Permit CITY OF TIGARD . ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2009 -00425
TIG ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/18/2009
Parcel: 2S113AA00300
Jurisdiction: Tigard
Site address: 16316 SW 72ND AVE B3
Subdivision: OREGON BUSINESS PARK I Lot: 0
Project: Spec space
Project Description: (2) 200 amp service and (14) branch circuits for TI
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 14 crt Branch Circuits w /Purchase 08/18/2009 $93.10
Service or Feeder
PHONE: 503 - 624 - 6300 1 ea 12% State Surcharge - 08/18/2009 $30.44
Electrical
2 ea Services or Feeders - 200 08/18/2009 $160.60
Contractor: amps or less
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 $284.14
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 OA 5 -101-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: 4 ( r Permittee Signature: erAi 6,9-7
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 603.639.4176 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.
,. ..
r
Electrical Permit ApplicatioREC V ri 11f t hrrl( 1 t :,: 0\1
City of Tigard Received G ■ '
11G 14 2009 DateB : O e : ���_ p -D 2 A
13125 SW Hall Blvd., Tigard, OR 9722 pit, Review /�
Phone: 503.639.4171 Fax: 503.598.1960 Date/13 : Ocher Petmr '4'/ 2QQ - 00/
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Pace 2 for
Internet: www.tigard or.gov 1 � �; DIVISION Notified/Method: li - Supplemental Information
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❑ New construction ® Addition /alteration/replacement Please check all that apply (submit 1 sets Glistens w /iteals checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
El Demol ition 0 Other:
where the available fault current ❑ Marinas and boatyards.
1:14, rIK:.•+7'-F 511111 I i 'fi 1;7• ii:TtT/,5
'r ;ri':- 'F•''' 1r. 1 r^ 1111 ,lrrt e
'Oita i�, It a y 1 i -, t r �i' e n y i h i i >,�`' �� l r'�'�'; ":I ° �'{iis "1 I��(j.�'�, j,',E xoeads 10,000 amps at 150 salts a, ❑ Floating beri
..111111 1119119WS1121 ItiW7x191L1111. ii 4vri.:uaslii ltliiit:ILhaIcalliirarialit. lalralhki SKRN 0x134 t& N t14dtV� Commercial-use 8 ldt a.
dwell: Commercial/industrial loss 14.000 ❑
❑ 1- and 2 -famil
2-family rag ® El building crops for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑ Other ❑ Firs pump. ❑ Installation of 75 KVA or
t " � ir!! -'u d , iu.:i i v , i LP sumw I ttpt' E W •-.3. -'ac.�r " -t} ut rip p,,00 s ' 47 ❑ Emergency system. larger separately derived system.
..il {IL . ! �k:Lfilil�ILaC� h �l a..•:,,it. <1.,- . -:!ir t - :A.;!. a,_ddt ....F iRil.d of t i, � . I ❑ Addition ofnew motor load of ❑ "A", "E '1 -2 ", "I -3 ",
Job no.: Job site address: 16 316 SW 72nd 100HP Of more. rampan`y.
❑ 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.: I Project name: 10bp 118 spec ❑ Sen'iceor feeder 600 amps ormare.
,411 f tE iTEMI lL 1;r l: M> a ii+�'i ILPll= FkIE l a '.
Cross street/directions to job site: o,,,,,iprisn oar P... Taal •
New residential single- or multi - family dwelling unit
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. 2. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential
i`l�br'�r:y "i : i TC ri�,ri: j:�o.:,ai'ur ^t n!t 1'I .'•. r•" 'ls'
lw fl/iita I111E.. ""rl i t {eu�Fs14 t of •i i : 9 1 i i -fe " Ih 9 iati1�t�� 1a5'µ1 rQ���� tge,.1: with above Rl 75.00 2
t. ie. Y,.,.., Y.„, G ..•:�,..w,olirit,mirnnce....a , b, l: I•. �rrl.`.. r, trtlrY !tr�(d77e����S:C'.!:t�Y'JCJ1 ( 64� 1
Limited energy. multifamily 75.00 2
Tenant Improvement residential (with above aq. f.)
Services or feeders installatioa and/or relocation
200 amps or less .. 80.30 '14,0.400 2
full voit! w.ti n g rw i p,1 i g 41 f i � 9$'141 1
I.;,riaki.l,t„ 1-i a.. trs r ...� uio. i. Ai ,.1(.. ti . ' 8.t!p x�. i. v _ o , . ..t. � _ A� ' 1 ; c K,ll .' - _ _ .j . 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 I 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended fors lease re or exchan a accordia to ORS 447 449 and 701. 401 amps to 599 amps 133.75 2
�, rat, g , g 449, 670
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
} ;r . : 'i :.lr `'4 i'> w . �y 1 a Ri� railril I p l ZI r Jt3 tI ' e
f ,.. :iY;2 ` • a..':1..1x :::.∎4 11 a lai i . ' LL t- .t, �i : f t Iii ' . : :4 ::�,__,41 2 above service or feeder fee
Business name: Johansen Electric Inc. each branch circuit t { 6.65 CO 10 2
B. Fee for branch circuits
Contact name: Charlynn Lelfsen
without branch service circuit ur feeder foe, 46.85 2
first branch circthit
Address: 10948 SE Valley View Terrace Each add'' branch circuit 6.65 _ 2
Miscellaneous (service or feeder not included)
City /State/LIP: Happy Valley, OR 97086 Each manufactured or modular "
dwelling, service and/or feed 90.90 2
s
Phone: (503) 698-3417 I Fax: : (503) 698 -2486 Reconnect only 66.85 2
E -mail: johanseneleet at msn.eom Pump or irrigation circle 53.40 2
1 • "t ,:. tit YM VI th a atl? �1 :ti fl 1 2. { :,:ltl! t1411let llMIE `tilf;I t rui t it - Sign or oudine ligthtbrg 53.40 , 2
Business name: Johansen Electric Inc. Signal cQCUit(s) or limited-
ct 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 a , of the above
Per inspection 62.50
Phone: (503) 698-3417 i Fax: (503) 698 -2486 Investigation per hour (l hr 62.50
CCB Lic.: 51539 ✓ I Electrical Lic.: 3 - 243C LI Suprv. Lic.: 2053S ✓ Industrial plant per how _ 73.75 �sj y � y
required: '{ tt?li l l vl:i. �l..1'S.1�-:11:�r��h ,4!.:. ti� !'I.t: mot. "ip ISl.'9t: N :
Suprv. Electrician signature, a 1241.../ Subtotal 2.5 3.70
•
Print name: Carl K. Johansen Date: 8 /14 / 0 9
Plan review (25% of permit fee):
State surcharge
Authorized signature: ( 1 ...... ./ r-
J r - TAL PERMIT FEE: � y /
, /
Print name: Charlynn J. Leifsen __ -Date 8/14/09 Tttim pe day after it has ee H a permit b not obtained within
7 180
( (
day after it has been accepted as complete.
• Number of inspections allowed per permit.
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