Permit 14 CITY OF TIGARD ELECTRICAL PERMIT
3111 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00089
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/15/2011
Parcel: 2S112DC00500
Jurisdiction: TIGARD
Site address: 15887 SW 72ND AVE
Project: Knouf Investments 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
6 crt Branch Circuits wo /Purchase 02/15/2011 $93.28
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/15/2011 $11.19
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $104.47
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 • ' ..: 2- 001 -0090. You may obtaira.a =_ =4 e rules o .7ect questions to OUNC by calling 503 232.1987 or 1.800.332
Issued _ Permittee Signature: �_ �i1.. �
ONO 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.
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Electrical Permit Applicatio L " For: 0H:1( I•: r St. 0 N1.1
City of Tigard DEB 011 Rece
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,� 13125 SW Hall Blvd , Tigard, OR 97223 p, S �® Plan Review t` �'�`/
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Phone: 503.639.4171 Fax: 503.598.19(30,1¶ Of OateB : Other Perroi : ` Z )1) 1 � its
T I i : ;t t: i r Inspection Line: 503.634.41 I �1 11 `pl p1V1�, pare Ready/Hy: la See page z for
Internet: www tigard- or.gov BUILD IV Notified/ethod: IMII Supplemental Information
-^ov" rt F - � ,lu a5, ,.. , £ .'ts.cntlrtrrr r € - ;i�nii:�. ."' §.ri 11`�� i..1 n1 Lt' ":-.:'•.' ''',.','4,:_t'.7 *i -gSFi r 4l
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❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ID Building over three stories.
ID Demolition I=1 Other:
where the available fault current ❑ Marinas and boatyards.
1V41'` 1 -" 111 181' 1;lr. e, :1 76`7�� ;1'.;' 1 ,.. i ' '.'i- .' "., .�• - 011 46 r � 'll'ilrai(, exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
tii.sitilpUi -: ; , ,, t . ; . Ill i1 t ,. : . di ": -. :.. , ,,.. i . G� R , ?2 , 1 1 v..:1 ;. ,,.f't r?.I W,i:5 eii
less to ground, or exceeds 14.000 ❑ Commercial -u agricultural
❑ 1- and 2- family dwelling ® Commercial:industrial ❑ Accessory building an for all other installations. buildings.
El Multi- family El Master builder ❑ Other: Cl Fire pump. ❑ Installation of 75 KVA or
fonstot;g a - ae n e e e.. n r ❑ Emergency system. larger separately derived system.
.1 (ll . n r1.; „_ r tr ) : lam, 0 1 e k h'.. K aszt rltik l.rli?''
t�;�li:>� •, �.�, .. ...., � r�� tt . 'I u .. _ � S
Hi„ , ahk4 Addition of new motor load of
❑ ❑ •. ., , 2 » . 3 .
Job no.: Job site address: / , � e 3 a / S W / / 100HPor Reme ancy. occup
❑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.: Project name: let � /� e �L
mid' �r/�L C, llJ ,❑ Service or feeder 600 amps ormore. b �nlN', _z s I p "V 11~11 1Kui 51
Cross street/directions to job site: aril ii'1:=,; °t';4' 1 Mtdi #; 1 " 1 )j( ,h.,` old `
Y,,. i� ��. °tip,
J Description i Qtr. 1 Pees I Teti{ 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'l 500 sq. ft or portion 33.92 1
Tax map/parcel Limited energy, residential
l no.: e .:`,:, „,.,.:- ,: • .
p Li
ill ut:e`• : 61_at�lrrtf dr • tlnn ,.._- - i 75 2
•Bill; ' ,:_ :.. l.4,:l .::.�,,;.:t,.,.:_ ,. • . & aid , 1 ; 1' 43 ' "0.01) .r ri :.. ': f (with above sq. fl.) -
Limited energy, multi - family 75 00 2
Teri ? . 7 .- - 1 rn ( - 1T - Y eL r)e ,4- residential (with above sq. It)
�/ Services or feeders i`vtallation and /or relocation
200 snips or less 100.70 2
I n: . 411
k11 '' ;" e t+}y ' :. ` '3u rai a ttQit § 1 171 $ r ?. '! ''ati t,,� -i �? 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
City/State/ZIP: /StatelZlP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1 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, alteration, or extension, er panel
Owner signature: Date: A. Fee for branch circuits with
a in•u"°' v � 1 : : , i tit ,• • ; I Ft
s )la1 ' k& w. above serv or fee fee,
ee,
3 ° # =4 I ii`ti h -. ; .:Y.,',;;;..-.1441
' 1 : - ° 1 111� iji dt i l o l .!8E " i1 In , 7.42 2
r„os t Iln I l3 i r , i= a r +: • 11, each branch circuit
Business n Johansen Electric B Fee for branch circuits wrthore
service or feeder fee, first j 56 18 6,, �g 2
Contact name: Charlynn Lei f sen branch circuit /
Each add'l branch circuit 5 7.42 3T. /Q 2
Address: 10948 SE Val ley View Terr Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City /State/ZIP: Happy Val ley, OR 97086 dwelling, service and/or feeder
Phone: ( 50 3) 698 I Fax::(503) 6 9 8 - 2 4 8 6 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
Email
l ` til l'‘ I w 1 1 " : k` we ?( 1p1, a tou > :s +' ;' Sign or outline lighting 67.84 2
ta§=1 ) e # tsie={as,...: , le± , { 1 .,• R•t,t M.,' i .'.•'
.- - �.: x�i.e� v l..w_= ;iux,,�r• �;;',4 ° e Signal circuits) or limited energy
Business name: Johansen alteration, or extension. Page 2 2
Johansen Electric Each additional inspection over allowable in any of the above
Address: 10948 SE Valley View Terr Additional inspection (1 hr min) 66.25/
City /State/ZIP: Happy Valley, OR 9 7 0 8 6
Investigation ( (1 tram) 78.18/ hr
PPY Y r Industrial plant (1 hr m in) 78.18/ hr
phone: (503) 698-3417 Fax: ( 503) 698-2486 Inspections for which no fee is
si cificall listed /s hr min 90.00/ hr
CCB Lie.: 5153 9 I Electrical Lic�C Suprv, Lie.: 2 0 53 S t 1 t�.•, �i'll 1 ' t "`;tt a r e t a ;t) t � . i : ; x
-
Subtotal 93,x,
.,6
Suprv. Electrician signature, required: o
Plan review (25% of permit fee):
Print name: Carl Johansen Date: 2 / 11 /11 State surcharge (12% of permit fee): / 1, lt d
Authorized signature TOTAL PERMIT FEE: /6y y
1 This permit application expires if a permit is not obtained within 180
nn Lei f s en Date: 2 11 11 i days after it has allowed been accepted as complete.
Print name: Charlynn y / / • Numbr. of inspections allowed per permit.
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