Permit n CITY OF TIGARD ELECTRICAL PERMIT
'>' 1 ` - COMMUNITY DEVELOPMENT Permit #: ELC2010 -00439
11 G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/25/2010
Parcel: 2S113AC00103
Jurisdiction: Tigard
Site address: 7216 SW DURHAM RD, BLDG# P
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: Otis Elevator
Project Description: Electrical for mezzanine.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 3 crt Branch Circuits 08/25/2010 $71.02
wo /Purchase Service or
PHONE: 503 - 624 -6300 Feeder
1 ea 12% State Surcharge - 08/25/2010 $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 through OAR • - 001 -0100. You .?..-. • - ' • - ,--• • 0 the rule- or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
/ i
Issued By: — /mss r =�� 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.
�• -i r' �''tix5 a 0
Electrical Permit Auulicatio •
City of Tigard AUG 2 4 2010 •
a 13125 SW Hall Blvd., Tigard, OR 97223 , �� 1
I6 P ; pl an Review
Y Phone: 503.639.4171 Fax: 503.598.1960 r . f I I :: l Li paters - Other Permit: � � ./1 - ill l.e
inspection Line: 503.639.4175 1 i f�, tr w v Date Ready/8y. @( flee 2 for
Internet: wivw.tigard- or.gov L L 1 1, P! `:.., Ll! . - !` Not fied/Meehod:
,�ti� Supplemental Iaformadoa
'''u +F1'1 ", a -'r'' "rn h '` la �' aaal�lr.�- +c`�! ,,. •• P q, cao, � anm 1 c„m+u^s�mr, �{,' �—
I s M . . � ' left! I `i'�ii.. f .. 1 ..,_ � t III t.....rn. wt}l3m$1 1aIN1¢.. i .
ciill;„>:._r�'!�GU'. �.l1'3rill�:.r�l'�w' ''sr,y. �.f/l� ♦FN� i I � � y' � �7 ' '� 1 2"j` 7,�'t �Z r . t ` ' a. � iy�• .
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit g sets of plans w/itcms checked below):
❑ Demolition ID Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories
r ,. t �+ 1✓, unp�trt ..wriasns'� WANT wheue the available fault cement ❑ Marinas and boatyards.
a � i f111e o er yj ,'ts,y, :errs , oi'$ ^ ; c —s�J- s7,h Ir' i r1 t, r ; "u„ 'i'lr•� p i:' f t +�'' li , l (le .,1::‘-'!;:,::: exceeds 10,000 empa at 150 volts or ❑ Floating buildings.
❑ ]- and 2- family dwelling J Commercial/industrial less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ Accessory building amps far all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other ❑ Fire pimip. ❑ Installation of 75 KV A or
1�'! '' Y 1 e s ri r :wr� �rn " �S�y eiuwn ; , qi A „ p Ss. i x! R r� ❑ system. get separately system.
. t'r3i1 Ii i.ylllit r ill YrluL..i6Mir. �rcte'.:• ' K be. g� Emergency Y
. �' ...._. '" ' ;, �aGe�, 6s.� , I.�iils����k�a �� ❑ Addition of sew motor load of ear x derived at
Job no.: Job site address: 100110 or more. occupancy.
7 216 S W Durham ❑ Six or mote residential units. ❑ Recreational vehicle packs.
City/State/ZIP: 9 Health•careface7iries. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal
Suite/bldg./apt. no.: I Project name: Mezzanine ❑ Service at feeder 600 or more.
Cross street/directions to job site: — 7/ " r ' 1
Description Qer. Pea. Total
New residential single- or multi -family dwelling unit
Includes attached garage.
Subdivision: I L no.: 1,000 sq. It or less 168.54 4
Ea. add'1 500 sq. ft or portion 33.92 1
Tax map/parcel no m Limited energy, residenial
a l
F3 } ie �W l !( [ I Sl G+ m rii�ep r c r e �v �s t si ;' i %! F• �`I�f +„ i + (with above sq. R) 75.00 2
1 4 d? t r l r .:..te a;. L.., I iw..,'ii i �i 1`{,Igdi . Limited energy,
„'r bove multi tkmrly
Fixture work at mezzanine residential (with above sq. R.) 75.00 2
Services or feeders installation, alteration, and/or relocation
z 1� ",gc: tt 7-'• e-q -mc,c a In , •s,M t + ". m t n:u - • 200 amps or less 100.70 2
Ii I u 7 � _ 1 C +. 8 t e ..y +(1 l kUt ; may, aM �' M1 l 7 :j 201 amps to 400 amps 133.56 2
. ,1t �ill�,..._rvl..: i,n�.rhxs:,;,:_1.... eiiyylsn i ..,..... ii'14i11`�L i.:a�laau�i, - -�i � 9 �'1,'.
Name: 401 maps to 600 amps 200.34 2
601 corps to 1.000 amps 301.04 2
Address: Over 1,000 amps or volts 55226 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or Is 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 temps to 599 maps I 168.54 2
Branch circuits - new, alteradon, or extension, panel
Owner signature: Date: A. Fee for branch circuits with
e , ROE e 5- ,+fie G { + 1 ,[tr , . lW {
9 i f i i eq�" l'� i ilrlE4t h, C 'wM > 1<'ats°rol r. +.- above service or feeder fee,
t&14f�t k� ,,: n , ,, atw erasers._ t _fit liukl: t +�:rtt/«, �: �,t.11,;., + Ilci.ul' each branch circuit 742 2
sines n ame' Johansen Electric B. Fee for branch circuits without
service or feeder fee, fast
Contact name: Charlynn Leifsen branch circuit 1 5618 56.18 2
Each add'( branch circuit 2 7.42 14, 2 Ill v ISII
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
City/State/LIP: Ha Va 11 a OR 9 7 0 8 6 Each m service or modular 67.84 2
PPY y. dwelling, service and/or feeder
Phone:(503) 698 -3417 I Fax: : (503)698 -2486 Reconnect only 67.84 2
E-mail. Pump oo irrigation circle 67.84 2
' 3 ei +a s tl + ,,, . test/ , , .,„ g , ,. Sign or outline lighting 67.84 2
111�e f �!ti!II�,e if r., iA ._IN i .9:.!.;,�" i / illidgIE I: st r ' e.':'-: Signal eircuit(s) or limited energy
Baseness name: Johansen Electric panel, alteration, or axle nsion Pa 2 2
Each additional inspection over allowable in any of the abov e_
Ate: 10948 SE Valley View Terr Additional inspection (1 hr min) 66.251 hr
City/State/ZIP: - Investigation (I hr min) 66.251 hr
fy Happy Valley, OR 97086
Industrial plant (1 hr min) 78.18/ In
Phone: (503)698-3417 Fax: (5 0 3) 698-2486
i nspetx i o oa for w no fax is
'ficaal listed Yr br men 90.00/ hr
CCB Lie.: 515 3 9 I Electrical Lic.: 3 - 2 4 3 C I Suprv. Lic.: 2053 S . .1 *,, � ii aC;,a ir2 i '7 w'' ,ii " n `1 °" !
�J� ~ �� Subtotal: ,�; •ti e 7 n .. 6
Suprv. Electrician signature, required: �� [. , a4: ! W. Plan review (25% of pen b t t fee): — I"
Print name: Carl ohan s en r ate: 8/24/10 '�Q`6 State surcharge (12% of permit fee): 8.48 1'" lja
— Itiiiii;rized signature: . TOTAL PERMIT FEE: 79.14 ---iekr 1
This permit application expires if a permit b not obtained within ISO
Print name: Charlynn Le f s en I Date: 8 / 2 4 /1 0 days tiom it has been accepted as complete.
Ntmrber fiatpecaoasallowad per period.
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