Permit • r � CITY OF TIGARD ELECTRICAL PERMIT
i
•�- . 6 COMMUNITY DEVELOPMENT Permit #: ELC2010 00671
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/03/2010
'TIGARD Parcel: 2S112DC00500
Jurisdiction: TIGARD
Site address: 15895 SW 72ND AVE 250
Project: Diagnostic Male Medical Subdivision: OREGON BUSINESS PARK III Lot: 40
Project Description: Electrical for TI.
Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES
10948 SE VALLEY VIEW TERR 15350 SW SEQUOIA PKWY #300
HAPPY VALLEY, OR 97086 PORTLAND, OR 97224
PHONE: 503 - 698 -3417
PHONE: 503 - 624 -6300
FAX: 503 - 698 -2486
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 12/03/2010 $78.44
Specifics:, Service or Feeder
1 ea 12% State Surcharge - 12/03/2010 $9.41
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work wit
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR • - 001 -0090. You may obtai• , • • • e,.s- direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. r
Issued By: .c../— ` ��-^ r Permittee Signature: . G.t �__ /. - _
O W —A C---
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Dec 03 2010 12:34PM HP LASERJET FAX p,l
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Electrical P r Tigard Application �� % 1 � Oli(o1 I. 1 FIt . tit u.NI.1
eceived .. ,
_ `J v , � _ Da . i d i _ �
13125 SW Hall Blvd., Tigard, OR `'r ' 3 ` -% � Plan Review
Phone. 503.639.4171 Fax: 503 598,196 c In B : Other Permit: i f / IQ - F i.
Inspection Line: 503.639.4175 O �G� Date
/B
Dato Ready/By: See Pagel for
'
Internet www.tigard ,G. . \ ). Notified}Method: M Supplemental Information
��qq } . a F'+M' IWII 4u* T 9F. mo o- � : L t I '1�; S$�sF t -d g��z aSEna t ,
€ a't` k l �z a$ - .i y .+t�;ellla." . _; k 6 ..i. i.� w. $"m. . ,l' !.s,,:.P a £ .i +4 t s, e '" `t dIP. . } 'tiiW �'' .:; t �k":E
El New construction ®Addition alter ..
7" ? , . ement Please check all that apply (submit 2. acts of plans w /items checked below):
❑ Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
P. ll ` Iw 11'i' l €ixtl � 11 i• FIT"g2 t a ) d t ®tAt t exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
d1i3ttilw a y s.t. Olde a er t hsa € MOD Ili F i IA oil 1109 , it G less to ground, or exceeds 14,000 ❑ Commercial - use agricultural
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building Amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other ❑ Fire pump. ❑ Installation of 75 KVA or
9 tt p k p r 1 11 a i ? I 11 ' . ; Ittlsaa At2 .. FFI.;g. Misr ,, 1 "g' t i l ti t j { {. ❑ Emer system. larger separately derived system.
,._.,3. ,' . ,."4:::' a: 9 t` a rrai , 41114 ill: } i ;III. U 1 �M I , 11I
'i! ❑ Add of new motor load of ❑ A 8 l -2 I -3"
Job no.: Job site address: 15895 SW 72 rid 2 5 0 ❑ 100HP or more, c a io
r Six or more residential runts. ❑ R R ecrereational vehicle parks.
City /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt no.: 250 1 Project name: Diagnostic Med i c a 1 ❑ Service or feeder 600 amps or mare
t i~ 4 'tv7 ps sal 1 7 '1'. €
Cross street/directions to job site: oesoipea'n per Fee. Tama •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft or less 168.54 4
Tax map /parcel no.: Ea. add'! 500 sq. ft. or portion 33.92 1
Limited energy, residential
'ii .* r , € a - 75.00 2
l t - 5 ,_ ° `- - 4t' �e,0 4 1 a �i l0,ill I di P ljl 14p1t] VII (with above SQ. ft,}
;ll :. s .. 4 Li energy, multi - family
- i mio it - "� Ve residential (with above sq. fl.) 75.00 2
L. .P CILI Y Services or feeders installation, alteration, Radio r relocation
200 amps or less 100.70 2
1 7 111 �, *v d 1 e r�s I € ' iii 7a.� N hr3 ip€F I'" a 201 amps to 400 amps 133.56 2
�r1th it,E "t:± -e � • - �... ,... 'tt'� -I r I ,. � +�4 t�.ttPterx =� <mF w_ t� � ,__
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, alteratio, or extension, pe panel
Owner signature: n Date: A. Fee for branch circuits with
�o it 3illa ;mot m ! ri} Py` rri �
r ; I a }s ra i tour 3;'' ! r 4 ,if T t 'r51 t above service or feeder fee, 7.42 2
each branch circuit
Business name: Johansen Electric B. Fee for branch circuits without
service or feeder fee, first 1 58.18 6.18 2
Contact name: Cha rlynn Le i f s en branch circuit
Each add'1 branch circuit 3 7.42 2.26 2
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
City /State /ZIP: Happy Valley, OR 9 7 0 8 6 Each manufactured se rvi ce ai l r feeler 67 84 2
ppy y r dwelling, service andlor feeder
Phone: (5 0 3) 698 f Fax::(503) 6 9 8 - 2 4 8 6 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail : z Sign or outline lighting 67.84 2
dC'It1 dP} ! -1 I r a '* ; X 1 .),:;, I $ y i S1: €f 1 1 _... 4 € €- �l
�}1 }l }11�tiYI�Yi €� � .. 3. _, � �a�n '€ - +at.trart�ttll�!'V!4�P1 #:4!? Signal circuit(s }or limited-energy
Business name: Johansen Electric
panel, alteration, or extension. Paget 2
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 Val 1 e OR 9 7 0 8 6
Investigation i plans hr min) 78. Iu hr
PPY Y r Industrial plant (1 hr min) 78. IS/ lu
Phone: (5 0 3) 698-3417 Fax: (5 0 3) 698-2486 Inspections for which no fee is 90 00/ hr
s •ecifitmll • listed A hr min
CCB Lic.: 51539 Electrical Lic,: 3-243C 1 Suprv. Lie.: 2 0 5 3 S f ' ao, ' l m �'°c 1 "ti` a ': ;,;
Subtotal: 78.44
Suprv. Electrician signature, required: C -: ,�04)Z � ( �/
Plan review (25% a
/fJ of perrni{ fee):
Print name: Carl Johansen Date 12 /3 /10 State surcharge (12% of permit fee): 9.41
TOTAL PERMIT FEE 37.85
Authorized signature:
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Janet Johansen Date: 12 /3 /10 r Number of inspections allowed per penit.
1:1 Building \Pemvts'ELC- PemtitApp,dse mow 0 440- 61 5T111105/COM/WEB