Permit Y A / / j i ck cA,0( ear, c (
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00712
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/23/2010
Parcel: 2S112DA00800
Jurisdiction: Tigard
Site address: 15055 SW SEQUOIA PKWY 130
Project: PacStar Subdivision: Lot: 0
Project Description: Demo work. 4/15/11, Reprinted permit to include (1) feeder and (15) branch circuits. BT.
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
Description Date Amount
Specifics: Services or Feeders - 200 amps or less 12/23/2010 $100.70
Branch Circuits w /Purchase Service or 12/23/2010 $74.20
Type of Use: COM Feeder
Class of Work: ALT 12% State Surcharge - Electrical 12/23/2010 $20.99
Total Number of Systems: Services or Feeders - 200 amps or less 04/15/2011 $100.70
Branch Circuits w /Purchase Service or 04/15/2011 $111.30
Audio & Stereo: N Boiler Controls: N Feeder
CCTV: N Clock Systems: N 12% State Surcharge - Electrical 04/15/2011 $25.44
Data & Telecommunications: N Fire Alarm: N
HVAC: N Instrumentation: N
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $433.33
Other Desc: 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 -0090. You may obtain a co. of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
G ! � Issued Br _ .�- �L-s �� � � _ 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' 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.
y CITY OF TIGARD ELECTRICAL PERMIT
" 2 COMMUNITY DEVELOPMENT Permit #: ELC2010 00712
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/23/2010
Parcel: 2S112DA00800
Jurisdiction: Tigard
Site address: 15055 SW SEQUOIA PKWY 130
Project: PacStar Subdivision: Lot: 0
Project Description: Demo work.
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
1 ea Services or Feeders - 200 12/23/2010 $100.70
Specifics: amps or less
10 crt Branch Circuits w /Purchase 12/23/2010 $74.20
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 12/23/2010 $20.99
Electrical
Type of Const:
Occupancy Grp:
Total $195.89
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 0 952- 001 -0090. ou ma • • - '• - r •y direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. `
Issued By �.�_ �_ Permittee Signature:
AM 31e;g2s
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.
c Ir � ,
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Electrical Permit Application DE C 2 2 20 F!lI: Or l 1( I: I `I.: I /, I.'
City of Tigard Y ' r � Permit No.:� p — Y 0. — • a 13125 SW Hall Blvd., Tigard, OR 97223 C TY OF TiG
.11N Phone: 503.639.4171 Fax: 503.598.1960 I gg I q /� y� • f , . : Other Permit:
�-Ir_ t, t -, IrtspoctionLine: 503.639.4175 L�t��E�l1� DI Bate /B RI See Page 2for
7
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
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❑ New construction ® Addition/alteration /replacement Please check all that apply (subunit 3 sets of plans w /items chocked below):
❑ Demolition ❑ Service or feeder 400 amps or more ❑ Building aver three stories.
"�e 1 y� ❑ Other: where the available fault current ❑ Marinas and boatyards.
1{ 11.';; : �:i l Vir .
i :'�l`1! II01101 }J I s 11 ; ", ' , . 1i 1,
!: exceeds 10,000 amps at 150 volts or ❑ Flowing buildings.
it it , .; (� 1:,, 1 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.
❑ Multifamily ❑ Master builder ❑ Other: 0 Fire pump. ❑ Installation of75KVAar
i:11.:: - ^'" u 1 (' I ; 1 ,t,u o t . it ,_! tr ot o .,:; . ' ` fi" 11 + -i4 k {t r 4, , it ; i,4r 1:1 Emergency system. larger separately derived system.
y , tisiffi.1, 1 ). 11 r ii' • ii,ludus_ 111, , r a1L +u., Lur� la� surd - : r,3ad t.si6,„4,1. " . i s ! mus t ,'t t:.r, :; r :i ❑ Addition a f new motor load of ❑ A , E ", `1 -'. ", l -3
Job no.: Job site address: /_; ° �// .0 '• /'' / 100HP or more. R icre ancy,
�' ❑ Six or more residential twits- ❑ Recreational vehicle parka.
City /State,2IP: ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldgJapt. no.: l( I Project name: geztDe / , Z „ ❑ Service or feeder 600 amps or more. I' 1y81 tip 1
Cross street /directions to job site: a "' ` 1
.1 b i
` Dseriprtoo Oh: �� _ �� "• . �,r. T.tal I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. R or less 168.54 4
Ea. ndd'1 500 sq. fl. or portion 33.92 1
Tax map /parcel no
a nor t ,"� 1 - lj _.,III Limited energy, residential
' l t is+i^ i4 t4't4 I , i t 01 '
! ` ,. ' IIlliII1 ;a (with abovesq.ft.) 75.00 2
p 1 '„ ° I Li mited energy, multi- family
O wok residential (with above sq. fl.) _ 75.00 2
�r Services or feeders installation. alterat)on, and /or relocation
_ 3tz1s .,L,s .,.� 200 amps or less i 100.70 /jap, 7D 2
Y, ° ; 4 "tj' s t I I f
, Ill r, I F 9 I� I l �, t `t I � i ,��p��', 7 �.Pi' . � �`i . 1 ,_ 201 amps to 400 amps 133.56 2
..�J G,y !..m
Name:
401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
CitylStaterLlP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 tunes 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.64 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: k Fee for branch circuits with
e� ,•, „� !•• r I r �+ „ r� r i above service or feeder fee,
R I, 1 II gty'yi iI(rg i � iliflIi(� lit I l” 1, a`' 7:42 2
ttN(r�L �1nIlYi1S� - ll1f �. - 1 11 1 �1� x' • rye/
�� - � °I!!� -' each � / 7•
Business name: Johansen Electric B Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Charlynn Leifsen branch =cult
Each add'l branch circuit 7.42 2
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
/State21P: OR 9 7 0 8 6
Each manufactured or modular 67.84 2
C'
Happy Valley, ey , dwelling, service and/ce feeder
Phone: (5 0 3) 698-3417 I Fax :: (5 0 3) 698-2486 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
Si or outline lighting 67.84 2
� a ra' ;aeII r n : i y _, - a 1�t�yt� {• E it+ : .fir grit 8h 8
-.(._ ' , Y rig,: , . t. n tYW dl li ,,-�'! ,y,! ' lltl� lrl' i. .I lr I .; . .. ,.,,.
sr Signal circuit(s) or limited- energy
Business name: Johansen E lectric panel, alteration, or extension. Page 2 2
Each additional inspection over allowable In env of the abov
Address: 10948 SE Valley View Terr Additional inspection (1 hr min) 66.25/1u
City /State/ZIP: Happy Valley, OR 97086 Investigation (1 hr min) 66.251 hr
Industrial plant (1 lirmin) 78.18/ hr
Phone: (503) 698-3417 I Fax: (5 0 3) 698-2486 Inspections for which no fee is
s.' liken listed % hr min 90.001 hr
CCB Lic.. 51539 Electrical Lic. / 33 - 24 / � I Suprv. Lic. 2053 5 y
„ - _ ;.1 :1:ri;t1 ' � s i l.il;a "i°
1 . cyTr 7'i. r ,
Subtotal: .9,0
6uprv. Electrician signature, required: J Plan review (25°/a of permit fee):
Print name: Carl J ansen Date: 12 /22 / 10 Stage sttrnharge (12°Yo of permit fee): ,ZQ
TOTAL PERMIT FEE: /1
Authorized signature: Thla permit appliatdom expires if a pert is not obtained within 110
days after
tiros It has been perm red as complete.
Print name: Charlynn Leif s en Date: 12/22/10
• Number a f inapectionsallowed per pemrit.
1: 1BuildiaalPermrt elELC- PermitApp.doc 07/01!10 440.4615171 1 /0 5K:OM/WEB
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* ** *ADDS TO PERMIT ELC2010- 00712 * **
Electrical Permit Application I (MI II i I( I 1 "I• (r \ 1 1
City of Tigard _
13125 SW Hall Blvd., Tigard OR 97223 Plan Review r,
Phone: 503.639.4171 Fast 503.598.1960 Date /B Other Permit:
I , , F , , -, Inspection Line: 503.639.4175 Date Ready/13y: QI Set: Page2 for
Internet: www.tigard- or.gov Notified/Method: /gni Supplementallnfhrmallon
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fit, iFy: 'F . • , _ it � .A rY .<l7 �.11 f'II•O . " di, � ,
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El New construction ® Addition/alteration/replacement Please check all that apply (submit laces of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building ovw three stories.
CI Demolition CI Other
where the available fault current ❑ Marinas and boatyards.
��A� I I'a >��,'; '" ty' " " ' ° 4 " S yt.- - " k `tr sa 1 50 volts or Floating bull
•. 4 �n..e .rurtiiYt iir)iiil :N3i lkt ' ..'"a! , , F i lH l t�,� � : exceeds 10,000 . : ;,. ex ❑ 8 ��
El 1 -and 2-family dwelling less to ground, on exceeds 14,000 ❑ commoxcial•use agricultural
g ® Commercial /industrial ❑ Ac cessory bui lding amps for all other installations. buildings.
❑ Multi - family El Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
a ,, ;; aµ p� wu* , , i u t „ . .5,I P, Emerge system. larger separately derived system.
- 1 I i it t-!.. . 'VA Iar+�Ki i i it T . C': . ' :. 4 ? n il ,- ti n' �I ^ 1 ❑ ., A ,...E„ , . 1 . 2 .. , ..1.3 ",
Y, :•. .t., ..... s o •.a• , •x.? s. ❑ Add of new motor bad of
Job no.: lob site address: 15 0 5 5 SW Sequoia, 13 0 Six or or more. occupancy.
❑ Six or more residential wets. ❑ Recreational vehicle parks.
City /state /ZIP:
❑ Health -care facilities. ❑ Supply voltage for more then
❑ Hazardous locations. 600 volts nominal.
Suite/bldglapt. no.: 13 0 I Project name: Yecuris 0 Service or feeder 600 amps or more
1 /t m l •r Yoe f = "`l. ! ' -r17- 0 • 14C -0:
Cross street/directions to job site: D escriptio n Otv re. Total
New residential single or multi dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Limited add'l 500 sq. fl. or portion 33.92 1
Limited energy, residential
• t r r r y a A a•i ys v ,: n M 75.00 2
'� ._a. t r '. . . 1.t....,c:z` Ti •a, v v" , ..,.,r® ,, a i l 1. s` fi�.. 5? i . ;I ; s., l iH�'ii t ifi ,k' (with above sq. ft.)
Limited energy, multi - family
75.00 2
ADDS TO PERMIT ELC2 010 -00712, has tenant residential (with above sq. ft) ,
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 ' 100.70 - 100.70 2
! a t• r) Y a a 4 ,-;;, jullttp, x ,d ; ( I " t .11#01M4 201 amps to400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
_
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: relocation
services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 1 125.08 I 1 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 extension, per panel
Owner signature: Date: A. Fee for branch circuits with
r • t s r � "� tt above service or feeder fee,
e: mod: Itp4i _ ,11(1( , ., >^ "r ..m,a.r 7.42
; N. ` . ,a, - � 'C,.. ..'rws- each branch cirouit 15 111.3 )2
Business name B Fee for branch circuits without
J ohansen Electric service or feeder fee, first 56.16 2
Contact name: Charlynn Lei f s en branch circuit
Each addi branch circuit 7.42 2
Address: 10948 SE Val ley View Terr Miscellaneous (service or feeder not included)
Each manufactured or modular
. City /State/ZIP: Happy Valley, OR 97086 dwelling, service and/or feeder 67.84 2.
Phone: (503) 698 -3417 I Fax::(503) 698 -2486 Reconnect only 67.84 2
E -mail Pump or irrigation circle 67.84 2
( a J ti t , Sign or outline lighting 67.84 2
titirr ll t.. , . , . ;" I t r .art ,N.,ir aiasiara t`u il;l iF ttltdl Signal circuit(s) or limited - energy
Business name: Johansen Electric panel, alteration, o r extension. _ Page 2_ 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
Investigation (1 hr min) 66 25/ hr
City/State/ZIP: Happy Valley, OR 97086
Industrial plant (1 hr min) 78 18/ hr
Phone: (503) 698-3417 Fax: (5 0 3) 698-2486 Inspections for which no fee is 90.00/ hr
•ecifits<ll listed Va he lain
CCB Lie.: 5153 9 1 Electrical Lic.: 3 - 2 4 3 C I Suprv. Lic.: 20535 ' Ij P 'f i , +iii 'n 7 a , 07'..7' '""" < ; illi
Suprv. Electrician signature, required: e , 1 1/ Subtotal: 212
sC / ° e � tlG � Plan review (25%ofpermit fee):
Print mane: Carl Johansen Dale: 4 /15 / 11 State surcharge (12% of permit fee): 25 .4 4
Authorized signature: TOTAL PERMIT FEE: 237.44
Thi permit application expires if • permit is not obtained within 180
Print name: Char l ynn Leif s en I Date: 4/15/11 data after it ran been accepted as complete
' Number of inspections allowed per permit.
I: IBuildingi ?ermitsIELC- ParmtApp.doe 07/01/10 440 - 46157(11 /05/C014/WPB
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