Permit CITY OF TIGARD ELECTRICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00018
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/06/2011
Parcel: 2S113AB00101
Jurisdiction: TIGARD
Site address: 16101 SW 72ND AVE 130
Project: Siemens Subdivision: PACTRUST BUSINESS CENTER Lot: 0
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
8 crt Branch Circuits wo /Purchase 01/06/2011 $108.12
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/06/2011 $12.97
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $121.09
Required Items and Reports (Conditions)
This permit is issued sub'ect 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 acc• •ance with a• • •ved 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. ATTE ON: Oregon law r- •. - -s ou to follow the rules adopted by the Oregon Utility Not ' := enter. Those rules are set forth in OAR
952 - 001 -001 i throu a OAR 952 -001 -• s • I. You btain a copy of the rules or direct questions to O • - • • - - • 1987 or 1.800.332.234..
Issued B Permittee . •cure: / /_'
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: /ff/
LICENSE NO. C/J 3 S
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 Application \ Nr,7 ‚• ole. ( )Fri ( 1•: I tit. O.I.,
City of Tigard
Ci ./ ° Received r Q0
I S --- • f Pemait No.: ,
�� O Date/B .
13125 SW Hall Blvd., Tigard OR 97223 / 11 �„ ,
Phone: 503.639.4171 Fax: 503.598.1 O" ''e' '.. other Permit: L 1 # / j i - ?
Inspection Line: 503.639.4775 � \ \ = ,,
Internet: www.tigard- or.gov )� ` v.r ,
•• 1 �,. IL I 1 11 q�n�n1111�W,enr4 nl ��elntgllr nAW Hit u � V. _ . `� mW � ftrF r ... T „ IC' 11 Gall`p
4[•' _ , 1,E2 1 I fi Ifl it i soif t n Ll' 1 .iuil�l0 1 l a a.'1I �l�U l ; 'b: nZira.�t+,'k •, i ' z:.;.
❑ New construction ® Additionlalteration/rep t � Please duck all that apply (submit 2, sets of plans w /itaas checked below):
❑ Demo llti On ❑Other ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault contra ❑ Marinas and boatyards.
t I' 111 ! i' r t c" f rc w �^ia "tw ° �'� • # 17 :�; exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
-. e - 1 - 3.1: inio area,* initst. aLle r - - s 1 � f l li iii . ..�i 1fY1� :: lass t0 grottod. or exceeds 14.000 ❑ Cammacial•uae agricultural
❑ I- 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
+ �n, s , tz+ s. , =s a�¢ ,�.ua s eta; 7e1 r(,.t 'i 0,1 ...4:"11,0 : i , r •„ • ,, -, , ❑ Emergency system. linger separately derived system.
a 'rr., -t,. la . r a t t ' �3 u.t r t -ai .• - t - al, Vd ii, l li - i:_ 0 Addition of new motor load of ❑•'A" . 'E . "1.2" •'l_3
I
Job no.: Job site address: 16101 SW 72nd, 13 0 or more t ee oeaupenry.
a or residential units. ❑ Recreational vehicle parks.
City/State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: Siemens Real Estate ❑ Service or feeds 600 amps or more
Cross street/directions to job site: 1.1 . Ulll '{��( "l'( '•'►'e+ I � i~ a ER t ; , bi� 174111 `
Ow. Fes
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'I 500 sq. ft. or portion 33.92 1
}yy Limited energy, residential 75.00 2
F; �� . { ,s 1 " �lf � i 41 (with above sq. R)
•
x� • . , .,t was: rV I >a•;` - " Limited energy, multi - family
Tenant Improvement
residential (with above sq. R) 75.00 2
Services or feeders isstafation, alteration, and/or relocation
200 amps or less 100.70 2
tl '3rW^s.OU : I Y n1 iii ie�`'d'. „ '.� {' ^,
, r G l l1:t Jt m s.'e as as a �x'}al Ti, . ^ li 311.01 I 4 � u:�:e:,k „ 201 amps to 400 amps 133.56 2
sas:,
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/S[aterZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less t 5 I 1
Owner installation: This installation is being made on property that 1 own which is not tot amps m 400 maps 12 59
2
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 ex tension, per panel
Owner signature: Date: A. Fee for branch circuits with
lgdtrr tf't!u >Aralst!lltjc a frss, tvad , , above service or feeder fee
a tt:i!,' " +: J I each branch circuit 7.42 2
Business name: Johansen Electric B. Fee for branch circuits without • /
service or feeder fee, First 56.18 �i(Q • / 2
Contact name: Charlynn Leifsen brmtchcircuit
Each add'l branch circuit 7 7.42 67.7 2
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not Included)
Each City/State /Z IP: Happy Valley, OR 97086 dwelmanufacturedormodular 67.84 2
PPY y r dwelling, service and/or feeder
Phone: (5 0 3) 6 98 - 3 417 I Fax:: (5 0 3) 698- 2 4 8 6 Reconnect only 67.84 2
E - mail Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
�t�✓� �gpg y � �e.r., fb I "� 4.i
�ritR1 +1�E;x' , �;.,�,St mql?,,, _..;u. it s.i�r+ir� = i �(,: 1r) Signal circuit ( s)ealimited-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/StaterZIP• Happy Val 1 ey , OR 97086 Investigation t hr min) 66.25/ hr
]Industrial Plant (1 hr min) 78.1181 hr
Phone: (503) 698-3417 I Fax: (5 0 3) 698-2486 Inspections for which no fee is 90.001 hr
cificall listed ' /ahrmin
CCB Lie.: 51539 Electrical Lic.: 3 -243C I Suprv. Lie.: 2 0 5 3 S , r ,, , EEFF9 i T"" rra. t r . . # • ` II
` Subtad: 6 •
Suprv. Electrician signature, required: n Plan review (25% of permit fee):
-Pint name: Carl J ns en Dat 1/05/11 State surcharge (12% of permit fee): 12• 7
Authorized signature: TOTAL PERMIT FEE: J f , O ( 9
This permit application expires if a permit is not ob L jned within 780
nn Leif sen l Date: 1/05/11 drape after it has hem accepted as complete,
Print name: Charlynn y • Nt�btsafinspeaionea0owedpapermit.
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