Permit ,, CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00090
TIGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/15/2011
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 380
Project: Spec Space Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project Description: 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
1 ea Services or Feeders - 200 02/15/2011 $100.70
Specifics: amps or less
15 crt Branch Circuits w /Purchase 02/15/2011 $111.30
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 02/15/2011 $25.44
Electrical
Type of Const:
Occupancy Grp:
Total $237.44
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 copy of the rules or direct questions to OUNC by calling 503 232.1987 or 1.800.332.2344.
Issued By: �/ �� - Permittee Signature: ✓ r .�G - �� •
//
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.
Electrical Permit Application FOR t)Fht( SE ONLY
City of Ti �` �.- O\\ Re
Tigard \ -L Date/B ': � �
U ..
Permit T o.
N. :• ■ 13125 SW Hall Blvd:, Tigard, OR 97?:23• Plan Review
•' Phone: 503:639.4171 Fax: 503.598.1960 C�� ` �� Date /B : Other Permit:
CC
1 i : .. R I.€ Inspection Line: 503.639.4175 ,..._''S w.• �( piste Ready/By: 0 See Page 2 for
Internet' www.tigard or.gov ^i O \ \1,/D' Notited/Methcd: Supplemental Information r.
�r C.L: r', �i.ftyi'€`� te} �I +, ;;t r -' ��r '�. K �1 - { t's �- ;,It:iii.:` 'it" - '3�rv..,c •e� 2:F., ?�':tr .' {' -rd t _1 ' s �: tkii� `�" .
r ,:�tus, i ili '
�ii'`�•.ti ;. 'iialp�l.r�`:�' ..,. ��.Q ;.: +1.t r�S6AfiY 'fkr ?iq,•' ::,. 'sit,iAa:'r . ,ndr �: l. u',.ear l.y:.. . .:a x
El New construction ® Addition/alteration/re
c i� plac t s- ement Please check all that apply (submit 2 sets of plans w /items checked below):
0 Service or feeder 400 amps or more 0 Building over three stones.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards:
:t €�iiM ;sr... sP'� Fa«�f44":: €ir.' + i ..r raq� - x, 3 �tA" - � f - - - �� r -- -
; I € '%i:,_ • r; ; i �7 t. "S ° �. - +i lt?r.`;`, € - .� „l s,
::.t..16. _ 14345 SI1�1114! €,. S '..:'i;tal.illgfl•- ::::._..;,.. exceeds 10,000 antes at 150 volts or ❑ Floating building
11�'z7is' € llailga:';:;: i[� m..,� .,.� ���;','S,, - ..: �,�.d t. - ._,
' less to tn
ground, or exceeds 14.000 ❑ Comercia!•use ag
Ei 1- and 2- family dwelling ® Commerciallindustrial ❑ Accessory building amps for all other installations. buildings
❑ Multi family ❑ Master builder ❑ Other ❑ Fire pump. ❑ Installation of 75 KVA or
, , tt •uSii• I - _ r - ;,� Emergency system. larger separately derived system.
V oilir':.y... €.iitlil8r6!q 5, ? ,ts i I ', t ! . 1 8 3 , H »,, ., (� r ,,,.:,, )v _," n7A1,n r - Z;tivi ❑ Additionofnewmotorloadof ❑• ", , E ,..• 1.2 , • . •1_3 ,.
Job no.: Job site address: lix or or e rre. occupancy.
I zoo 631. `� ��� ❑Six or more 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: e 6a2-..:-.3136 �e'e ❑Servrce feeder 600 amps or more.
`"'�"- d €i et lsx7Ei�CC�:'.:F3;:iiISiY- ,,.ila€tK, Irr
'6si;iii;� -:.;. -' _..h;.z:j:er�.r - -•, ,: F•, '! `! ? . 113T411 r �w «
Cross street/directions to job site: -%"7------ �_ Description I Qtr• rt rr. '1 Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft or less 168.54 4
Ea add'I 500 sq. ft or portion 33.92 l
Tax map /parcel no.:
,, .inn r , s•. 4" Limited energy, residential 75.00 2
�lil ...,+k• iti:.c .. ri� � ,� 41
fe!i .n., r'rilr..,+ 9 11,1{ •,4 -,. , ,...SIll, '�l� ..���� 't 1''t y :'i, q ty ' ' , i „'ttllallwt (with above sq. ft)
..:a ` y ,w13I�.r+- :i . ,- '.:`fit
! Limited energy, multi- family 75.00 2
5 a
Gt_ 11 e v f, - PiAdvur ?I � ) f residential (with above sq. ft.)
�l Services or feeders installation, alteration, and /or relocation
200 amps or less / 100.70 /46.7C 2
'1%; a . �.:� a,,. _ i 'n;; =.'ia1�Jt01,:, >t`''•Ef'Si' ',n..,k _•.�:.. d
l i a '1E P3,1 tt:' 1 _ ' � l< =r rl•'i":41:. t 201 amps to 400 amps 133.56 2
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
e p t a services or feeders installation, alteration, and /or
City /StatelZIP:
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps t 1 125.08 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 168.34 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
(ilk =; i1 n; ., :;l t ..� _ I t 1:t; : " fiu7? . y : ;i f
4 above service or fee fee, 7.42 f 2
ln X41:- , : tll'"j;_. �. s ��
#i ?::�;r..,,l.., .SfJ}ttil _? ;u:: °f ! ?ti:;stu'tM�s,- ; =:i:.;liiird.ii ,Sr.•,.t= ?,a�r':'�s.: /
" ?�• -•• �' ,••�. each branch circuit
Business name: Johansen Electric B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Charlynn Leifsen branch circuit
Each add' I branch circuit 7.42 2
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
/StateiZ IP: Each m serv tured,or modular
Ci
ry Happy Valley, ey , OR 9 7 0 6 6 67 84 2
dwelling, service and/or feeder
Phone: ( 503) 698-3417 Fax: :(503) 6 9 8 - 2 4 8 6 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: 67.84 2
yu,5.,:.;::; .."LrrµN.,:.. y .,. ...y.. saar a Sign or lighting
rout me
•sp=
r§'.`���;. �� °- , �'l:- ' +�ti.' .,,.g:r .'�.' ��llis e 7 1 '' _ `'y,li �:i "atl's:.rlf �,. ti.11��iw '';' Signal circuits) or limited energy
panel, alteration, or extension. Paget 2
IjusineSSttame: Johansen Electric 4
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.rLLP: Happy Valle OR 97086
Investigation (1 min) 66.25/ hr
ppy y . Industrial p lant (I 1 hr rain) 78.18/ hr
Phone: (503) 698-3417 Fax: (503) 698-2486 Inspections for which no fee is 90.00/ hr
specifically listedd�V, hr min 1
:�., ,,.:, s aa x t y er Vit; ry
CC$ Lic.: 5 Electrical Lic.: 3 !�� 2 , 4 , 3 � C Suprv. Lie.: 2053S _._....:'• " �'��>i�l�':� � < !.:�.t€t,sr, , ,.- . , ;.
Suprv. Electrician signature, required: �. �'G.�. L wtiq�Q / Subtotal:
Plan review (25% of permit fee):
Print name: Carl Johansen Date: 2/11/11 State surcharge (12% of permit fee): 2,g
I TOTAL PERMIT FEE: 2 3'7 „4S/
Authorized signature:0 i'1, i1 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Charlynn ' I V � Leif ss e Date: 2 /11 / 11 • N d um of inspections allowed per permit.
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