Permit CITY OF TIGARD ELECTRICAL PERMIT
1111 COMMUNITY DEVELOPMENT Permit #: ELC2011 00190
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/12/2011
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. Phase II.
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
14 crt Branch Circuits wo /Purchase 04/12/2011 $152.64
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/12/2011 $18.32
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $170.96
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 -001 -0090. You may o. - _ .f , - • = or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
•
Issued By: _.- ��� /" Permittee Signature: ' - _ i -I -
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
RECEIVED
Electrical Permit Applicatio , >i: t l� rlt l `I OM R 1 2 2011 Received ,
City of Tigard Date/13 : `���� t• e
13125 SW Hall Blvd., Tigard, OR I F T IGARD Plan Review
B Phone: 503.639.4171 Fax 503. • t Dnte/B : Other Permit:
;. ; I , Inspection Line: 503.639.4175 BUIL I G DIVISION Dale Ready /By: H See Page 2 for
Internet: www.tigard or.gov Notified/Method: � ) Supplemental Information
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Please check all that apply (submit j sets of plans w /items checked below):
El New construction ® Additio n/ahteration/replacement
CI Demolition CI Service or feeder 400 amps or more ❑ Building over three stories.
❑ O ther. where the available fault current ❑ Merina9 and boatyards.
ItA? t'la?I'01 )1i #-1 >!4i . i.. y l.,;, y ..,s1.CN .lA,:.. � �'r'[II FJ i.$ kr " Na+i . 4 0 v..:
, exceeds 10,000 amps at 150 volts or El floating bu ildings.
iireiti c tr _ - - • ' less to ground, or exceeds 14,000 ❑ Commercial-um agricultural
❑ 1- 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
rR r i a F r. . , a � y { T • , ❑ Emergency system. larger separately derived system.
. •v*�ti3,Ili 44 10IYllt1111t+f + S ► . e$ -, t� Jt fi tiAt , ttitttit4IIntt r s r 4 ❑ Addition of new motor load of 1:1 "E ", "1•£', "1 -3 ',
Job no.: Job site address: 15705 SW 7 2nd 1001 or more. upa*+n -
❑ Six or more residential orals. ❑ occ Recreational vehicle parks.
City /State /ZIP: ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite/bldgJapt no.: I Project name: Bridgeport CI m
Service or feeder 600 amps or ore
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Cross street/directions to job site: Description
t Ott. I Rae. I 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'1500 sq. ft. or portion 33.92 1
Tax map/parcel parcel n0 Limited energy, residential
ca. 4 i y� a 75.00 2
��I � 1 k s ! : �,,,�I , at n + �`�� a�t r 4� s+l•O, ;' (with above ft. )
Limited energy, multi- family 75.00 2
Finish of TI for PacTrust residential (with above _
Services or feeders installation, alteration, and /or relocation
�. 200 amps or less 100 2
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,u•• t tn1';'r t7nR.y'tt Tt :�. �:.
,a,. , • -',., r �,'�. 1 +, �Ii�s�i. }�?!?$dx ��`�r't�� ? ' '"° ", �z`y�� 201 amps ro 440 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: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 I 1
" 201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps I 168 54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
a.w E saes. above service or feeder fee,
Toni-P..41.1 t i u . s:m . i + t A• , ' l'r € ' l Ri ta41 f ; t; '�' � t k : 1s r 'ry ` each branch circuit 742 2
Business mine: Johansen Electric B. Fee for branch circuits without
service or feeder fee, first
Contact name: Charlynn Leifsen branch circuit 1 5618 56.18 2
s Each arid': branch circuit 1_3
Address: 7.42 96.16 2
10948 SE Valley View Terr Miscellaneous
Each manufactured or modular 67.84 2
City/State/ZIP: Happy Valley, OR 97086 dwelling, service and/or feeder
Phone: ( 5 0 3) 698-3417 I Fax::(503) 6 9 8 - 2 4 8 6 Reconnect only 67.84 2
E -mail: Pwnp or irrigation circle 67.84 2
1114.11 l 01444 7. 1 f iliIj� ms's ri , )iii r' ±'. p i 1's-sk�i N' Sign l ircu ir►e lighting 67.84 2
Si circtnt(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 (1hr min)
6625/hr
City/State/ZIP: Ha Vai l e OR 9 7 0 86 Investigation (1 hr min) 66.25/ hr
Happy Y Industrial plant (t hr rain) 78.18/ hr
Phone: (5 0 3) 698-3417 I Fax: (5 0 3) 698-2486 Inspections for which no fee is 90.00/ hr
specifically listed (r/= hr min)
CCB Lic.: 51539 I Electrical Lie.: 3 -243C I Suprv, Lie.: 2053 S AK. ,1: +I >r» Bh(t it3` 1`lgims i�r iii
Su P signature, rv. Electrician si ature required: �/' - Subtotal: 15 2.64
9 uired: /� ur
4...." Plan review (25% of permit fee):
-Print name: Carl Johansen Date: 4/11/11 State scharge(12 %of permit fee): 18.32
Authorized signature: 0A ,. ��" TOTAL PERMIT FEE: 1 d 0 , 9 6
T his permit application expires If a permit is sot obtained within 180
Print name: Charlynn Le i f s en Date: 4/11/11 days after it has been accepted as complete.
0 Number of inspections allowed per permit.
l: tEuildindFrmtits &ELC- PermitApp.doe 07/01/10 440.4615T0 I/0t/COM/WEB
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