Permit p CITY OF TIGARD ELECTRICAL PERMIT
111 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00191
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/13/2011
Parcel: 2S 113AC00103
Jurisdiction: Tigard
Site address: 7244 SW DURHAM Pk 600
Project: Tolt Subdivision: PACTRUST BUSINESS 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
15 crt Branch Circuits wo /Purchase 04/13/2011 $160.06
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/13/2011 $19.21
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $179.27
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 OA - 001 -0090. You may obtain a copy of the- ralesrn ct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B - — 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 AppliaFCEIVED I ( I l i ,H I I ( l I 'I I ) \ I 1
City of Tigard Received DatelB .. L/ ws Pem'ii Nt : 4 0 -- 0019
• 13125 SW Hall Blvd., Tigard, C4'22 2 2 011 Plan Review
• Phone: 503.639.4171 Fax: 503.598.1960 Date/H : Other Permit:
t �. Inspection Line: 503.639.41 Dm Ready/By: • 0 See Page 2 for
Internet: www tigard - go�TY OF TI GARD NonfiedTMethod Supplemental Information
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❑ New construction ® Addition/ alteration /replacement Please check all that apply (submit /sots of plans wlitems checked below):
❑ Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition El Other: where the available fault current ❑ Marinas and boatyards.
4,46f "!? 1giiniktt i , 4" a w� ,r ' yzi+!ls 3Sll- u�•r: amps 0 Floating buildings
.. , _ r I lets t exceeds ground, or exceeds at s 1 relies or
❑ 1 -an 2 dwelling less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
y g ® Commercial /industrial ❑ A ccessory building amps for all other installations. buildings.
Multi- famil ❑ Master builder ❑ Other: 0 Fire pump. ❑ Installation of 75 KVA or
er ,cv ;. I t ., a� s . a s kiit6a, ❑ Emergency system. larger separately derived system.
i,,, 1.0i,i11411Fr7 1 m t s - Addition of new motor load of ❑
Job no.: I Jab site address: 7244 SW Durham, 600 loeHP or n1Ofe occupancy
❑ Six or more residential units. 0 Recreational vehicle perks
City /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal.
Suite/bldgJapt. no.: 6 0 0 I Project name: TOl t LLC 0 Service or feeder 600 amps or more
rl ar ?„ r I IT ens. •-
+`..
Cross street/directions to job sire: Description I
: t
I Qty. I Fee. I Total
New residential single- or multi- fancily dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map/parcel no.: Ltimited energy. residential
dr iden ti alion 33.92 l
stial
r at 11!: i ti.i. -..!f ..,. t irmila {1i t. R, . ..l . ■• :.; s 1 #1 sxi ! 'i:i.la 75.00 2
ti �"t�ll>R- (with abovesq.ft.)
Limited energy, multi - family 75.00 2
Tenant Improvement residential (with above sq. ft.) -
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
tr 6 FIt u 1 aF+' s ; , F 'u _ _ 201 amps to 400 amps 133.56 2
:u.
r 11=6.. , i . !. l''t -O iii 1 „ , a , '. .:: , , . . .il , 3 ti P?
Name' 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
' AAldress: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or Feeders installation, alteration, and /or
ty relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 1 1 125.08 1 2
Owner installation: This installation is being made on property that I own which is not
401 amps to 599 amps 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
: rt .
s }t .. t� � above service a feeder fee. 7.42 2
9 �'. 1 r r8 i ' .t .,. each branch circuit
Business name: Johansen Electric B. Fee for branch circuits wi bout
service or feeder fee, first 1 56.18 56.1E2
Contactname: Charlynn Leifsen branch circuit
Each add'' branch circuit 14 7.42 103 . e eg
Address: 1 0948 SE Valley View Terr Miscellaneous (service or feeder not included)
Each manufactured or modular '
City/State /ZIP: Happy Valley, OR 97086 dwelling, service and/or feeder 67.84 2
Phone:(503) 69B - 3417 I Fax::(503) 698 - 2486 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E
n i fyeir w aP ►[ .F. 1, I f t S r. r F Sign or outline lighting 67.84 2
,,;,W,,, F, dAtrt sr' a ilk t i . lt'' Signal circuit(s) or limited-energy
Business name: Johansen Electric panel, alteration, or extension. Page 2
Each additional inspection over allowable in any of the abov
address: 10948 SE Valley View Terr Additional inspection (I In min) 66.25/ hr
City /State./ZIP: Happy Valley. OR 97086 Investigation (1 hr min) 66 25/ hr
pPY Y • Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 698-3417 Fax: (5 0 3) 698-2486 Inspections for which no fee is 90.00/ hr
s ecificall listed 'Jo hr mm)
CCB Lic.: 51539 Electrical Lic. �Q /e
2 43 C
Carl J nsen 4/11/11 Suprv. Lic.: 20535 ' - •IYg � ; t.`' ati .•'.; ,< r � „_,. , , �
Suprv. Electrician signature, required: �.. g,c„] ° Subtotal. 16 0.06
Print 'tame: Date: State Plan stuchargreview ( e ( ]2 ° /s /o of of Subtotal:
fee : 19.21
J TOTAL PERMIT FEE: 179.27
Authorized signature: This permit application expires if a permit is not obtained within 1
Print name: Charlynn Leifsen Date: 4 11 11 days after it has been accepted as complete,
/ • Number of inspections allowed per permit
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