Permit F �� CITY OF TIGARD ELECTRICAL PERMIT
• '"l COMMUNITY DEVELOPMENT Permit #: ELC2011 -00258
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/17/2011
Parcel: 2S102CC00700
Jurisdiction: Tigard
Site address: 13599 SW PACIFIC HWY
Project: Nevaeh Designs Subdivision: FREWINGS ORCHARD TRACTS Lot: 15
Project Description: TI
•
Contractor: JOHANSEN ELECTRIC INC Owner: HORTON, DENNIS M & ELISABETH A
10948 SE VALLEY VIEW TERR 19220 VIEW DR
HAPPY VALLEY, OR 97086 WEST LINN, OR 97068
PHONE: 503 - 698 -3417 PHONE:
FAX: 503 - 698 -2486
FEES
Quantity Description Date Amount
10 crt Branch Circuits wo /Purchase 05/17/2011 $122.96
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/17/2011 $14.76
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $137.72
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 O • ' = 2- 001 -0090. ou ma • • - • a copy of t rules or •irect questions to OUNC by calling 503 40 987 or 1.800.332.2344.
Issued By: // Permittee Signature: .6 1L■■
'' 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.
pECEIV
Electrical Permit Application 2011 ; t 1" 1'tI(I Isis 0\1.1
PP MAY 16
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City of Tigard �
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SW Hall Blvd., Tigard, OR 97223 a jr+GA „ X .- I i
® Phone: 503 - 639.4171 Fax: 503.598.19�Td �' Other Permit:
till :.f.
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, ; , „ inspection Line: 503.639.4175 PIA* pA�1 �! r" )' �� N la te ReadyfBY: See Patte for
Internet: www,tigard- or PLr...'t 11 i alp Notified/Method: 0 Supplemental Information
1. F:,x?�i� ;tf l r^F�I..I�iC;F3i! 111iti51dgllll i�l' I�:F � •.I - = Y , 4 ' ' -hE al P,!. -
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❑ New construction ® Addition/alteration/replacement Please duck all that apply (submit 1 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other:
sit where the available fault current ❑ Marinas and boatyards.
stt t't 1k�F i C7li i)mpljjirl(xr.. to •',•:-...••.`",:_.' a`K .: tC41 t 3 :� ! '" - 4441 3k iltp ?$ • , .g i cacao 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Cotnmereial -use agriculdual
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installation. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
, , ' ,� 3' � � y pp ct 11- , „• -- . ❑ Emergency system. larger separately derived system.
trz , _ r l �6 i a , .11 : t ,r tre Ntit n t l> , i24∎4: t a atiik4 01. . .. ry . ° 1,. tl ,, : ' ;fl ( i ❑ Addition af new motor load of
l
Job no.: Job site address: 13599 SW Pacific Hwy rnore. co
❑ Six o orr more residential unit R
. ❑ Recreational vehicle parks.
City /State /ZIP: ❑ Health -care facilities. ❑ supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: G I Project name: Nevaeh Designs ❑ Service OT feeder 600 amps or more
Cross street/directions to job site: nesemnoen Oh Fee. w
1 Ta �
New residential single or malti family dwelling snit.
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no add' 500 sq. ft. or
Ea 1 portio n 33.92 1
„�
Limited energy, residential
u�r �I
nit Iv`” r � r I Epr �+f i � "l�snr;�a gam,,. , .,. -r. ; !f. , ` e l rt 4 with above sq. ft. 75.00 2
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
ai .Vi r' _ 3 . e . . s _ d , " Jl , S r�1 rrs, ^f ltt t ' t ' 201 amps to 400 amps 133.56 Name: 40I amps to 600 amps 200.34 I 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 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 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, per panel
Owner signature: Date: A. Fee for branch circuits with
v r stir a se rvice or feeder fe
,r z Yi .,...so, 7.42 2
each branch circuit
Business name: Johansen Electric B. Fee for branch circuits without -
service or feeder fee, first 1 56.18 56.18 2
Contact name: Charlynn Leifsen branch circuit
Each add'] branch circuit 9 7.42 6 6. 7 8 2
Address: 10948 SE Valley View Terr Miscellaneous (service ur feeder not included)
Each manufactured or modular
City /State/ZIP: Happy Valley, OR 97086 dwelling, service and/or feeder 67.84 2
Phone: ( 0 3) 698-3417 I Fax::(503) 6 9 8 - 2 4 8 6 Reconnect only 67.84 2
E -marl•
Pump or irrigation circle 67.84 2
:'. a q �; a u W:N�a.:rr.a :54 ,:: !..' t oss• r !':: Sign o lighting 67.84 2
Y+I.;ri' a ',, # � .,1+',¢, y ,.. r . t : cpi alt ?' _,:; r outline
r.,1`• it 4,:l:kl, ..l.i. i E 1 'A ! U r , .r ;.:.,. .l o ... iiiikii;llii r: 9 ,suitlesb... :
"r: Signal circuit(s) or limited-energy
Business name: Johansen Electric panel, alteration, or extension. Paget 2
Each additional inspection over allowable in any of the above
Address: 10948 SE Valley View Terr Additional inspection (l hrmin) 66.25/hr
Investigation (1 hr min) 66.25/ hr
City /State /ZIP: Happy Valley, OR 9708 6 Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 698-3417 I Fax: (5 0 3) 6 98 -24 8 6 Inspections for which no fee is
90.00/ hr
s. - ificell listed y hr min
CCB Lic.: 515 3 9 I Electrical ic.: 3 — 2A3 3 C Suprv. Lic.: 2 0 5 3 S . !AM ! ..s a .41.5. '1 x N1 1, U r , 477 3 5rAtf ,, v,11111 ,- , Ott
•
subtotal: 122.96
Suprv. Electrician signature, require Plan review (25% of permit fee):
Print name: Carl - ansen I Date: 5/16/11 Stale surcharge (12% of permit fee): 14 . 7 6
Authorized signature:
TOTAL PERMIT FEE: 13 7 . 7 2
This permit application expires tf a permit h nor obtained within 180
days after it has been accepted as complete.
Print Warne: Charlynn Leifsen Date: 5 16 11 • Number of inspections allowed per permit,
l: \Budding\Pemuts\ELC PemdtApp 07/01 /10 440- 4615T(11 /05 /COM/WEB
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