Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 00544
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/05/2010
Parcel: 2S112DD00400
Jurisdiction: Tigard
Site address: 15940 SW 72ND AVE B17
Subdivision: OREGON BUSINESS PARK I Lot: 17
Project: MAX VIZ
Project Description: Electrical for TI.
Owner: FEES
PACTRUST Quantity Description Date Amount
15350 SW SEQUOIA PKWY SUITE 300
PORTLAND, OR 97224 4 crt Branch Circuits 10/05/2010 $78.44
wo /Purchase Service or
PHONE: 503 - 624 -6300 Feeder
1 ea 12% State Surcharge - 10/05/2010 $9.41
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 $87.85
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 ma obtain -_ • - or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: �/ Permittee Signature: . _I.
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.
Electrical Permit Application + 0 FOR OFFICI: list.: O:\I.\
City of Tigard y� Received •
a 13125 SW Hall Blvd., Tigard, OR 9 Plan Review
': C Phone: 503.639.4171 Fax: 503.598.1960 J 9 Iate/B : Other O Permit: ,N / i
R
t i c, n k o Inspection Line: 503.639 Z 4' l� �� ate y: See Page 2 for
Internet: www.tigard or.gov l O 1 ; Notified/Meted/Met hod: Supplemental Information
TYPE OF WO PLAN REVIEW
❑ New construction ® Addition/alteratioV4Scement Please check all that apply (submit ii sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
Tess to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ® CommerciaUindustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: I Job site address: 15940 SW 72nd I Six or or more residential R occupancy. Recreational 0 or more residential units. ❑Receational vehicle parks.
City /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
. ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Max-Viz ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Deseription 1 oty. I Fee. 1 Total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
— Tax map/parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 I
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
Tenant improvement residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 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: ( )
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
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or ex tension, per panel
Owner signature: Date: A. Fee for branch circuits with
. ® APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
I —
Business name: Johansen Electric B. Fee for branch circuits without
service or feeder fee, first 1 56.18 6 18 2
Contact name: Charlynn Le i f s en branch circuit
Each add'I branch circuit 3 7.42 2.26 2
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
Valley, OR 9 7 0 8 6
Each manufactured or modular
City/State /ZIP: Happy 67.84 2
ppy dwelling, service and/or feeder
Phone: (5 0 3) 698- 3 417 Fax:: (5 0 3) 698-2486 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
panel, alteration, or extension. Page 2 2
Business name:
Johansen Electric Each additional inspection over allowable in any of the above
Address: 10948 SE Valley View Terr Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Happy Valley, OR 9 7 0 8 6
Investigation plant ( 1 r m ) 66.25/ hr
PPY Y r Industrial plant (1 hr min) 78.18/ hr
Phone: (5 0 3) 698-3417 Fax: ( 503) 698-2486 Inspections for which no fee is 90.00/ hr
specifically listed ('/, hr min)
CCB Lic.: 51539 Electrical Lic.: 3-243C Suprv. Lic.: 2053S ELECTRICAL PERMIT FEES
/ Subtotal: 78.44
Suprv. Electrician signature, required: ' ■ - • -! ado./
Plan review (25% of permit fee):
Print name: Carl J hansen en Date: 10 / 0 5 / 10 State surcharge (12% of permit fee): 9.41
TOTAL PERMIT FEE: 87.85
Authorized signature: A This permit application expires if a permit is not obtained within 180
Print name: Char 1 n f s en Date: 10 / 0 5 / 10 days after it has been accepted as complete.
yn • Number of inspections allowed per permit.
(:\Building \Permits\ELC - PermitApp.doc 07/01 /10 440- 46t5T(11 /05 /COM/WEB