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Permit IN, CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2010 00401 :TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/03/2010 Parcel: 2S112DA00800 Jurisdiction: Tigard Site address: 15115 SW SEQUOIA PKWY 110 Subdivision: Lot: 0 Project: Spec Space Project Description: (3) branch circuits for restroom remodel. Owner: FEES PACIFIC REALTY ASSOCIATES Quantity Description Date Amount 15350 SW SEQUOIA PKWY #300 PORTLAND, OR 97224 3 crt Branch Circuits 08/03/2010 $71.02 wo /Purchase Service or PHONE: 503 - 624 -6300 Feeder 1 ea 12% State Surcharge - 08/03/2010 $8.52 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 $79.54 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 to • .! • •AR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issue. By: Permittee Signature. . _ - i . rte __ OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease or rent. OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' - �: . • Date: - LICENSE NO. Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. • lectrical Per Ap�i">!c '8� r `' �, ia�l, (li� Ic Ital t1�Ia � `" M City of Tigard Received t3'Ar e ` O �O Date/$ Q� A Permit No.. ��e rO' D 13125 S W Hall Blvd., Tigard, OR 9 !�,..:'' � . " Plan Review ether Permit: Phone: 303.639,4 171 Fax: 503.591.1960 \\I' DateIB Inspection Line: 503.639.4175 P � � • � Date RewiyJBy: ®See Page 2 for Internet; www.tigetd- oi.gov r i ' �A\ --ON ® Notified/method: Supplemental Information yyIrty�& �, �, �� 1 } �� �T' 3 - �>J� ^` F ",1kq}tt�ttry�tF C ( �' � ,}gyp r' q '9 F Ird ' y'ua /l} t 1 1 :: K 1 , . , , , VIE } , i,tk Y!. `�" t r W a. tt.ft4rl}!lil,±.'C. 1 ti .. ,yi S TiI } ! "7'tpg . li 1 .. i t i l -,,,",�.,kt,,. 7}k.,: ;.7 JS Y. • , 1/ '1 1 ,,,, 1 I . 1. tli. aerdiL+lua '' ,, . : F. A : 0 ❑ New construction ® Addition/alteration/r aejment Please check all that apply (submit' sets of plans w /items checked below): El Demolition ❑Other. ❑ Service or feeder 400 amps or more El Building over three stories. Err , rn , i ° rj 1 i a} , ur m where the available fault current ❑ Marinas and boatyards. 4, i , tit �,c+io, r, TaN. .,.,,., _ r _ r n ,} . o �w _ Y 7 . f i t ,, ik, : }ti 4 exceeds 10,000 amnia 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial-use agricultural ❑ 1- and 2- family dwelling © Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi -family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or ii a 5 tr4f7 1 p a a 1I,tw u , FP i1�r, t Ir, .+l,:rruwwm s 1 w w i8 1r1 }} ,i . a ❑ Emergency system. larger separately derived system. os,u 41 . ,.,. _Wiii'; , 5 ka:t.,l piAi„at• � x P f . c - .1 Orr ,ainuld; .1..�at i11 'S . .' mil Ili ❑ Addition of new motor load of ❑ A ",''E "1.2 ", "1 -3 1001IP or more. occupancy. Job no.: Job site address: 15115 SW S e q'uo i a , 110 ❑ Six or more residential units. ❑Recreational vehicle parks. City /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations 600 volts nominal. Suite/bldg./apt. no.: 110 I Project name: p e C 2 31 re s t r oom ❑ Service or feeder 600 amps or more i1E1 , , . aC'.1nigti tom'1i1rlat � , w �' Cross street/directions to job site: ne , t : +. ! °'I ° Qtr. Fee. Tool • .. New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: I Lot no.: 1,000 sq. ft, or less 168.54 , 4 map /parcel no : Ea. add'1500 sq. ft. or p ortion 33.92 1 H n)p a ,, a,+nra nr w, , „ U _ Limited energy, residential ,1- . '� .;dl �l i'a� '" ,+-" ..'. a 'u :, ,�} - , i ', • ;, ?: * t t :II (with above sq. ft -) 75.00 2 .. i rr....:alriy iaC a,i.e,:la�". ?�IIIi " , Limited energy, multi - family 75.00 2 Res t room remodel residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation _ 200 amps or less 100.70 2 -,, l` irt, � Sri i L t . T? 1e-' . 141, , , ° ,� Tit0 ' I ' , t ' ry fix' j - i05 �.s 141 tFl iii 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 Temporary services or feeders installation, alteration, and/or City/State /ZIP: relocation Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits— new, alteration, or extension, p er panel Owner signature: Date: A. Fee for branch circuits with yi1G { N , tt l '; s yam+ s1 �' 't - '� ' p above service or feeder fee, lea.` -. .. + �1Y at.r n - err U 'cLl , ILI, r it `` ' �a,a: a '.a mina 'i ; udil,- ......l; ii '. F -,i !, 742 2 each branch circuit Business name: Johansen Electric B. Fee for branch circuits wahow service or feeder fee, first C`Yi Charlynn Le i f sen branch circuit 1 56.18 56.18 2 sci Each add' l branch circuit 2 • 7.42 L . 2 4. Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not included) air/slaw/al': Happy Valley, a OR 9 7 0 8 6 Each manufactured or modular 67.84 2 PPY Y r dwelling, service and /or feeder Phone: (5 0 3) 698-3417 I '( 503 ) 698-2486 Fax:: Reconnect only Pump 2 E-mail: or irrigation circl 67.84 2 , �6 ; r;.. �if4 r , hxy 4 y c a Sign or outline lighting 67.8 2 1 -'.fi ,.: 'ill �rt�.. ; , t � :- l, i1 I d'7 t i 1 i ,�li`' I Signal circuits) orlimited- energy Business name: Johansen Electric Panel, alteration, or extension. Paget 2 Each additional inspection over allowable in any of the abov Address: 10948 SE Valley View Terr Additional inspection (1 hr min) 6625/ hr City/State /ZIP: Happy valley, OR 97086 Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr ruin) 78.18/ hr Phone: (5 0 3) 698-3417 Fax: (5 0 3) 698-2486 Inspections for which no fee is 90.00/ hr iftcall Iusted Y2 hr min CCB Lic.: 51539 1 Electrical Lic.: 3-243C I Suprv. Lic.: 2 0 5 3 S 4tiii ` ,1M q S_`", II� 'it's g"° " "_ r .: . 'f a ,:a21; ,r. 9. ea%d it Subtotal: 11:1--,--e5 7 . Suprv. Electrician signature, required: Plan r (25% o pe t Sub fee): Print name: Carl ohansen Date: 8/3/10 State surcharge (12% of permit fee): B-A-8• ei . , TOTAL PERMIT FEE: 2r Aatlsori2etl Signature: . This permit application expires if a permit 6 not obtained within 180 4 - Clays after it has been accepted as complete. "1 ' Print name: Charlynn Le s n I Date: 8/3/10 Number of inspections allowed per permit. l: lnuitdinePennits12LC •r'amvtapp.doe 07/01/10 4404615T(Lrro5KOMMBH I • d XBd 13C213S131 dH Wd2S : Z t 0102 co 2nd