Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00262
T l G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/04/2009
Parcel: 2S113AA01100
Jurisdiction: Tigard
Site address: 16588 SW 72ND AVE, BLDG# B11
Subdivision: OREGON BUSINESS PARK I Lot: 0
Project: Spec Space
Project Description: TI - (10) branch circuits.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY
#300 10 crt Branch Circuits 06/04/2009 $106.70
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 06/04/2009 $12.80
Electrical
Contractor:
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 $119.50
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION = _•n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 • ugh OAR 9 • -0 ' 0104 You may obtain a copy of the rules or direct questions to OUNC by calling .246.6699 or 1.800.332.2344.
Issued B • Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' 1 // �Cl/� �.�_ Date: •
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on the Job site at the time of each inspection.
•
Electrical Permit Application, et ^ �", -, 11.,,,E ()Fri' L. , �,:
City of Tigard
l'
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D d ( Q / 09 'l' Permit No.: ii..eAe 09- e
13125 SW HaII Blvd., Tigard, OR 97223 ¶ N a n Re
vie
Phone: 503.639.4171 Fax: 503.598.1966UN Y L L Nan "
Other Permit:
• „ c 1 . Inspection Line: 503.639.4175 Date Ready/By: iw in Sea Pare 2 for
biterrret www.tigard-or.gov ` ' N tiff / ►� �
1 1 ; \ �® o edlMMhod / r b Supplemental informed= tF! i -r l rt n4: +l.11r� if' � r t , t rdF � r ,
1 it lt$, r ti � Idlt - i) 3° 1 71s 1111 4,' ni, i , I r c II i
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.� 1>t'l..l,,�ll,; , ,. !, ili�l_I�,� . t :�f�:;. l�u�� �� ,�!���I,1:!:; � ,� :,;�.. � • �w�,:. , ' :• ,.,
Please check all that apply (submit b sets ofplms w /items chocked below
❑ New construction ® Addition /alterationfreplacement )
13 Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑Other:
where the available fault current ❑ Marinas and boatyards.
,
S I ,1 i '; ,
i i ( 1 11 , , �� 1 • . rc t,• "t+1.1 t::. • t i ic." "� IS i ",.`,:vs',JF exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
❑ 1 - and 2 - family dwelling ® Commercial/industrial leas to ground, or exceeds 14,000 C:1 Commercial -use agricultural
❑ Accessory building amps for all other insiatlations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installauonof7S KVA or
vS ^'.; . 5 t ' - u 'rid,{�°' cafiaur' i Etna after system. 1
1 ,` , t'llil ,� * s L ' : :-4, y � „'d de� r n(1 l rlh Yr 4 4 .- : li 0 s Y Ys larger separately derived system.
r "�.., ., „' �� I�' ����': ; E t :lF; � ❑ Ad dition of ne w moms load of
I ri ❑ "A" "E" "I -2" ••I -3"
Job no.: Job site address: it O ❑ Six 5 5.� o r 1 ?�-9 A S most. Recr y.
ix o or r woo rt residential wits. ❑ Recreational vehicle parka.
City /State /ZIP: ❑ Health - care facilities. ❑ Supply voltage for more then
A
El Hazardous locations. 600 volts nominal.
Suite/bldg. /apt_ no.: edit I Project name' 5 C UA C a / +, y ❑ Service or feeder 600 amps w morn.
-.V: —i';1 4",iWi',jlri Tf Th' i ii ' '.,.r .l �I! 41 �...� r It jf:r' :' a'.::
Cross street/directions to job site: • Description sea s 0 ' •
New residential single- or multi- family dwelling snit.
Includes attached garage.
Subdivision: I Lot no.: 1.000 sq. fi or less 145.15 4
Ea add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: _
il . Limited energy, residential
I,l? fTi Liw 0.f, 4 `,!14iiGl ' It°"I'"" i s'. t I P, �7i i 4 -I.r with above 0. 75.00 2
T0 1 n I w �, ,� ^ _� J Limited energy, multi - family
C 1 f 75.00 2
� � U aL04'}d � residential (wills above eq. k.)
Services or feeders installation,alteration, and/or reloeattoo
200 amps or less 80.30 ' 2
,, {; .A• i t ',, -. pp � , . ter:
q::) nr -, , ,.
.�:L `a d 1r Yiy1 °;1:: ' . �I ,{; i+ cam!! il I, li,: : , . J!I. , i :: 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 /Statc/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 t 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
I intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
o I pi?fr*nrr y , „e {I `1 � vgym A. Fee for branch circuits wide -
ULM ,i: q iL"v,�8, �• ,1 =1<s `P' 7.11 ` 1 lu 1 - I I E ;a�a",s,� a . .!3; t ll' „t above service or feeder fee, 6.65 2
each branch circuit
Business name: Johansen Electric Inc. H. Fee for branch circuits
Contact name: Cbarlynn Leifsen withou service or feeder fee, f 46.85 2
first branch circuit yL.
Address: 10948 SE Valley View Terrace Each add'I branch circuit _ q 6.65 ' 5 1 -S5 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Happy Valley, OR 97086 Each manufactured or modular t
90.90 - 2
dwelling, service and/or feeder •
Phone: (503) 698 - 3417 I Fax: : (503) 698 - 2486 Reconnect only 66.85 2
E -mail: Johansenekct( )msn.com Pump or irrigation circle 53.40 2
t; 3X'31' rl` ` -1 N )''I ot`- y;Lra "'T.,” . *: ili 1,:li t . , 1 ! 1., j lf),i.a it , -':` ; l'ir Sign 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/Z1P: Happy Valley, OR 97086 Each additional inspection over allowable in an of the above
Per inspection 62.50
Phone: (503) 6983417 Fax: (503) 69&2486 lnvesti tion
ga per hour (: hr min) 62.50
CCB Lic.: 51539 Electrical Lic.: 3 - 243C S rv, Lic.: 2053S Industrial .hint • rhour 73.75
Suprv. Electrician signature, required: �” "'' "�"�" °`' '
Subtotal: 06.10
Print name: Carl K. Johansen 1 Date : / 0 I+ log Plan review (25 %ofpem»t fee):
l State surcharge (12% of permit fee): / 2.. go
Authorized signature TOTAL PERMIT FEE: / 9
Print name: Charlynn J. Leifsen Date: This permit applieatbm expires Ha permit is not obtained within ISO
I r 1 loci days after it bas hem accepted as complete.
• Number of inspections allowed per perm[.
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