Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00279
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/25/2011
Parcel: 2S 113AA00600
Jurisdiction: Tigard
Site address: 16130 SW 72ND AVE B1
Project: Spec Space Subdivision: OREGON BUSINESS PARK I Lot:
Project Description: (2) branch circuits for lighting.
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:
FAX: 503 - 698 -2486
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 05/25/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/25/2011 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 9.,,,01 -009'. 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: i7A/ / 7 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 Application .1- I ST:•ONI.N
C of Tigard MAY 2 Received
Dated3 : Alliria ,
Permit Noele 4 0+
70/7-0.
ii ..-
Ili- ■ 13125 SW Han 131vd., Ti 4 2011
Tigard, OR 97223 , , „,„., Plan Rmiew •
' • 1111 • Phone: 503.639.4171 Fax: 503.598.150; I' O r ' • Date/B : Other Permit:
1 - : ,..,.,, p. D Inspection Line: 503.639.4175 MilLDEV . Dam Ready/By: EMI Fit see Page 2 for
Internet. www,t igard Notified/Method: Supplemental information
7MtirYln4aSiliA :10114rox•!. 0 lik91 liP; 1 .-.J.: ?• I i ni . 4104 191 . ! . ,'I N - l'i : J. -. ::; 'ii I :.*941
ri ' v x .l.lidllte;:dlrid “ I ' 5' ...„2 . , ..,,s,i, „,. .:..... ,,..,■ .::_!,,,,, , - ,.„ -- :,_,..:.,. ..
New construction l Addition/alteration/replacement Please check all that apply (submit a sets of plans w/iiems checked below):
EJ E
CService or feeder 400 amps or more 0 Building over three stories.
0 Demolition 1:: Other: where the available fault current 0 Marinas and boatyards.
ci , oom*.oil. ,:i,exi i, i ., i11. 140 -...0 1; or 1,77.,:ir,„,,,;.;!,1r, exceeds 10,000 amps at 150 volts or El Flooring buildings.
less to ground, or exceeds 14,000 0 Commercial-use agricultural
D 1. and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Mu hi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
0 Emergency system. larger separately
..:, ,::,,,:,-;,.. 0 Addition of new motor toad of derived system.
1DOHP or more. oc.cupancy.
Job no.: I Job site address: 16130 SW 72nd 0 Six or more residential units. 0 Recreational vehicle parks
City/State/ZIP: 12Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: Vacancy Spec _ 0 Servioe or feeder 600 amps or more.
A.,14, 11i, Eli? 7.'.. ri '1' l!! •r. it= ,";,1*:!.1
Cross Street' directions to job site: Description ( NY. Fe. Totd
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. tl. or less 168.54 4
Ea. add'I 500 sq, ft, or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
,,Narp: . ...„..,
AgliktinTTat9kiii***40WYkik1Wi0100-t.4'rrtHV roiv.s
.''....,....,:.11;iirs'ilOti (with above sq' ft) 75.00 2
Limited energy, multi-family
75.00 2
Lighting work residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps ot ins 100.70 2
clitilr, '..' . ii,...4,04:iis.1444111stft 201 amps to 400 snips 133.56 2
• . —.2..,: :I , ');. , c ''''' I -,.'
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
Temporary services or feeders installation, alteration, and/or
C ity /State/Z I P: relocation
Phone: ( ) Fax: ( ) 200amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
am 168.54 to 599 amp 54
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps . , 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with [
'Alotrop11i1' t.:,L;i0,g;: ,t: , . 14 , 'Adimpktf.F. bove service or feeder fee,
7,42 2
;Ai; ■.,..:;1,..!,44,101ectiru ...e,' . *, . , ' , . ... montatal, 0 .,,,,11,,,,D,,a,g , ,r.q. , ..„„;: . i:, ,, II: L „„„ . ..q v.::,,, ,i.
a
each branch circuit
Business name: Johansen Electric B. Fee for branch circuits without
service or feeder fee, first
.18
Contact name: Charlynn Leifsen branch circuit 1 56 56 2
Each addi branch circuit 1 7,42 7.42 2
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
Eadi manufactured or modular
City/State/ZIP: Happy Valley, OR 97086 dwelling, service and/or feeder 67.84 2
Phone: ( 5 03) 698-3417 I Fax: : (503) 698-2486 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E . Sign or outline lighting 1 67.84 _ 2
0 ilifinron1I Signal circuit(s) or limited-energy
panel, alteration, or extension. , Page 2 _ 2
Business name: johans en Electric Each additional inspection over allowable in any of the above
Address: 10948 SE Valley View Terr Additional inspection (I hr min) 66.25( hr
Investigation (1 fir min) 66,25/ hr
City./State/Z1P: Happy Valley, OR 97086 Industrial plant (1 hr min) 7818/ hr
Pbone: ( 5 0 3) 698-3417 Fax: ( 5 03) 693-2486 Inspections for which no fee is
9000/ hr —
s. cificall listed Yi hr min
6,VCCB Lie.: 51539 Electrical Lic.: 3 - 2 43C Suprv. Lic.: 2053S I Mk; .! ,f• .f021
Subtotal: 63.60
Suprv. Electrician signature, required: (:),0„,c, )" t .... , . ,,,, .
. . , Plan review (25% of permit fee):
,.
Print n ame: Carl Jet / Date: ansen 5/24/11 . State surcharge (12% of permit fee): 7.63
TOTAL PERMIT FEE: 71.2
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
- Print name: Charlynn Leif sen Date: 5/24/11 * Number of inspections allowed per pennit.
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