Permit , y CITY OF TIGARD ELECTRICAL PERMIT
II COMMUNITY DEVELOPMENT Permit #: ELC2010 -00388
1 3125 SW HaII Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/28/2010
F I t 41 17 9
',`,.;.•,.:':.', ,,, ; Parcel: 2S112DD00400
Jurisdiction: Tigard
Site address: 15912 SW 72ND AVE B17
Subdivision: OREGON BUSINESS PARK I Lot: 17
Project: JOHN CRANE INC
Project Description: 26 branch circuits for T/I
Owner: FEES
PACTRUST Quantity Description Date Amount
15350 SW SEQUOIA PKWY SUITE 300
PORTLAND, OR 97224 26 crt Branch Circuits 07/28/2010 $241.68
wo /Purchase Service or
PHONE: 503 -624 -6300 Feeder
1 ea 12% State Surcharge - 07/28/2010 $29.00
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: B
Total $270.68
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance, with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: KAV Permittee Signature: _f 6 A _': A - ) =J'c /- -..�'�
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
CaII 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
RECEIVED
JUL 2 7 2.010
Electrical Permit Application FOI< 01.1.1c1:: l.:'l: o m \
City of Tigard CITY GFTIG
13125 swxa11131vd.,Tigard, OR 972 Nan DIVISO Review
Ilu
' 1 t+ Phone: 501639.4171 Fax: 503.59$.1960 DateJB
Other Pemvk a i . • - , , o r
t ,. , :;, t ; Inspection Line: 503.639.4175 Date Ready,'8y: rte:
Internet: www.tigard- or.gov Notified/Method:
i }/£ 1 ¢ Wl , , f y � a ha C lei '. F R S b.r •
n „rj .�, sM„ ?, - M'}t:`..:D., t. *. "n A . 1e � , .r .�e-.� 9`r"i /,�,.�„lF �.. ..��I4�•�,� „'�`."'�,. °... .. t -•]r, 4 - t �i� i...,. aSctn. r ..
❑ New construction E Addition/alteration/replacement Please check all that apply (submit a sets of plans items decked below):
0 Service or Seeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards.
ti sU pal r t i tip t tf Vic• µ .ity �+. ). f ' a f ' �'� , J } .... y; "', . ' exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
-o r o .." k ' ..4 yu a :r r? , - �
L1+ less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
❑ 1- and 2- family dwelling ® Colnmercialfmdustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family 0 Master builder ❑ Other: ❑ F,re pump. ❑ Installation of 75 ICVA or
. '�� ^N65't n.a;.n'.T /`n.. i '`t .. �..Qa �...,. .: ;:Aiyi :'i'ull.i'aii5> =i4i i', • system.
t't, � ❑ F�ter$eocYsystam- larger `E sepm�ate y
t,t ; b,.t .T. j4t3yp, i "g MP�A `F^1' Y r. „ . ;{I , *�
1,n., >� (t,,e�' ;.3:... � ?,. ,,,1�,..,, �, , r .. y ❑ AdditionofnewmoTOr loadof ❑ A', ", °1 - 2 ", "1 - ",
Job no.: - Job site address: looHP or road occupancy. ion
15 912 $ W 7 2nd ❑ Six or more residential ante_ ❑ Recreational vehicle perks.
City/State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/61dg,tapt. no.: 1 Project name: John Crane ❑ Service or feeder 600 amps or lucre.
.iTH . 1 N`i5s b t, t t M`'F C . ,2nfw' S. E. • ] V -
Cross streetidirections to job site: Description pee. 1 Taal
' New residential single- or multi- family dwelling unit
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or toss 168.54 4
Ea. add'I 500 sq. ft or portion 33.92 1
Tax map /parcel no.: Limited energy. residential
ir y t + r a r "" y},�.y,a a, d, I h ri 1 r 1 with above an,. �� R.) 75.00 2
.:+r,:. .'`r. .<n. r. a:,�4 , r;:.'l;r?' n ;S�'�1?�R!?0" . A 5z..NT .: ae,".,:x.di
Limited energy, multifamily 75.00 2
Tenant Improvement residential (with above sq. It)
Services or feeders installation, alteration, and%or relocation
200 amps or less 100.70 2
a" s t , , 4 ^7 { }. �, £� },r r t °`'' aa'�ti ° v r ` 4n, 'I "'' 201 amps to 400 empa
.56 2
$ -,a,� ��4. ,ice e ?r...,r +,rt r nett,.. , r. ..". S . ' ttit„` �''�..., t .i`, c 4.Vgf i':
401 amps to 600 amps 200.34 133 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2 ,
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) I 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 r0 coo 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
Branch drenits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
.5V/Ai/fr. . 9 a aP: y ., ,; . , i ;fr 7 i s v : ,;p ' f , above service or feeder fee, 7. 2
s , .l„ or ,. Y .t. .. 1/ n:/`J.5 .: as,.$ I a..,;' :,i' v #0 .'. its; .ii . N .7.. each branch circuit
Business name: Johansen Electric B. Fees for branch circuits without
service or feeder fee, First 1 56.18 5 5.18 2
Contact name: Charlynn Le i f sen branch circuit
Each add'I branch circuit 25 7.42 185.502
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder net included)
Each manufactured
City/State/ZIP: Happy Valley, OR 97086 dwelling, service a r 67.84 2
Phone: (5 0 3) 698-3417 I Fax:: (5 0 3) 698-2486 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
67.84 2
Siga or outline lighting
} 4S ! `;:t :.at r s } �- y to :µms. "S4•*'_ b 1 r ,1 L; :y e' rJS ' ! t � - r . ' 3 , j h�
x:v ac, f.:t :.;�>, ,s r °,. ".'; .: a, r. r , i t; ere I t. t t „.,, :). _.... 3. Signal cireuit(a) or limited energy
Business name: Johansen Electric easel, alteration, Or octal atom . rage 2 . , 2
Each additional lntpedlon over allowable in any of We shor
Address: 10948 SE Valley View Terr Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.251 hr
City /StatetZIP: Happy Valley, OR 97086 Industrial plant(1 hr min) 78.18 /hr
Phone: (5 0 3) 698-3417 Fax: (5 0 3) 698-2486 In spections for which no fee is 90,001 hr
cr£icall listed S4hrmin
CCB Lic.: 515 3 9 I Electrical Lic.: 3-243C I Suprv. Lic.: 20 5 3 S 5 t.;`,.? _. ,.:•£i(; ',t r.isi.f'':s'z'r - 7 1 6 :,r z . ,;f;'N4 .. ;.
subtote 241.68
Suprv. Electrician signature, required: tet. plea review (25% of permit fee)) :
Print blame: Carl Johansen Date: 7 / 2 6 / 10 State surcharge (12% of permit fee): 29
i i TOTAL PERMIT FEE: 270.68
Authorized signature/ ' J �( Ma permit application expires if a permit h not obtained comma.
180
yn I Date: 7/26/10 days after It has been accepted as comma. Print name: Charlynn Leifsen f se • Number of inspections allowed per permit.
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