Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00277
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/25/2011
Parcel: 2S113AA01100
Jurisdiction: Tigard
Site address: 16580 SW 72ND AVE B11
Project: Surgeline Subdivision: OREGON BUSINESS PARK I Lot:
Project Description: (8) branch circuits for TI
Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES
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: 503 - 624 -6300
FAX: 503 - 698 -2486
FEES
Quantity Description Date Amount
8 crt Branch Circuits wo /Purchase 05/25/2011 $108.12
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/25/2011 $12.97
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $121.09
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 52 -00 ,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: �� • V Permittee Signature: t ' / /°, / C4-770A/
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.
itril .
Electrical Permit Application 1 l L t v LI .}oR 01.11(1: ( tit. ONL'l
' R- of T and _, .,
, �
74 •� g MAY 2 4 2011 Date :. • 35 .- • Penni'No.:6C Oc(/ // �z�7
i 13125 S W Hall Blvd., Tigard, OR 97223 Plan Review 9 �
p Phone: 503 639.4171 Fax' 803.598.196 n DateBy: °Hier Permete / ea 09 7
Inspection Line' 503.639.4175 V III Ut I R 1I' i 1 D Date Ready /By: lu� l Supplemental Information
ris: HI See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION," N ''''''' f
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tr : . P: _ - .. 'I.,'l. . '� M1 1- x,.:::ny - if .... i .@ ":
0 New • construction'.:, ,5.:�u . ' � 11Addition/alteration/replacement , , Y , .:t.::, .} iffki; x .- :: i :u1'i � cec all that apply (submit l at appy sumt; sets of plans w/ terns checked below):
)X61
❑ ® Please cheek P es.
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards
tr ,, ��.� b i£ rtua• exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
tai+11,1 5 `- ti a.4:41 II gI I, �,,t.YS t,fi . . i ., a # u I'I' :141 :'
- `y , less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling N Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
.Sias, ,,:,.:- ':. Isa. - i ,,;p,,., .
.c• rill, ; } r > - r: . : t3/F t iup,c ❑ Emergencysystem. larger separately derived system.
. •�-�. ,:F , :;,a"r�lli.� ;ld:�.j�y� lit; t " € 'l ' ph �' a,dlli'',17;1e i� E)i.l'` ,
• a - s; •; � .! , ' .,,,.: : x;ttCtt�r�L i � - :, .0 - :.... + l�` - , waw.iw ❑Addtion of new motor load of .. .. .. - 1 " •,
100HPormore. occupancy.
Job no.: Job site address:
16 5 8 0 SW 72nd ❑ Six or more residerdial units. ❑ Recreational vehicle parks.
City/State /ZIP: ❑ Healthcare facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: I Project name: Cobb S(,( 7/ M E ❑s ervice or feeder 600 amps or more_
i ,.: s.'*- ar'°t w
,i =�El: ••�.Yi - I �sce�€ # e, - , s��. t S;�`;I 4 G
Cross street/directions to job site: Description I Qty. Fee. I Tote 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
no.: Limited energy, residential
Tax map parcel Li dt rills l
(�� l�iittlit �`! , t .:. ;,;;I141 -I10 �11 d�y 1 iN ' i .4 it with above s R. 75.00
�t'?�� ; ,Ihilia , 'I� •' +liu"llr litii {1'vr,;.i�.,. , ;.� ; - I!o! ±�il� "•r " �1t4' 1ii�" �ct:.,,; ,.c':.' ;.s,tfiiFil ;6� ( Q. )
Limited energy, multi- family 75.00 2
Tenant Improvement residential (with above sq ft )
Services or feeders installationotIteration, and/or relocation
200 amps or less 100.70 2
.il ,l '. x `fir' .1414101P a'- '''1Ri1;:ir ;' _ �iii
,, , i ,,
�!�^ , :, �f,. „r
' I ,5. r , ,31 4',, 1, 201 am
s 'I 1 p to 400 amps 133.56 2
,. ;: • { '' , ( .: t'+ot. �i r ,`
^. - IL. 'N: I[� !.
' I' ,t€ ,ll i6i
�, i Lk
401 amps to 600 amps 20034 2
Name:
601 amps to 1,000 amps 301.04 2
Address: over 1,000 amps or volts 552.26 2
City/State/ZIP: /State/ZIP Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fa ( ) 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 125 -08 2
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, er panel
Owner signature: Date: A. Fee for branch circuits with
ji+ l , ay5{k i 11! +> , , a + , I lia tr above service or feeder fee,
,. ; �se t1 +� 11 : ::, t ° i . :,:,',..^,r ,, ii:4 1l l @.. r+l i u , . ''- 1, 9 . t i .,: Ai ,, rY a O a " # f C l4 each branch circuit 7.42 2
Business name: Johan Electric
B. Fee for branch circuits without
. service or feeder fee, first 56.18 6.18 2
Contact name: Char Lynn Le i f s en branch circuit
Each add'l branch circuit 7 7.42 1. 9 4 2
Address: 10 9 4 8 SE Valley View Terr Miscellaneous (service or feeder not included)
' . 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 Fax::(503) 6 9 8 - 2 4 8 6 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: . 2
. e „Il t : _- Sign or outline lighting 67.84
1 4.1':
ltu, sue` ;'{'•lil,PL,:.tyr^)€t11 ,'., '., k , ':�u •'° '1 ;,:,:vF I, ilk;is r''"' it or limited-energy
'. � ,i • . ,..s'
gr" ll._ -�W. m _� � x��li� � ,. , . �_ :. , ,< €,r'it�1r�'''�,n- ,. t :;.ta.! Signal circa (s )
Business Warne 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 (1 hr min) 66.25/hr
Valley, OR 9 7 0 8 6 Investigation (1 hr min) 66.25/ hr
City/State /ZIP: Happy Y Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 698 Fax: (5 0 3) 6 9 8 - 2 4 8 6 inspections for which no fee is
90,00/ hr
A s. - ctfical hated i rmin I p t ':u:siti {iti r. i ... wc. a ! , : !! 4 r .i ii.' is CCB Lic.: 515 3 9 Electrical Lia: 3- 2 4 3 C Su rv. Lic.: 2 0 5 3 5 �':
Subtotal: 108 12
Suprv. Electrician signature, required: e t Plan review (25 /, n of permit fee):
Print name: Carl J sansen Date: 5/24/11 State surcharge (12a /a of permit fee): 2,97
TOTAL PERMIT FEE: 121.09 t/
--- Authorized signature This permit application expires if a permit is not obtained within 180
Print name: Char 1 nn Lei f s en Date: 5 / 2 4 / 11 lope after a it has been accepted m complete.
y " Number of inspections allowed per pemiit.
t'.n lding\Pernilm\ELC- PermitApp doe 07/01110 440- 4615T(11/OSICOMJWEa
{7 • d XEJJ 13C I3SFJ1 dH WELS :6 T102 i72 Real