Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00276
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/25/2011
IYGARt] Parcel: 2S112DD00200
Jurisdiction: Tigard
Site address: 15862 SW 72ND AVE 200
Project: National Mortgage Subdivision: PACIFIC CORPORATE CENTER Lot:
Project Description: (1) 200 amp or less; refeeding panel
Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES LP
10948 SE VALLEY VIEW TERR ATTN: N PIVEN
HAPPY VALLEY, OR 97086 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 698 -3417 PHONE:
FAX: 503 - 698 -2486
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 05/2512011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 05/25/2011 $12.08
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 952 - - 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800 332.2344.
Issued By: - / ' Permittee Signature: 7 AJ /97 f e/9
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 Applieatid CO FOR(u :i - i('r. 1 tih ON1,1
City of Tigard 1 AY 2 4 2011 D e ve � ' o�- Pen i!No. �leael, -- DO a 74,
13125 SW Hall Blvd., Tigard, OR 9722 Plan Review
�' Phone: 503.639.4171 Fax: 503.598.19_ f( � w�r�yy Date/B : Other Permit:
1 l U cf,. ('r Inspection Line: 503.639.4175 CI Y OF TIi�Pni;'tD Dace Ready By: El Sec Page 2 for
Internet: www.tigard or.gov 99 ` . t lLDING DIVISION Nolified/Method: Supplemental Information
i . 'tt: i ..l IaJ i e.' J �, 5 .; ni S4 t�Ftilnl nt ... 1 i 'h= , st'a _ -.T . I
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❑ New construction ® Add ition/al t eration/replacement Please check alt that apply (submit? sate of pleas w /items checked below l:
❑ Demolition E.3 Other:
CI Service or feeder 4 CI 00 amps or more Building over three stories.
uu where the available fault current ❑ Marinas and boatyards.
i i {lt S i i1 �(lll - "r', L, . ' 1 T''', lug -' . -,. _ exceeds 10,000 amps as 150 volts or ❑ Floating
All I t.' I:, tc `t671 ``''`'o- �IL� ` 641" buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ® Commercial industrial 0 Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑Fire pump. ❑ Installation of 75 KVA or
4, l Yn t l ail t • r,rmrw e lt�tn3'§ .;a *°�• a ppnyr u1 au i .. n l - ❑ Emergency system. larger separately derived system.
I i :4" s,: z '' r 0 s ]b o.'' '. p ,. v ti ° .
� s i � ;fft� Po ' *t ''
r „Fs � �. ❑ Addition of new motor load of ❑ "A" "E", "1 -3"
1
Job no.: Job site address: 15862 SW 72nd occupancy.
CI o or r or more.
more residential unite. ❑ Recreational vehicle parks.
City /State/ZIP: ❑ Health -care facilities. El Supply voltage for more than
!� ❑ Hazardous locations. 600 volts nominal.
Suite/bldg.,apt.no 2 00 ' P roject name: N ational Mortgage
c] Service or feeder 600 amps or more Hazardous
e � b ,
iii!. ) :::�wlii` , „.tj.i Y l , t r' 1 F
Cross street/direct o site: i ription Q ' o ,
l � I Fee. a I Total I '
New residential single- or multi- family dwelling unit
includes attached garage.
S' ubdivision: Lot no.: 1,000 sq. ft. or less 168,54 4
Tax map /parcel no.' • Ea add'l 500 sq. ft or portion 33.92 1
is i;1;;' It : ran t t Limited energy, residential
t 1 ` '1F ,,'! tep 6Z .,A i';i', 6 :cal ilrlrsln IEa I R . i..' 1 t k;'. -M ! (with above sq. R.) 75.00 2
Limited energy, mult - fam 75.00 2
Ref eedinq panel residential (with above sq. ft.) _
Services or feeders installation, alteration, and /or relocation
200 amps or less 1 100.70 100.70 2
l lllr t" ild . = i t II 'Tr l 1.-. • - r cp"r ° , 1 .. ,; s; � t 1', I$ will 'I . , 1 ibti 11 � Ii� EE. , , , , ,
t.. 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 123.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 166.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
+ { f K aqr1 •" _.: above service or feeder fee,
't ` si , t r 4:. ; ..aitl. r� „Etr i4 to ,r 1 31 . g 't 3 •:r " r'. i titw it t4L, -T.. iiix;
' L i .n. i �' laN•...„ each branch circuit 7.42 2
Business name: Johansen Electric B. Fee for branch circuits without
service or feeder fee, first
I 56.1 B 2
,-
ontactname: Charlynn Leifsen branch circuit
Each add'I branch circuit 7.42 2
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
City /State/ZIP: Happy Valle OR 9 7 0 8 6 Each manufactured service a d/ r modular 67.84 2
PPY Y r dwelling, service and or feeder
Phone: (5 0 3) 698-3417 Fax: :(503) 6 9 8 - 2 4 8 6 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail —
Sign or outline lighting 67.84 2
y 0 P
.
gyl �� rg�� / f ' ", �� Llt'I,„ m " " "l,,,r Tsta€t`- trtrd�i. a kllnlu.zi�`' . QI Signal circuits) or limited energy
Business name' Johansen Electric panel, alteration, or extension. Pima 2
Each additional inspection over allowable in any of the abov
Address: 10948 SE Valley View Terr Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Happy Valley, OR 97086 Investigation (l hr rain} 66.25 / hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (5 0 3) 698-3417 Fax: ( 5 0 3) 698-2486 Inspections for which no fee is 90,00 / hr
s. cificall listed '/z hr min
i 1 CCB Lic.: 51539 1 Electrical Lie'.: 3-243C Suprv. Lic.: 2 0 53 5 g130 " ' 1 . v T 7`47 71 t „' ;
Suprv. Electrician signature, required: C i t
D
Subtotal: 10 0 . 7 0
�.� Plan review (25 /e of permit fee): /
Print name: D ate: S tat e surcharge (12% of permit fee): _ 12.08
/
C ar l �TQi;1 n 5/24/11 TOTALPERMITFEE: 112.78
✓ ✓✓
,-Authorized signature: fl /rD / /IAe This permit application expires if a permit is not obtained within 180
Print name: Charlynn L f s en Date: 5 / 2 4 / 11
days aft a it has been accepted as complete
t
y * Nurnber ofinspectionsa llowed per permit_
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