Permit
n CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2010-00016
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/12/2010
Parcel: 2S112D000500
Jurisdiction: TIGARD
Site address: 15875 SW 72ND AVE
Subdivision: OREGON BUSINESS PARK III Lot: 40
Project: Spec Space
Project Description: Add/alter (4) branch circuits for TI.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 4 crt Branch Circuits 01/12/2010 $78.44
wo/Purchase Service or
PHONE: 503-624-6300 Feeder
1 ea 12% State Surcharge - 01/12/2010 $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 952-001-0100. 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.
Electrical Permit ApplicatiOl C „ ` 1 i a €" . ' r4" t r; I ' y 4, • ; ' � �
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5 City of Tigard Received
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i at 13125 SW Hall Blvd., Tigard OR 97223 • 1 n DacelB
e s a Phone: 503.639.4171 Fax: 503.598.1960 7 EI O Date/13 �iew other Permit: .
14.17:1 ° 4 1 f: Inspection Line: 503.639.41.75 Date Read /B : ms: ! + !a See Page 2 for
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i Internet : � www tigard- or.gov RD Notified/Method: Supplemental Information Information :1 J. �1.. ti + lriusu, LJi. art Nn 6ettai i , . . 1•r ,. t' 4!lj3.I }lip ,r4'fi`,!k,.t5dlr tl , 'l ...4 -°iTj 4 n,, to r n, - .i 6 • •
❑ New construction ❑ Addition/altefation/replacement Please check all that apply (submit 2 sets of plans wfttenis rhaJced below):
ID Demolition ❑ Other:
El Service or feeder 400 amps or More ❑Building over three stories.
where the available fault curre ❑,Marinas andboaryands.
t r . 1 t � � Ix , �i' � ' ; H E m . . d 1 1 1 7, t, '.'i7° I dt g l 1 lll , --"`r l ! r4j. i+t' j exceeds 10.000 amps at 150 volts Ur 0 Floating buildings.
a i tsbsLvi du ° 1 + ' . a i ts I 16 1 1 a c i . - P less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building g amps for all other installations. buildings.
❑ Multi-family . 0 Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
}`ti 1 It Td 1 =,fir t r i r ❑ c s stem
tA1 51IF F p �i E .. � tP I d I t : _ l �. a rf .1 1 ffr ' •L tl f111 ,1 i ; a is Sen Y Y ❑ 1 ger�eparately de 3ved system.
1 ' , �� � • ., t: � . Emer ' ❑ of new m load of
Job no.: Job site address: 15 8 7 5 SW 72nd , 21-e- 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: ❑ Health -care facilities. ❑ Supply voltage, for more lien
❑ Hazardous locations. 600 volts nominal.
Suite/bIdgJapt. no.: _2_14_ I Project name: Vat an ,p
C , ❑ Service or feeder 600 snips or n more �e }�
°'� ,. ) 1 .,A' .10 ; t1 i 5 ,. r `aE° g 1.r 3:E' :s . nil ;. ; h it Y . .
nen, -,,.,. <3 5,
Cross street/directions to job site: De odpdun et►: P Toni
New residential single - or multi- fainiy dwelling unit
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. ft or less 168.54 4
Ea. add'! 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, r
�ts.Tirn' 1 s �, l 1 " y s1 t,'t lai'"1. ( w t) 67.84 2
rs '� °,r.�'� <..1:�: >dh ti d rz _ [%a� . �r - ilit n f' u� a1 with above tti
Limited energy, multi- family
j' i ?rnl Im P ill(iNfil' residential (with above sq. 6 ) 67.84 2
Services or feeders instaltation and/or relocation
f ua+ r fit{ a � a t y r t t 200 amps or less 100.70 2
l 8t ILL,,1PaE ,g, a n, ' 113F11 V • , - � f 'd ,; r .► g c 1; 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: ( ) Fax: ( ) 200 amps or less 59.36 1 1
Owner installation: This installation is being mode 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 1 168.54 2
OuTlersignature: Date: Branch circuits - new, alteration, or extension, r panel _
$ 1 .149 „tp Ill A. Fee for branch circuits with
"; r. , �i n' ;•r l - . - �- lr) , { a elr t . , - r 1 e ' . W 1 a above service or feeder fee,
to el at . a r z• ui , ] Ibr -,� .. a .... :... te y each branch circuit 7.42 2
Business name: Johansen Electric Inc H. Fee for branch circuits
Contact name: Charlynn Leifsen service or feeder fee, ; 56.18 5(.1 q 2
first.branchcircuit p
Address: 10948 SE Valley View Terrace Each add'l branch circuit 5 7.42 22..24, 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 Fax: : (503) 698 -2486 Reconnect only 67.84 2
Email Pump or irrigation circle 67.84 2
�rnr
ii ;. N L'" / 1 'r n� r' 'P °' '' ' t -' t 1 3 " S or outline lighting .. �"q'•It�,'� e; Wla`a ¢�1Rl,] rfi�i "� Sign � g 67.84 2
Business name: Johansen Electric Inc Signs] circuit(s) or limited-
energy panel, alteration, or
Address: 10948SE Valley View Terrace extension. Describe: Page 2 2
City/State/ZIP: Happy Valley, OR 97086 Each additional over allowable in any_ of the above
Per inspection 66.25
Phone: (503) 698 -3417 Fax: (503) 698 -2486 Investigation per hour (1 Iv min) 66.25
CCB Lie.: 51539 Electrical Lic.: 3 -243C I Suprv. Lic.: 2053S .Industrial plant erhour 78.18
Suprv. Electrician signature, required: k t -r•,' .1., 47 t7 � 1,-llil i tgliiii
►� Subtotal: ri R, I
Johansen Date: Plan review (25% of permit fee):
Print name: Carl Johansen
61 (III 1 b 'State surcharge (12% of permit fee); 9 ,, 41
/� �
Authorized signature: b ri , g5
l ;•1/ TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Charlynn Leifsen Date: D i iii D days after it has been accepted as complete.
I:�Build ogPenruts El C•PomurApp doe I.0/01 /09 ` Ntanber of impactions allowed per permit.
4404615T(11 /05MCOM.WEB
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