Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00115
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/01/2011
Parcel: 2S112DC00100
Jurisdiction: Tigard
Site address: 15705 SW 72ND AVE
Project: Bridgeport Distributing Subdivision: OREGON BUSINESS PARK III Lot: 2
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
20 crt Branch Circuits wo /Purchase 03/01/2011 $197.16
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/01/2011 $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 0 • r : - 001 -0090. You may obtain a co• •f the rule •uestions 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 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 I t 1 1 1 1 r l I I t I I ,F 11\ t 1
City of Tigard Received
Date/B : 72 Fermat No.: F , r_
13125 SW Hall Blvd., Tigard, OR 97223 Plan m r
Si
Phone: 503.639.4171 Fax: 503.598.1960 p ; other Permit Inspection Line: 503.639.4175 Date Ready/By: ® P E far
Internet www.tigard or.gov Notified /Method: Supplementallnformatioa
t �, , .. t , , i t I I $�: iAI 1 .1 1 1 i 1 m.. . a.c „,,: t i ^..., .: tiro- 4 t ' ; i II 'F "
ll t9 l WCI� � C 31 .,vldrl„r¢ Ff4 �tSV � : L'l
Please duck all that apply (submit a sets piece wtitem checked cheed bellow): El New construction ® Addition / alteration /replacement
❑ Demolition [3 Other: El Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
l 1 to r <aw 4 's :
atyar
�t; t . `.''i •: 1,. 1' tm� ay t .,: p . p, r � �,ti I9Y.s ; exceeds 10,000 am at 150 volts or ❑ Fl 14,000 ❑ Co mme ia i -u a.
qs ::r „ .r., a , i.. . u <: N ' e " less to ground, or exceeds xcmi as tabuse agricultural
❑ 1 - and 2- family dwelling IN Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - fancily ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
.4P mi ... ;hV 'o-u,ti Ftrra v I ;its rr • y,, r r t ❑ Emergency system. larger separately derived system.
4
J .. & f 1 1: i'� is 7s + �' '..
a 4 at t e t a ' , ❑Addition of now motor load of ❑ "A" E” "1 -2" "1 -3"
Job no.: Job site address:
157 SW 72nd six HPo<mre�, Recreational ❑ six or more residential/ orals. ❑ Racaeatiaoel vehicle parks.
City/State /ZIP: Cl Health - care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Bridgeport f lj ft , �j( 4 -t Cj ❑smnccarieeder6aoampsarmas
f r R s r t3 L
Cross street/directions to job site:
r. �
Description flag . s1 :2 " . .," . l �. :
tkpon Our. pee, Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: 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 no.: Limited ener residential
it i :` > p " ° " £'` ra tutj ' ! ,` e ' 1 l ly " I ith b
w aove S ft 75.00 2
'Anita. s r.. iiG1S`t:, .i,. a .. - -,i i �...0 t , 'Ili,,,• iili X18 ' lt ` t ,',.• . 1;11...', _. ( Q. ) • Limited energy, multi - family 75.00 2
Tenant Improvement residential (with above sq. ft) _
Services or feeders installed° alteration, sad/or relocation
200 amps or less 100.70 2
? -�" . r' =.. ° J a ' " N r� laic I r K ! , s �t` .i ' .s 1 . tm "r ,:l... o ■ 'ld +iL� '...'.r
i; ,r - '' ,, , 201 amps to 400 amps 13356 2
.
Name: 401 amps to 600 amps 20D.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1.000 amps or volts 552.26 2
City/ State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I F ax: ( ) 200 amps or less 59.36 I t
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. amps to 599 snips 168.54 2
Owner signature: Date:
Branch circuits — new, alteration, or extension, per wand
;TIPP tWftilai tM �w, , 'I' 1' VIZ t� 414i iii u r "`u s PTi , above service or feeder fee,
14 ,tlfGa ° l Gam,. �mWWY�4 Ju diiti =..W ..: #.
= T '( each branch circuit 7.42 2
Business name: Johansen Electric B. Fee for branch eircuuts wirhata
service or feeder fee, first 1 56.18 56.18 2
Contact name: Char 1 ynn Leifsen branch circuit
Each add'l branch circuit 19 7.42 140.9$2
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
C /Sffite/ZIP: Each manufactured or modular
City/State/ZIP: Happy Vall , OR 9 7 0 8 6 dwelling, service and/or feeder 67.84 2
i
Phone: (5 0 3) 698-3417 Fax:: (5 0 3) 698-2486 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
�� a , i , i , ; ,, 5 r Sign or outline lighting 67.84 2
,. 3 , 'dill // 1[86 1: rllt ' IF.i. .,'Y ,1 tr ,',1 x � ' ili Signal circuits) or limitedenergy
Business name: Johansen Electric panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the abov
Address: 10948 SE Valley View Terr Additional inspection (lhrmin) 66.25/hr
Investigation (1 hr min) 66.25/ hr
City /State/ZIP: Happy Valley, OR 97086 i
Industrial plant (1 hr train) 78.181 hr
Phone: (503) 698-3417 I Fax: ( 503) 698-2486 Inspections for which no fee is 90.00/ hr
s.ecrficall • listed /a hr min
CCBLic.: 51539 I Electrical Lic.: 3-243C 1 Suprv.Lic.: 2053S tu 1"'a`,;, ",.I
Suprv. Electrician signature, required: Subtotal: 197. 1
Plan review (25% of permit fee):
Print name: Carl Johansen Da 2/28/11 State surcharge (12 %of permit fee): _39......44---- )3.6
J TOTAL PERMIT FEE: 2 3 6 k,
Authorized signatttre�
T his permit application expires if a permit is not ohaainslifinthin 180
Print name: Cha r l ynn Leifsen r Date: 2/28/11 days after it bas been accepted as ampler,.
0 Number ofinspectiona allowed par permit.
I:\ Building \Permia 07 /01/10 440.4615T(i I/05/COM'WEB
1 • d XHd 13C?I3SH1 dH Wd80 :21 1 102 82 gad