Permit CITY OF TIGARD ELECTRICAL PERMIT
" , COMMUNITY, DEVELOPMENT Permit #: ELC2010 -00328
Date Issued: 07/01 /2010
T1G'ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S113AC00101
Jurisdiction: Tigard
Site address: 16655 SW 72ND AVE 200
Subdivision: PACTRUST BUSINESS CENTER Lot 0
Project: Stash Tea
ProjectDescription: (15) branch circuits for TI
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 15 crt Branch Circuits 07/01/2010 $160.06
wo /Purchase Service or
PHONE: 503 - 624 - 6300 Feeder
1 ea 12% State Surcharge - 07/01/2010 $19.21
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 $179.27
Required Items and Reports (Conditions)
Thiis;.pe�mit 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 OA 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: Permittee Signature: QAr 4
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 lbe 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.
RF-cr‘ �" ' 'k„ ( '?3 i ; Tk t F c a u w a r tg w e1 Electrical Permit Application E r � a a 1 t)It ( ll 11 ..k I tit O \1 y, ' I i" i. ..
�k y ,r � 1 2ece rved _ i
: City of Tiga a ,�j
� , =:a .. fit i � ' t No
h '- -� a 13 t25 SW Hall Blvd., Ti rd, OR 97223 Date /B / . �o '-l-W. 62-6 7 i r
r a. Phone: 503.639.4171 Fax: 503.598.1960 OtherPerttu
2 JUN 2��� Plan Review
Date /B : ltu/�oe0 ill /f/
E , , I a Inspection Line 503 639:4175 Date Ready/By: See page 2 for
raw .,. a�., : Internet: www tlgard- or. . ,� Nonfied'Metbod: Sapplemental Information
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❑ New construction ® Addition /alteratiOn/iepLaeerneIlt ' Please check all rbat apply (sulinvt a sate ofpinne w /Eteros;checkod below):
ID ❑ Service or feeder 400 amps or more ❑ Building over three stories.
rnolition ❑ Other.
i �` ,� s ¢ 1 [l where the available fault currant ❑ Hennas and boatyards.
i# iiir. 1 a 11 , ,` ii118 or'i r 1 i 6 Wi 'r: � 1 s..4 ,.1 i ii It I:B f,, .wi q;iitsitili)1' exceeds 10,000 amps at 15 volts or ❑ Floating buildings
less to ground, or exceeds 14,000 ❑
❑ 1 -and 2- family dwelling El Cm
omercial/mdustrial ❑ Accessory building Commercial-use i agricultutal
amps for all other installations. buildings.
0 Multi-family ❑Master builder ❑ Other: ❑ Fire pump.. ❑ lnstallaticn of 75 KVA or
d f t: E im eui ,,. . - ❑ & system ,larger separately derived system.
.
r(,s E. �ik o_ s 3:a5 off; r t c c , R' tlllil i a t ?° N$ Mb/a= ■ �+ � �ms ❑ Addition of new motor load of ❑ "A ", `E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 16 6 55 SW 72nd 100HP or more. occapaacy.
-❑ Six or more residential units_ ❑ Recreational vehicle parka.
City /State/ZIP: .,� ❑ Health -care facilitieii. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no . 2 0 0 Project name: S t ash Tea ❑ Service'or feeder 600 amps or more.
Cross street/directi ob site nearroawa - .. Qty. F. , total •
New residential single or multi - family dwelling unit
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. or less 168.54 4
Ea.,add'I.500,sq. ft. or portion 33.92 1
Tax snap /parcel no L imitedener re sidential
• G I 1 a , F , ° ' S Pm A : 8 ,l E f' id 4 5t t p . li �' 67.84 2
misoV V°,. his is . I ,,, µma em + ir I .i 4 1, r i,. .,,. v0 tlii (withabovesq:lL)
Limited energy, multi - family 67.84 2
Tenant Improvement residential (with above sq. 11)
Services orfeeders installation, alteration, and/or relocation
• 200 ainps.orless 100.70 2
1 . i! E I . alt* rt . s , . t . t ,. p ' .I 'i rt , 1 f t w- ; �M, v liE ' 3¢ 1 t 2 01 am s to �� 7r�
.",.1k �u. x uc,a _ i .�� t�P'�E �' e; +. ,rh�, �'f P 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 _ 1 59.36 1 1
Owner instafladon: 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
signature Date:
Branch circuits— new, alterations, or extension, er panel
Owner
A. Fee for branch circuits with
v ,' t _ <a „ i' , i S' !a ' r I i rs e gl aF 'I,tt. -m 1 ; s Ir' l r ._ above service or feeder -fee,
.r a e r each branch circuit 7.42 2
Business name:, Johansen Electric Inc B. Fee for branch circuits
without service or feeder fee,
Contactname: Charlynn Leifsen
first branch circuit 1 6 , 1 8 56. 2
Address; 10948 SE Valley View Terrace Each.add'l branch circuit 14 7.42 03.8 3 2
MisceUaueous(service or feeder not included)
City /State/ZIP: nappy Valley, OR 97086 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 Pump or irrigation circle 67.84 2
1M ,. ' .- 4 't`r> 1# . i s s 11 r t h.
,E � , � s+t,<�, a . a.,.�..0 illti�,it� ®�,� , e ;;w,ti s a�.�„ '1l71t, w �a _, e ,xkkiifi,' Si or aitline,lighting 69;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 an • of the above
Per inspection 66.25
i . ', r, e: (503) 698 [Fax: (503)698 -2486
/ Investigation per hour (I hr min) 6625
` CCB Lic.: 51539 " 1 Electrical Lic.: 3 -2 Suprv. Lic.: 2053S " Industrial plant per;hour 78 18,
Std' a �
• ' 3 ` 1 a il'ti 2 �' k'i
Suprv. Electrician signature, required: .. / - 1 / Subtotal: 160.06
Plan review (25% of permit fee):
Print name: Carl Johansen Date: 6 /2 9 /10
State surcharge (12% ofpermit fee): 19 . 21
Authorized signature �" TOTAL PERMIT FEE: 179. 2 7 ii
That permit application expires if a'permit is not obtained within 180
Print' name: Charlynn Leifsen Date: 6/29/10
days stty it has been accepted as complete.
1: 1BuildingPemtits■ELC- PmmitApp.doe 10/01/09 4404615T(11 /05/CMIMED • Number of inspections allowed per permit.
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