Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2011 -00305
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/07/2011
Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 140
Project: OMEP Subdivision: TIGARD TRIANGLE CENTER Lot:
Project Description: Electrical 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
3 crt Branch Circuits wo /Purchase 06/07/2011 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/07/2011 $8.52
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty C. •• 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 ' suance, o 'f work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notif ati•• - nte Those rules are set forth in OAR
952- 001 -0010 through OAR •52- 001- 0091�u may ob - • • of t. questions to OUNC by callin. 50;FA987 o .800.332.2344.
Issued By: / /.f% f.dir,1_ �i �_ T Permittee Signature: tr,Av
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.
Oge e/ • dr /it- pt2S5%D1,t El strike Permit Application ; 1 Ul (Ht i f l I I. : t;, � i 1 _ .
"Received
City of Tigard tern .Q PermitNc.: j // -Oa ,
13125 5 W Hall Blvd., Tigard, OR 97223 JUN 7 2 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 AA Date/B , Other Permit: A / +) // -00 Inspection Line: 503.639.x175 C ITY OF T!" `t) Date Ready/By:
Internet: wwtv.tigard- or.gov gat RD Notified/Method: iI
P1r ur a-..u,
,� r ,(, ].''alt F( ai n li 1 t n ' il£ R3 viii., =u a --�,r'- '
�}�� r �sei ��, � t�l I 1 t "I tall � VIII � ` � , q k areas rrwaas � t ea _
t " 2 mungsuIIIt rim,.,1,4,„t . iR t: , , , . ' . � , ; 1 „ 4 ,• a .'lr ` r . "tt ` :cif
.
` � %�. ,�> ?R�t x,. ..ever §say €- ,���F:r.,, �.0 L'xi Ain. .3. _
❑ New construction ® Addition /alteration/replacement Please chock all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition ❑Offer 0 Service or feeder 400 amps or more 0 Building over three stories.
' where the available fault current 0 Marinas and boatyards.
. , 1 t it mtt i�� als Ilp k 1 I I } t 3 b r n 'r f i u,ti�y. p `d 1n = fifth exceeds 10,000 amps at 150 volts or CI Floating buildings.
Si 7 f�w�, nti. a��ut, wt., muuNr' �fi3ftk4 ,�- .
Commercial/industrial leas to r all ground, other enceada 14, ❑ Commercial-use dinar agriculnhral
❑ 1- and 2- family dwelling
❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: 0 Fire pump. C] Installation of 75 KV A or
,, r r- ] f tr ,1 ,X , , s ' ,� t � "' i t ¢ s of ❑ Urgency system. larger separately derived system.
_' *--: •• ` • hen r rilakt, tstaisrfEi ; r. , a: ❑ Addition of new motor load of ❑ `A" "E" " 1.2" "1 -3"
Job no.: Job sit address:
12909 SW 68t 140 1 bc or io mom. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt, no.: 140 I Project name: Oregon Partnership ❑ Servic } e or feeder 60 anrps or more. ;�ygt
2 s t 1 te- 1F4'; ,1 1 i, "y! 1 0a itzi1 i
.....� AIGtm'L1E l
'Cross street/directions to job site: tksrnptioa Q. Fee. Total •
New residential single- or multi - family dwelling unit
Includes attached garage.
3'tibdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential
, lr a.it Ir w, ird.wutun7h 9 e' e. tl, •err p. err pt's 1 ' b
(with aove sq. ft)
75.D0 2
l6'l rauh.i ;7 e.#iicra�i ,in :n, ,std i tri.ls r 1: .aw ..
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.
1- tf.. 1 y w t€ r ;ri'st t5.! ' 1 r1 1 gv�N �= 1, Rilip)• ��p
i i ' t ' , ,,. 1 b # z I i ' , 1 , . tit hl i4rii a t ti � ' his 3, 201 amps to 400 amps 133.56 2
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.
City/State/ZIP' Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 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 am to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
' Sc �d « •d t a r l d u sw i t e s 's e above service or feeder fee, 7.42 2.
each branch circuit
Business name: Johansen Electric B. Fee for branch circuits without
,r• service or feeder fee, first
C``ontactname: Charlynn Leifsen branch circuit 1 56.1 56.18 2
Each add'l branch circuit 2 7.42 14 .84 2
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
City/State /ZIP: Happy Valley, OR 9 7 0 8 6 each rots service manufactured or modular 67.84 2
PPY Y dwelling, service and/or feeder
Phone: (503) 698 -3417 I Fax::(503) 698 -2486 Reconnect only 67.84 2
E Pump or irrigation circle 67,84 2
{ @yt� Si or ou tline lighting 67.84 2
1 0a ER vIllit 9�a ialali�lr 7 . . 7 i q s� - 7a.: 1, Sign g
.it�'nc, a. ,I �' r: Wit; .a.., .x ,�F''t` ..i,lao I'' o.m: i�1m d o.': Signal circ uits) or limited- energy
1usiness name: Johansen Electric panel, alteration, or extension. Page 2 2 ,
Each additional Inspection over allowa In any of the abov
Address: 10948 SE Valley View Terr Additional inspection (I. hr min) 66.25 / hr
City/State/ZIP: Happy Valley, OR 97086 lmest;gati on (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (5 0 3) 698-3417 I Fax: (5 0 3) 698-2486 Inspections for which no fee is
90.00/ hr
s.ecificall listed �' /ahr
CCBLic.. 51539 Electrical Lic.:3 -243C I Su .Lis. 3S r '"'lt $"`
/J�/f �/ prv. : 2 0 5 ',l� 5 �is,,� � a { 'W-�.x.' .: az:t't' 1�3 � wL�1.�L�i. '
Su Electrician signature, required it Subtotal: 71.0 2 -
Plan review (25% of permit fee):
Print name: Carl h ns en Date: 6/7/11 State surcharge (12% of permit fee): 8.52 -
Authorized signatu TOTAL PERMIT FEE: 7 9 7
Tbis permit application expires if a permit is not o ed within 180
Print name: Char ynn Lei f s e n [Date: 6/7/11 days after it has been accepted as compkte.
• Number of inspections allowed per permit_
Ll Building 'PamritstELC- PemotApp.doc 07/01/10 440.46151111/05/COM/WEB
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