Permit q CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00711
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 180
Project: Versalogic 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
20 crt Branch Circuits wo /Purchase 12/23/2010 $197.16
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/23/2010 $23.66
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $220.82
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 , • • •f the ules • direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ._! Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property 1 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.
Electrical Permit A plicat
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City of Tigard Received »az�B : IO Permit x°.: 7Z-1_0,d �
• 13125 SW Hall Blvd., Tigard, OR 9721EC 2 2 2010
Plan Review
Phone: 503.639.4171 Fax 503.598.1960 Dat ; , Other Permit:
1(; , ,, 1. ., Inspection Line: 503.639.4175 CITY `te (4 1 Date ReaReady/By: til See Page 2 for
Internet: www.tigard or.gov null r � Notified /Method: E Supplemental Information
n ittigts�'di Il 7 n ! �I(l. rr" H> 1 . } �( i t t ° �(: . (�i�`, u� T ,w !f
h7 i 11 ��Yix����l� ,v�ll��I����+...i ° t +(�. ...,.,.. 4rc ' � .. .,>~': ��; R� * ? a�.!li.�'P.' iu 1 � 1 � �i -y " �� .9�1�' I k t,�,,.�.� �Il� a iif.
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 1 sets of plans w /items shocked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Oa r;
nr, l3ru ., .ti 1 ; s ?fin. u r n�? t 1l 'r 4i �' where the available fault current CI Marinas and boatyards.
i al
!i i I 6 a�, i ',' r1 ?i4_ t ' c a'w V ll� ;al II ( {.N' .. n exceeds 10,000 amps at LSO volts or Floating buildings.
S „�ii utt. • . + . I i, f' ['Floating Iess 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 ❑ Master builder ❑ Other: ❑ Fns pump. ❑ installation of 7S KVA or • • r e t r : v- fr , l ❑ Emergency tem. 1
1i t :' a il: t 1 ! '1::' -," t : 1 ii w 'c; 1 - 1 .4 ,11 B YsYa ergerseparaoclyderivedsystem.
1_I , tlw ma j iki,, . r n.t an - f • � _. ut :f ii, . I: i 7j t;. ❑ Ad o new motor load of
Job no.: Job site address: ❑ A "0 "1 -2 ", „ 1_3
l� SlV . JY /V Six or of more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parka.
City/State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
h ❑ Hasardoua locattmis 600 volts nominal. Suite/bldg./apt. no.: 1 , J V I Project name: V 4 , g c ❑ Service or feeder 600 amps or more.
4:. i, } a' trlf?!1., r
;1 E . V.. t FIn. �I 1 t5l8!;a ``e
Cross street/directions to job site: nsuripasit Fes I Total
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. add'l 500 sq, ft. or portion 33.92 1
Tax map /parcel no.: .
a+N „tr �R rqr 1 t .N Limited energy, residential
u' lilllr ..' 1: lil liti t 'rd e�d.b MI i:Ca 1 .. h.w #61(`100, , ��,�. ;,<� ; I ' , 3 t;..l, (ith above sq. R.) 75.00 2
► Limited energy, multi- family 7500 2
. 1176 PM* residential (with above sq. R.)
Services or feeders irntallatioa and /or relocation
• 200 amps or less 100.70 2
.: (t t ltrta;� ybnuu ,:r r t t I ..
4l =•• -7'( f Irekr. ;tt:11,i G liii ;a � , ! ,: f ;:"4 l I♦• i;” ., iwuui 1; ``t"A 201 amps to 400 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
CitylState'ZIP Temporary services or feeders Installation, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 1 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 snipe to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. For for branch circuits with
r.. ,. 10 I r i w irzi to 71 " t i e (s ,,...f !pal u r r t ; _' 4 above service or feeder fee,
t t .,1kP+naivau x..: x`tr+:�a�sMt� , •, • rile :i.S< t Plsf 7.42 2
eac b ranc h c
Business name: Johansen Electric B. Pee for branch circuits without
service or feeder fee, first i 66, //
Contactneme: Charlynn Leifsen branch circuit / 56.18 e /t� 2
Each add'I branch circuit lei 7.42 I 2 1110. ii
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
Valley, OR 97086 dwelling, service andlor feeder Each manufactured or modular
City /StateaZlP: Happy 67 84 2
PPY Y
Phone: (503)698-3417 I Fax:: (5 0 3) 698-2486 Reconnect only 67.84 2
E -mail Pump or irrigation circle 67.84 2
r ,r; Si or outline lighting 67.84 2
- i ' 't'y- <1 - il- l ,' Signal oircuit(s) or limited energy
Business name: Johansen Electric panel, alteration, or extension. Paget 2
Each additional inspection over allowable in any of the abov
Address: 10948 SE Valley View Terr Additional inspection (lltrpan) , 66.25/hr
City/State /ZIP: Happy Valley, OR 97086 Invati gaff on (I hr ruin) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (5 0 3) 698-3417 I Fax: ( 5 0 3) 698-2486 Inectis or which no e hr
CCB Lic.: 51539 Electrical Lis • i sp tftcall on f ]t sled 71 hr mife is 90.00 / n
I :3 -243C Suprv. Lic.: 20535 w ail' 't' =,. :.pit ':l ?7�t "��'� "�. , :.,
Suprv. Electrician signature, required: t . Subtotal: 4 V. " et 1, �Si
Plan review (25% of permit fee):
Print name: Carl Jo ansen tom: 12 / 22 / 10 State surcharge (12%ofpermit fee): I1./, `j$ ; .6,6,
TOTAL PERMIT FEE: ..22q./8 viho. tra
Authorized signature: This permit application expires if • permit is not obtained within 180
days after It has been accepted as complete.
Print name: Charlynn Leifsen I Data: 12 / 22/10 • Number of inspections allowed per permit.
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