Permit a CITY OF TIGARD ELECTRICAL PERMIT
';; COMMUNITY DEVELOPMENT Permit #: ELC2009-00620
. i Date Issued: 11/17/2009
T t G Ail. D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 350
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: Deltek
Project Description: Add /alter (4) branch circuits for server room.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 4 crt Branch Circuits 11/17/2009 $78.44
wo /Purchase Service or
PHONE: 503 - 624 -6300 Feeder
1 ea 12% State Surcharge - 11/17/2009 $9.41
Electrical
Contractor:
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 $87.85
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 -00 01100. You may obt py off thhee \ rules or direct questions to OUNC by calling 503.2466699 or 1800.332.2344.
Issued By: (Y1 V' X 1fL' °� 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' \ Q A Q
)P Date:
LICENSE NO. i
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.
A.1
Electrical Permit Application E � V E l'zfe-*; ' `` 1! < �. � s. .
City of Tigard Received
Date,B : _ 4 Permit No oillI 044 • 0 0 • 110 13125 SW Hall Blvd., Tigard, NOV 16 2009 OR 97223 Ptah Review 6.
. .! - 3 Phone: 503.639.4171 Fax: 503.598.1960 D /B Other Permit
i yr 3 Inspection Line: 503.639.4175 CITY OF TIGARD Date Read r 6 c 2 for
Ready/By: � Supplemental lufor � Sec P a
,1� Internet: www tigard -or gov Notified/Method a mation
I � 1 �► 1 at
r� ifk 1,.�. ',1 - , . 11 �,' K J tVe rl k dis or I 'G loll` d:.. , ..I it e s t ill 1 1 1 . hEN l l e .a , ) , l xI ' 1 tsli ti �: 4 f it ,
� r F,�u3, W its + 'cu. i , , art- r iE+a I� s, t1 . r „ri l;ai � 1 � n���;1)
❑ New construction Addition/alteration/replacement Please check all that apply (submit g sets of plans w /items checked below):
❑ Sery ice or feeder400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other.
where the available fault current ❑ Marinas and boatyards.
r . l vii it " ' 71 t o ;' t 0 i IP� t
ti : t �t�"t` f't 11t1st"IWV4ii th i e' exceeds 10,000 =gnat 150 volts or ❑ Floating buildings.
iii u66Min !. i°? less to gromd, or exceeds 14,000 ❑ Commercial -use agticultual
❑ 1- and 2- family dwelling fC Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
r t sdnidu l
s ,.. `� CI Emergvuy system larger separately derived system
1:,1 is i lE� no - ! , , ..dmlar3r . l t, 1 t� r ' 'I 4!fll 1 1' ; 1 1 i f.q .' t - - , r s VI II ❑ Additionof newmotorloadof ❑ "E_ .. l - 2 - 3•
Job no.: Job site address: 124109 s Q 100HP or more. R cre ion
v`' O new ❑ Six or more residential snits_ ❑ Recreational vehicle parks.
City /State /ZIP: T ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal
SuitelbldgJapt no.: S C) 1 Project name: Dej t tR 0 Service or feeder 600 amps or more.
s gg t
u )I t i ! li it *I.i- : P14 a cs. ' Ifs l&H , l' . x34 guff' I 3
Cross street/directions to job site: Deaeriottaa coy. Fee Total •
New residential single or multi family dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. ft. or Tess 168.54 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 1
Tyy�e I y a Limited energy, residential
lt ` ' ,. i ht. 4 ... ,.. !L. , ii, 44, , -- Xi , .,.t .^.. �1.11Ll Ili 1. .., t' ' t 11 9, ,,,rd (with above sq. ft.) 67.84 2
!� S2�vt' room ri(,L.p'1(�L�,�,�5
Limited eid energy, (with above sq. multi ) 67.84 2
r residential with ab ft
Services or feeders installatio alteration, and/or relocation
� } yy, p J� ` II 200 amps or leas 100.70 2
M i } 1 yt1 ` �Y 5x 1 If ll &t ! Ili 1fl l kllS.l ; '1fl4,., s r i p! r 0s.liula.:l�l amps P
�t t,, t. ? ! 4 ray ' e L',i .'l"#= 201 am to 400 amps 13366 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
reloca
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 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, rent, 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
1113, gf i r i �° M(+n►� ' „..• I � a,. y S! a'?' It t I :,. a' above service or feeder fee,
each branch circuit 7.42 2
Business name: Johansen Electric Inc B. Fee for branch circuits
Contact name: Charlynn Leifsen without service or feeder fee, 56.18 5y, t¢ 2
first branch circuit
Address: 10948 SE Valley View Terrace Each add'I branch circuit .3 7.42 .zte 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Happy Valley, OR 97086 Each manufactured or modular
67.84 2
Phone: (503) 698 -3417 I Fax: : (503) 698 -2486 Reco line, t o nlye andlor feeder
Reconnect only 67.64 2
E -mail: Pump or irrigation circle 67.84 2
of. g� 1°1.lYr ,' n �acg,... •.; r , ,r,. , 7 tn ° "!'s''t Si or outlineli tin
,c114� _ ! 1 s ' , u , a, 1 LL t i 5 1'Li a.►r a3 11 x 3 ` , i.'i Sign 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 any of the above
Per inspection 66.25
Phone: (503) 698 -3417 Fax: (503) 698 -2486 Investigation per hour (I hr min) 66.25
CCB Lic.: 51539 I Electrical Lie.: 3 -243C Suprv. Lic.: 2053S Industrial plant per hour 78.18
Suprv. Electrician signature, requirede k Subtotal: 2@ ,y4
Print name: Carl Johansen Date: (1 1 La I Oe Plan review (25% of permit fee):
State surcharge (12% of permit fee): ei , &. 1
Authorized signature: .i ( (..../ .----------- TOTAL PERMIT FEE: en , g
Charlynn Leifsen 1 Date: } [�
This permit appleatien expires if a permit a not obtained within 180
Print name
• 3 I days after it has hem accepted as complete.
• Number of inspections allowed pa permit.
:( Budding \Pemdts\ELC•PermitApp, 10/01/09 440.4615Tt11/05/CO:VLWEB
Cyknr L i r\
•d AO
T Xdd 13Ci•13SFi dH WdSS s� 600Z 91 N
I
CITY OF TIGARD ELECTRICAL PERMIT
o COMMUNITY DEVELOPMENT Permit#: ELC2009-00620
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/17/2009
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 350
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: Deltek
Project Description: Add/alter (4) branch circuits for server room.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 4 crt Branch Circuits 11/17/2009 $78.44
wo/Purchase Service or
PHONE: 503-624-6300 Feeder
1 ea 12% State Surcharge - 11117/2009 $9.41
Electrical
Contractor:
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 $87.85
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 952-00;'0100 You may obtain a py of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: °L 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.
Electrical Permit AlinlicationRECEIVECIm W2,11111111UGM
City of Tigard Received Permit No.
13125 SW Hal] Blvd., Tigard, OR 97223 NOV 16 2009 Date Bv:
Plan Ret~ew
Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit
Inspection Line: 503.639.4175 CITY OF TIGARD Date RcadylBy r lid SeePage 2 for
Internet: ww A, rigard-o-.gov Nodfied(Method: Supplemental Information A1111 DING QUISIOW l i(.tl:~, III " II 4
1 i ,r t r ai t t I ~i~iiire.~rt 1.." r r; .u t a r.' i Y:Y=~,~ E"
❑ New construction Addition/altemtion/replaeement Please check all that apply (subrt t I sets of plans w/items checked below):
❑ Demolition Other. 0 Serv ice or feeder 400 amps or awre 1] Building over Ihree stories.
where the available fault current ❑ Marinas and boatyards.
4~ ° es " t Y l r f {t ` r exceeds 10,000 amps at 150 volts or 0 Floating buildings.
w t ti #c less to ground, or exceeds 14,000
❑ I - and 2-family dwelling Commercial/industrial 0 Accessory building [1 commercial-use agricathual
g maps for all other installations. hwldirrga.
❑ Multi-family ❑ Master builder ❑ Other: 0 Fire pump. ❑ Installation of75 KVA or
" , 0 Emergency system. larger separately derived system.
ws ~ F~I 0 ~l it ,;tom 0 Addition of new motor load of ❑ "A° -E-"1-2", -1.3-,
4
Job no.: Job site address: 1261 Q 9 9,A) U,64 ~ ` IooHP or More. occupancy.
0 Six or more residential units. ❑ Recreational veinclo parts.
City/State/LIP: 0 Health-care facilities, ❑ Supply voltage for more than
0 Hazardota locations. 600 volts noahmal
Suite/bidgJapt no.:~ Project name: T)ej ~e ❑ Service or feeder 600 crops or mote
1 d` r ` ri t "t sTV-
Cross Street/directions to job site: [rrrrn No. Fee Total
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 s ft. or less 168.54 4
Fa. add'] .500 sq. ft. or portion 33.92 1
Tax map/parcel no.: t Limited energy, residential 67.84 2
li l }i~ r r lu.~ U L 1 • I_ . a ItM tl j (T l with above . tt.
52 , oofM Limited energy, multi-family 61.94 2
r -1 residential with above . ft
Services or feeders installation, alteration and/or relocation
200 amps or less 100.70 2
E + u'~~ I flirn I r4 f 1
9~„_ ' ~ a L'~ ~ ` 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/State2[P: Temporary services or feeders twtaflation, alteration, and/or
relocation
Phone: ( ) 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
l 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: Date: Branch circuits- new alteration or extension r panel
A. Fee for branch circuits with
i above service or feeder fee,
t r.:..,.. 7.42 2
each branch circuit
Business name: Johansen Electric Inc B. Fee for branch circuits
Contact name: Charlynn Leifsen withotrr service or feeder fee, , 56.18 ~j1,,1 ¢ 2
first branch circuit
Address: 10948 SE Valley View Terrace Each add1 branch circuit 7.42 z(v 2
Miscellaneous service or feeder not ineluded)
City/State/'LIP: Happy Valley, OR 97086 Each manuactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 698-3417 Fax; : (803) 6913-2486 Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
MET, 17;1111 z- E Sign or outline lighting 6284 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
CitylState/ZIP: Happy Valley, OR 97086 Each additional inspection over allowable in an of the above
Per inspection 66
Phone: (503) 69"417 Fax: (503) 698-2486 .25
Investigmttigation per hour (1 hr min) 66.25
CCB Lic.: 51539 Electrical Lie.: 3-243C Suprv. Lie,: 2053S Indtlstriat plant per hour 78.18
~ I t'r
Suprv. Electrician signature, required Subtotal:
Prim Carl lohansen Date: Plan review (25% of permit fee):
tname: 1
1ls oq
State surcharge (12% of permit fee): , y
Authorized signature: TOTAL PERMIT FEE:
Print name: Chart nn Leifsen Date: This permit application expires if a permit is not obtained within 100
y 1 days after it has been accepted as complete.
• Number of inspections allowed per pomut.
1:iBud&ngTa7rdtsTLC-PanWtApp.doe ID101109 440-4615T(IIM/COM/WE5
d
i Xd-J 13Ci'13Sd_1 dH WdSS : t, 600Z 91 noN