Permit CITY OF TIGARD ELECTRICAL PERMIT
o COMMUNITY DEVELOPMENT Permit #: ELC2010 00448 •
T1 CAP D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/26/2010
Parcel: 2S112DC00201
Jurisdiction:
Site address: 15865 SW 72ND AVE, BLDG# C
Subdivision: Lot:
Project: ChemWest
Project Description: Electrical for TI.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 8 crt Branch Circuits 08/26/2010 $108.12
wo /Purchase Service or
PHONE: 503 - 624 -6300 Feeder
1 ea 12% State Surcharge - 08/26/2010 $12.97
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 $121.09
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 0A • •2- 001- 0100. You m, • • - • - • -- th •- - = -stions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued B = = �- 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.
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.
� ECEIVED
Electrical Permit Applicati t . I n lz t t l ill l l N f I r\ l .l
1,,,,,_ City of Tigard ,U G 2 5 7.010 w : , I r
13125 SW Hall Blvd., Tigard, OR 972 plan Review
t- Phone: 503.639.4171 Fax: 503.598.1960 Date/B . • 01126i Permit: r
,, ,, r, Inspection Line: 503.639.4175 CITE! OF TI Date Ready/By: C S
See ' g for
Internet www. tigard-or.gov DING DIVIS Notified/Method: WilM Supplemental ( formation
, -r lOp n 1, nftl Iii ;l NILIwI ipa Bar le i it I .,. . . fi r, 'dir rim r _ X11 y ux . ic with � 1 y�¢[�� Yirr�
l - rs.'BI7111 . .. _u.:11711'AI aili1VI 6,5iidar*: ;i:11mIg 'rl' "rt ' -.'!4x•1 { !: � :41.1: 4 7r1166:m r l M1 k��ppsEidg
l l
❑ New construction ® Addition/alteration/replacement Please check all tint apply (admit 3ems of planswfrtema chocked betow)
❑ Service err feeder 400 amps or more ❑ Building over duce stories.
❑ Demolition ❑Other
where the available fault current ❑ Marinas and boatyards.
xjiiii lIr ill,i Y ra ' �,, - :: _IIt `t r I tro u tLtu-1 tryr sron�r FIt( r> r to S ntr eju • exceeds 10,000 ❑ Flaming boil
telti •.'Sa.. L ti !w-/1 �I!, i'ialza �)i�_ .. .r yr :f i �r•5' . in? � �'..? amps e s 14,000 ,000 or buildings.
1:1 1 and 2 - farm dwelling ® C ommercial/industrial lento Brenta, or motets ons. ❑ Commercial ding agricultural g 0 building amps for all other instillations. buildings.
❑ Multi -farm ❑ Master builder ❑ Other. ❑ Fire pomp. ❑ Imtallation of 75 KVA or
`4y i h ^r roc- 91 =P 1 7 1 ry�r la74771f34�dlra •• g I CI Eme cy %'stem. larger aepantely derived rydam.
+ ,:.. aI, !YW9,,,. t uarllti,a ltli r , uirr,L},!.tar.II i.iLl itrietiseia m :.2 ;i• di.. M :• • ❑ Addition of now motor load of ❑ A ". "E ", "1 -2 ", "I.3 ".
job no.: job site address: 15 8 65 SW 72nd 100 m more.
res Rocre occupancy.
CI or more resideaGal 1111116. ❑ 11eatatiooal vehicle patios.
City/State/ZIP: ❑ Health -care fatalities ❑ Supply voltage for more than
❑ Hemrdous locations. 600 volts nominal.
SuiWbldgJapt. no.: C I Project name: Chemwe s t ❑ Service or feeder 600 .. or more.
Cross street/directions to job site: r :t - • ,x atgl& .. ' g" i i 1
Deserladon " Ors: Pos. Total
New residential single- or multi -family dwelling unit
Includes attached garage.
rttbdivision: I Lot no.: 1.000 s¢ ft or less 168.54 4
Et add'I 500 sq. ft. or portion 33.92 1
Tax map/parcel no.:
!'r!1 i{ fi'g� r,, .err- of }.rs r`8r '+ �,�{�� i 7 , Li mited energy. residential 75.00 2
ii, , : r S�',ntim,Tf"a,m.1.` ?.;lr�i,u:,�r 9�Gr s: ,ai...,.r j 7 I I 5 �' . (with above s9. ft)
Limited energy, multi- fancily 73.00 2
Tenant work - fixtures residential (with above sq. R )
Services or feeders instaUatloo and/or relocation
200 amps or less 100.70 2
, D) ll � n ur r. »x ere u,:4 v +a � , r . , g 201 to 400 amps .. f.;i®r •I 't . " ."+ I + � i - 1!3: n f 'i i' iiE> r �i!',a. : �� , - iYe 1 . ' I E %! Ps 133.56 2
- p
✓nduerWr iiS• - n i � r.:..ra r s. � ' .�
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 /State2lP: - Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 I 1
Owner inatalladon: This installation is being made on property that I own which is not 201 amps to 400 amps I I 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 1 68.54 2
Branch circuits- new, alteration, or extension, r panel
Owner signature: Date: A. Fee for branch circuits with
+i:' S' I I i w • 1 "sr Is a ` �'`Er ` 1 G, I I i i" c '87' ` r 1 it '`'` a" a ^' m i l s a _�, a .1 above service or feeder fee,
:. >.1f16 t a;:
ricii:si.:.. . . .. rrmu � :a: .l7.44 dsain�ev ' ,i. - i urill l ti:... u. :C i .u.w dla:r_ ;n d . �� ' .4J 7.42 2
each branch circuit
Businessntune: Johansen Electric B. Fee for branch circuits without
service or feeder the, first
tontactname: Charlynn Leifsen branch circuit 1 56.18 56.18 2
Each add'I branch circuit 7 7.42 51.94 2
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not Included)
City/State/ZIP: Happy Valley, OR 9 7 0 8 6 Each manufactured or modular 67.84 2
PPY Y r 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
rIs1t' .�n�.spuJ4}PI$7FLgt?� t t,i'. ::nla flS1. t v- �.,,, -.'s •nllra• :xa lr:z• ]�� j �r-0�rtlr ff , Sign or outline lighting 67.84 2
i�
1 '1Sirkli: ^:.!*.•,ii. 3;.71Tn91Yd1ta77� il EE: :�i,;127..•.4 ✓, rSl!' :I'.I� 1 t62Y: t fa Signal cireuit(s) or limited-energy
Business name: Johansen Electric paten, alteration, or axeeasion. Page 2
Each additional inspection over allowable in any of the abov
Address: 10948 SE Valley View Terr Additional inspection (1 hr min) 66.25 /hr
Investigation (1 hr arm) 66.25/ hr
City/State/ZIP: Happy Valley, OR. 97086
htat,suiel plant (l hr min) 78.18/ hr
Phone: (5 0 3) 698-3417 I Fax: (5 0 3) 698-2486 Inspections for which no fee is 9000 / hr
ifc listed 'h hr min
CCB Lic.: 5153 9 I Electrical Lic.: 3 I Suprv. Lic.: 2 0 5 3 S +' ?':,!gr 1 'q i ;+` +:i i 7" ° :e: • ' °iii ;" 'y ;l r
-
Subtotal: 108.12
Suprv. Electrician signature, required: 6, f/ e �/ Plan review (25% of permit fee):
Print name: Carl Johansen (_ /' Date: 8/25/10 State surcharge (12 %ofpemcit fee): 12.97
Authorized signature:
L1 TOTAL PERMIT FEE: 121.09
I
This p ermit appBeadoa metres ifs permit is not obtained within 180
days Print name: Charlynn Leifsen I Date: 8 / 2 5 / 10 • Number of impactions u has �`e permit
a' CO
• mspeetions allowed per permit
L1RuilatrglPomatslffi.0 -P mitApp.doe 07/01/10 440.4615T(L 1105/COM/WEB
I - d XHd 13C213SH1 dH WdLO :C 0102 SZ 2nB