Permit CITY OF TIGARD ELECTRICAL PERMIT
I: COMMUNITY. DEVELOPMENT Permit #: ELC2009 -00368
T I G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/23/2009
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 400
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: Silken Management
Project Description: Install (1) 200 amp or less feeder or panel, add /alter (20) branch circuits.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY
#300 1 ea Services or Feeders - 200 07/23/2009 $80.30
amps or less
PHONE: 20 crt Branch Circuits w /Purchase 07/23/2009 $133.00
Service or Feeder
1 ea 12% State Surcharge - 07/23/2009 $25.60
Contractor: Electrical
JOHANSEN ELECTRIC INC
10984 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 $238.90
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 hrougn OAR 952 - 001 Yo may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By% ,� t l / 1 I I i _, Permittee Signature: ki r.1 � f
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.
s i t x
Electrical Permit Application ' 1.01. 1: I,1, 1., t ,I, e r, I ,
� ` ! . C Received
t 1
City of Tigard ��D
Date/B . Pertaa No.: • CO 13125 SW Hall Blvd., Tigard, OR 97223 �j► ��: t•
Phone: 503.639.4171 Fax 503.598.1901UL Pearl Review
Dete/B . Other Permit:
inspection Line: 503.639.4175 2 ��9 neat Ready/By: ,, See Pagel for
Internet: www.tigatd ot.gov Y . NodfiediMetlrod: Supplements! Information
z I rrfrfq�q�,�a; �(��tgq�yy::^^�tCJS :tt1.' :�r+fiY' 6ilc icF � �F ,�1 "�'�_�-t�p :} I. 11.4,i-,...":. t�a.• r rrpr ' ril/t '1 .n�+ •• ;, �r y �
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❑ New construction ® Ad d ition/alteration/rep . ce A � I 1 Please check all that apply (submit 1 sans of plans wrterns checked below):
❑ Demolition ❑ Other, ❑ Service or feeder 400 amps or [Dare ❑ Building over three stories.
I •[ ! { g � L try tore a ti_; where tie avaikbk fault curt ❑ Marinas and boatya¢da.
k i( t a "; .! ??f! I , �ii',liiii '.::1., e t,+, • •. j1 2N n � a !'t Z exceeds 10,000 aunps ar 150 volts oa ❑ Floating buildings.
❑ 1- and 2- family dwelling ® CommerciaL'ittdustrial lest to ground. or exceeds 14,000 ❑ Commercial -one agricultural
❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fns pump. ❑ Installation of 75 K VA or
•p f�i L11 I I•q , i %'• x yilxaw ,xs neon. ; y a S v �a> w ❑ E c system. larger separately Y
:.:.°F/tll 1. mgk < " I ri,oronik lr � t.J Ii ;:# cilrYZOi roi {� y� t74 Emergency Y Y CnL er 1 dar{vede system
nz•.J.a;a• ':moo ,ori.amu..i u1' '•kilo 1!r17fU II:�.1 'Nit ❑ Addition anew motor load of ❑ "A ^, `E^..1 - 2 - 3'
Job no.: Job site address: 12909 SW 68th Pkwy 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parts.
City /State/ZIP: ❑ Health - care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldgJapt. no.: 4 0 0 I Project name: Silken Management ❑ Service or feeder 600 amps or more.
In !I:. ,��
Cross street/directions to job site: 1 k !£t ;,� -:-r ,,!o-,„i,r!' -.. Mil ' �i..;l
nesertanen Qty. ' Fee. Total •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1.000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.40 i I
� , �r:,„r,,,,r „ Iy ' a- , Limited energy, residential
i m • , 'il 3tfli ' I;»+�ill ' 4'ia 1 .. , , y Ai ( 75.00 2
! 4mis:ea;Lnlui.�tiecli A.wl: R it' ., (with
Tenant Improvement Limited energy, multi- family 7500 2
residential (with above sq. ft.)
Services or feeders installatton,aheration, and/or relocation
]� w i re "•1A,+1 mr r u w a la r y I 1^ i`I 1 y a 200 amps or Less 1 80.30 ' 8 0. 3 C 2
in' hilt', iifi� r47•r iinioar� ALME '�.�.fi"¢�5! 11°__iKI iou, a, i � t _ ..11 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
Address:
601 amps to 1,000 amps 240.60 2
Over 1,000 amps or volts 454.65 2
City/State21P: Temporary services or feeders installation, alteration, and/or
I relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps I I 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 [maps to 599 amps 133.75 l 2
Owner signature: Date: Breach circuits - new, alteration, or extension, pe panel
�( "3 A. Fee for branch circuits with
lt�� ieraiNa `fF ' r n' f it �' i t , °y' + 5� � zE �' :a :l : 'am ' ia'�, � ,' , "i: `_' ' above service or feeder fee, 20 6.65 13 3 2
Business name: Johansen Electric Inc. each branch circuit
B. Fee for branch circuits
Contact name: Charlynn Leifaen without service or feeder fee, 46.85 2
first branch circuit _
Address: 10948 SE Valley View Terrace Each add'1 branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/ State/ZIP: Happy Valley, OR 97086 Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: (503) 698.3417 Fax: : (503)698 -2486 Reconnect only 66.85 2
E -mail: johansenelect@msa.com Pump or irrigation circle 53.40 2
t
=:er UTIS111ETZyal:, w.;;,t,RWt:MrilftlalNMIIIZAitA1ERIII :50I:6'', Si or outline lighting 53.40 2
Business name: Johansen Electric Inc. Signal circuit(s) 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 • oftbe above
Phone: 503 6983417 Per inspection 62.50
( ) Fax: (503} 698 -2486 Investigation per hour (1 hr man) 62.50
CCB Lic.: 51539 [Electrical Lic.: 3 - 243C Suprv. Lic.: 2053S Industrial t . hots 73.75
Su signature, required: /�_ i _ /J �/ �� t' � e }t+� ":» ` la i ;'e_r , ` i [ ' i.' u$ i
prv. Electrician tared: `�C.f /
' t
Subtotal: 213.30
Print name: Carl K. Johansen pate: 7/22/09 Plan review (25 of permit fee):
State surcharge (12% of permit fee): 5 • 6U
Authorized signature-
1 TOTAL PERMIT FEE: 2313 . 9 0
Print name: Charlyrm 3. Leifsen I Date: 7/22/09 This permit ■ ppileadon expires era permit is not obtained within 180
days after it bas been accepted m complete.
I: ■Huild ,oglPermits'Flt 03/23/06 • Number of inspection allowed per permit.
440- 4615T(I 1/0 5WCOM/WPB
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