
residential (with oboe sq, ft.) 75.00 2
ices feeders installation alteration, and/or relocation
'I A. °N°' `.tr�M1`ul'�i:rala� ahvAttnL R
.1:, v e n u, r; 1' aver�` M 't; 1 t t <
200 Sery amps or or less 30.30 2
v al.�r�w�
Name. «, 4 (' .' n k! 201 amps to 400 amps 1 106.85 106.
401 amps to 600 amps 160.60 2
Address: 601 amps to 1,000 amps 240.60 2
City /Shaba /'ZIP; Over 1,000 amps or volts 454,65 2
Temporary services or feeders installation. alteration, and /or
Phone: ( ) relocation
I Fax: ( )
Owner installation: This installation is being inade on property that I own which is not 201 200 amps to or amps ro le 400 0 amps 100.30 f 2
66. 1
I
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps I ]33.75 II
Owner signature
Date x, < Branch circuits -new, alteration, or extension per 2
{ atpa� r rs 1t�rt. 1; E p , pe panel
s` " t5 1 `:t[i i��'S "alf 1 P{ I ml o n �"w t wr s`a��ts' = -a? A. Fee for branch circuits with
,ts lf4'�51.: .a NIM � M above service or feeder fee,
Business name: Johansen Electric Inc. each branch circuit 20 6.65 133 2
Contact name: Charlynn Leifsen B Fee for branch circuits
without service or feeder fee,
Address: 10948 SE Valley View Terrace fuss branch circuit 46.85 2
Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /Statae/Z1P: Happy Valley, OR 97086 Each manufactured or modular
Phone: (503) 698 - 3417 'Fax:: (503) 698 - 2486 dwelling, service and/or feeder 90.90 2
E - mail: johansestelect@man.com
Pump only 66.85 2
/ R181 s a�r+v a Pump or irrigation circle 53.40 2
s ^' . V . t a l" tft"fXii, t � �°�'i Sign or outline lighting o-t JV,: k'P • gng 53 2
Business name: Johansen Electric Inc.
Signal circuit(s) or limited -
Address: 10948 SE Valley View Terrace energy pal, alteration, or
extension. Describe: Page 2
City/State/ZIP: Happy Valley, OR 97086
Each additional inspection over allowable in an of the above
Phone: (903) 698-3417 J Fax: (503) 698 -2486 Per inspection 62.50
CCB Lic.: 51539 Elect Investigation per hour (1 to min) 62.50
Electrical Lie.: 3 -243C I Suprv, Lie.: 2053S Industrial plant er hour
Suprv. Electrician signature, required: u r ; , ,-.„ 73.75
Print name: Carl K. Johansen �• Subtotal 239.85
,a ate: 9/28/09 Plan review (25% of permit fee):
Authorized signature; State surcharge (12% of permit fee): 28.78
TOTAL. PERMIT FEE: 2 6 8 . 63
Print name: Charlynn J. Leifsen
Date: 9/28/09 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete:
LNBuitdi lgTermirs\ELC.Pemutgpp.doc 05/23/05
* Number cf inspections allowed per
44 o-4615T(11 /e5/COM,wEa p permit.
OiNekt
- - I ' d Xl d 13C213Sd1 dH Wd T . :6 6002 82 daS
Electrical Permit A licatidnt~
2 g 200`
City of Tigard C r Receives n
l7ate~B : Farrel No.:
t CC ■ cc) E~2
13125 SW Hal1131 vd., Tigard, OR 97223
Pl
an By: 066 permt:
Phone: 503.639.4171 Fax: 503.598.~~94-~ / T1Gh _ Ej,(p 2-C09.00 i~(r
Inspection Line: 503.639.4175 I t r `h F F M Ready/By; runs: B See Past 2 for
Internet: www.tigud-or.gov hanfied[Method: sapplementaltafoemwdon
s 1~
T !t W .I, f tl 1iC ~M,..1 j ICI s i3 )NAM, ENTIRE
•4
❑ New construction ® Addition/alteration/replacement please check all that apply (submit j sets ofplans w/i ras checked below):
Service or here the available 400 amps as urenc more C3 0 Building orvcz three Mairmas and boatyards.
Q Demolition 0 Other: w
sh, T , "llil'l t'," too" exceeds 10.000 amps at 150 volts or 0 Floating buildings.
{ r tl'il less to ground, or exoeods 14,000 0 Commercial-use agricultural
❑ 1- and 2-farnily dwelling ® Commercial/industrial D Accessory bulldin,
amps for all other ierstaIlatioas. buildings.
❑ Multi-family ❑ Master builder tither: 0 Fire pump. 1] Installation of 75 KVA or
UN O Emergency system, larger separately derived system
. . I u M ' 0 Addition of new motor load of (]'W "E" .,1.2' "13",
Job no.: Job site address: 12909 SW 68th Pkwy 100HP or more. occupancy.
❑ Six or more residential units 0 Recreational vehicle psrks,
City/State/ZIP: ❑ Health-care faalities ❑ Supply voltage for more then
OHazardous locations. 600 volts nominal.
Suitelbldg.lapt.no.: 150 project name: Schaller Financial 0Service orfeeder 600eapsormom
A'~RIK I t, Mill
Cross street/directioas to job site: nescri hoe Fee. Tatal
New residential single- or multi-family dwtWng unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145 15 4
Ea. add'] 500 sq. f' or portion 33.40 1
Tax map/parcel no.
Limited energy, residential 75.00 2
withabove s
Limited energy, tnWti-family 75.00 2
Tenant Improvement residential with she- ft.
Services or feeders installation alteration and/or relocation
200 amps or less 80.30 2
201 amps to 400 amps 1 106.85 106 F2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/SMW/ZIP: Temporary services or feeders installation, altersdoo, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.95 1
Owner installation: This installation is being made on property that I oven which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent- or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133,75 2
Owner signature: Date: Branch circuits -new alteration or extension r el
A. Foe for branch circuits with
MIR Ma l above service or feeder fee,
t ao 6.65 133 2
each branch circuit
Business name: Johansen Electric Inc. B Fee for branch circuits
Contact nerve: Charlyon Leifsen without service or feeder fee, 46.85 2
First branch circuit
Address: 10948 SE Valley View Terrace Each add'I branch circuit 6.65 2
Miscellaneous service or feeder not included
City/State/ZIP: Happy Valley, OR 97086 Each manufactured or modular 90.90 2
&.01ing, service and/or feeder
Phone: (503) 698-3417 Fax:: (503) 698-2486 Reconnect only 66.85 2
E-mail johanseaelect@rrtsn.eom Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
Business name: Johansen Electric Inc. eneerg r 5ily circuit(s) er limited-
petal, 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 as of the above
Per ins action 62.50
Phone: (303) 698.1417 Fax: (503) 698-2486 Investigation per hour (1 ru min) 62.50
CCB Lic.: 51539 Electrical Lie,: 3-243C Suprv. Lic.: 20535 Industrial plan: per hour 73.75
Suprv. Electrician signature, regWmd: Subtotal: 239-85
Print name: Carl K. Johansen ate: '9/28/09 Plan review (25% of perrttit fee):
State surcharge (12% of permit fee): 2 8 . 7 8
Authorized signature: / TOTAL PERMIT FEE: .
Print name: Chart J. Leifsen Date; 9/26/09 This permit appheation expires if a permit is not obtained within 180
ym days after it has been accepted as complete:
' Number of inspecnong allowed perpemut.
t\Building+PermitsTLC-PemnApp.dac 05123/06 ` 4 40-46 1 5 7(11/051COMfMl3
~Ci~~ L~'s c~
- •-T: Xd3 13r83Sd-1 dH Wd T tr :6 6002 6z dos
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2009-00508
0 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/30/2009
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 150
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: Schuller Financial
Project Description: Install (1) 201-400 amp panel, and (20) branch circuits.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 1 ea Services or Feeders - 201 to 09/30/2009 $106.85
400 amps
PHONE: 503-624-6300 20 crt Branch Circuits w/Purchase 0913012009 $133.00
Service or Feeder
1 ea 12% State Surcharge - 09/30/2009 $28.78
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 $268.63
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 AR 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246,.,66^99 or 1.800.332..23444.
Issued fly: C Permittee Signature: A-,ko
OWNER INSTALLATION ONLY r
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.