Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: C
1 111 4 ...
° COMMUNITY DEVELOPMENT DATE ISSUED: 6/1 0/2008 EL 2008 0 325
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S113AD-01800
SITE ADDRESS: 16650 SW 72ND AVE B12 ZONING: I -L
SUBDIVISION: OREGON BUSINESS PARK 1 LOT : 011 JURISDICTION: TIG
PROJECT: JOHNSTONE
Project Description: Emergency meter replacement.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
PACIFIC REALTY ASSOCIATES JOHANSEN ELECTRIC INC
15350 SW SEQUOIA PKWY #300 -WMI 10948 SE VALLEY VIEW TERR
PORTLAND, OR 97224 HAPPY VALLEY, OR 97086
Phone: Contact #: PRI 503 - 698 -3417
FAX 503 - 698 -2486
FEES
Description Date Amount Reg #: ELE 3 -243C
[ELPRMT] ELC Permit 6/10/2008 $80.30 LIC 51539
[TAX] 12% State Surchar 6/10/2008 $9.64 SUP 2053S
Total $89.94 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By • / /�_, /, _ - Permittee Signature: �P / jam r�_!
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNERS SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: 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.
/°'
r
• RECEIVED
Electrical Permit Application JUN 0 9 2008 1 0R1)1..1.1(•1. I',I. iI\ I 1
City of Tigard Received
1 . 13125 SW Hall Blvd., Tigard, OR 97229reny OFTIGARD F Review �
' k Phone: 503.639.4171 Fax: 503.598.1960'" 1 DtdB . Other Permit
1 - Inspection Line: 503.639.4175 BUILDING DIVISIO Date Ready/By:
"iy Internet www.tigard- or.gov ,�{,�e�' ,�i�� s�tll•Id1 Notified/Method: J p � � r! , �,' ., j,
11lL I , ,'- 1•fal� j ��� ey Ilb�ll� I ,1hek;: t: „11 , t
'', ' itH'1 ` .. IM IL { Er .k i�rAJfiYftl ii %i . #. , •
El New construction ® Addition/alteration/replacement Please check all that apply (submit 1 gets of plane w/isems checked below)
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault curry i ❑ Maur and boatyards.
WIWI IAtYe71ry'l+e:l1 S!t 4oaa, X T Ei
d " , i' ,�� , ' t ` �0 M . ti iy1;
i t+ !', " :' r '' f@ GS+ ei+$ Ilfs:lutlGe miu a iiee x .l }.k �. �i: '`: , y"1! 1�; 1: �1.. exceeds 10,000 less to ground. or 14,000 sat 150 volts or Flo bail El CominarciaF a s.
agricultural
❑ 1 -and 2- family dwelling ® Commercial/industrial ❑ Accessory building
amps for all other installations. buildings.
❑ Multi- farnil ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
7 tt1 a+ 1 l I {1 fr;,-y .iPa uyyls 1§4nesisl ;vt o4•cu( m-. , i1.:p . , c:. , ❑ Emergency hem. larger separately derived system.
IA `. :1 i , Jail arar ,LL `•I l zt/ '� IeYitt R; ?
Y :' , � �k t . • 1. . i .1.,,- y
..r'n - ]ri:,�� 3 ■tOsuwe m�ueatsi '''11 � r rirt : 1 I. ❑ Add i t i on anew motor load of
Job no.: Job site address: 166 5 0 SW 72nd 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parka.
City/State/ZIP: El Health - care facilities. ❑ Supply voltage for mare than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 1 I Project name: Johnstone ❑ Service or feeder 600 amps orroom
Cross street/directions to job site: , ��'�� �`' A' � i- o+ , - ""� up T ota l •
New residential single- or multi-family dwelling unit
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. R. or less 145.15 4
Tax map /parcel no.:
Ea. add'l 500 sq. ft or ponion 33.40 1
Limited energy, residential
e l ue waL. yy. yr�r p q 4 '* with above fl. 75 2
l `. t. �t 1 11aii �' 011 "r �► " . ! (W, •''•,i r d- . :;, .,. ( sq. ) •
Limited energy, multi - family
75.00 2
Emergency meter replacement residential (with above sq. ft) _
Services or feeders installation alteration, and/or relocation
auardv,u urw 200 crops or Tess 1 80.30 80.3 2 EN ` Illr }: :`� 1�.t+t ?tip M I r�e 11 _ amps 00 ps 06.85 2 •
tu}ef4i w;n., - 1 20] to 4 am 1
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 1 1 .
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 75 22
exchange, according intended for sale, lease, rent, or exc di and 701. 401 amps to 599 amps 133. � to ORS 447, 449, 670 ,
Owner signature Date: Branch circuits - new, alteration, or extension. der panel
r l r< g rr , re- A. Fee for branch circuits with
I I l ; f ; i ,�l;u � y a 1 4 ar;: - to above service or feeder fee, 6.65 2
each branch circuit
Business name: Johansen Electric Inc. B. Fee for branch circuits
without service or feeder fee,
Contact name: Charlynn Leifseo first branch circuit 46.85 2
Address: 10948 SE Valley View Terrace Each add'I branch circuit 6.65 2
Miscellaneous ( service or feeder not included)
City /State/ZIP: Happy Valley, OR 97086 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (503) 698 - 3417 Fax: : (503) 698 - 2486 Reconnect only . 66.85 2
E - mail: johanseneket@msn.com / Pump or irrigation circle 53.40 2
- °�s�r -�. a ..
��ILERIN '. •�h ,.a>�.-1 .L:d.."E 7311 j tZE ' Lt . 14 , p '' , Sign or outline lighting 53.40 2
Business name: Johansen Electric Inc. Signal circuits) 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,of the above
Per inspection 62.50
Phone: (503)698 -3417 Fax: (503) 698 -2486 Investigation per hour (1 hr min) 62.50
CCB Lic.: 51539 Electrical Lic.: 3 -243C I Suprv. Lic.: 2053S Industrial P'°° r 73.75
Suprv. Electrician signature, required: �� Q L/ : a , t
'v !` Subtotal:
Print name: Carl K. Johansen Date: 6/9/08 Plan review (25% of permit fee):
State surcharge (12% of permit fix): 9.64
Authorized signature: 0 k
TOTAL PERMIT FEE: 89.94
Print name: Charlynn J. Leifsen I Date: 6/9/08 This permit application expires ifs permit is cos obtained within 180
days after It has been accepted ere complete.
• Number of inspections allowed per permit
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UOL ®ING D 'IVBSO ®N PERMIT #EtIC,Z O
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 `.. r� n��Npui q �(
Inspection Requests (24 Hrs.): (503) 639 -4175 : €.- ` 'I ?\
k! .1,
INSPECTION WORKSHEET FOR DATE: 1. 10 • 01 TIME: PAGE:
SITE ADDRESS: 16 6.5 S 1■ ') Z efoi. so CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 6 . %Q . 0r% Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments /Instructions:
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G 0e)L Date: 6. ' Phone #: (503) 718 - 2 - 710