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Permit CITY OF TIGARD ELECTRICAL PERMIT 2 ' COMMUNITY DEVELOPMENT Permit #: ELC2011 -00327 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/15/2011 Parcel: 2S 101 AD03200 Jurisdiction: Tigard Site address: 12909 SW 68TH PKWY 290 Project: Spec Space Subdivision: TIGARD TRIANGLE CENTER Lot: Project Description: 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 1 ea Services or Feeders - 200 06/15/2011 $100.70 Specifics: amps or less 6 crt Branch Circuits w /Purchase 06/15/2011 $44.52 Type of Use: COM Service or Feeder Class of Work: ALT 1 ea 12% State Surcharge - 06/15/2011 $17.43 Electrical Type of Const: Occupancy Grp: Total $162.65 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 160 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 OAR 952- 001 -0090. You may obtain a co• of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. 1.800.332.2344. Issued By: _ % rmittee Signature: 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 1,Em t)l is.R E t tit.: l)C1,1 , Electrical Permit Application City of Tigard I lent Review .� 2 13125 SW F1u11131vd,'1'igard, ux 1 97223 1 U N 1 5 2 011 - ., ,• . Phone: 503.fi39A Othor Permit: ' — 171 Fax: 503.S4R.19f0 Date/B /I_ ` J ; ; • l 0. i;i.> Inspection Line: 503.639.4175 CITY OF TIGARD pan Ready /By lee Page 2 for Internet; tvww.tigatd- or,gov 1 N DIVISION Notified /Malhod: 111M. Supplemental Information TYPE aF WORK PAN R*VflISV ❑ New Construction in Addition /alteration /replacement Plane ehw k all That apply (submit l rats of plans wAtems checked below): Demolition ❑ Other: 0 Service or leader 400 amps or more 0 Building over three stories, where the available fault currant 0 Marinas and boatyards. ) :': .'' ; CA EGO Y' col CGNI':101Crti'�l�I ; ' ' exceeds 10000 amps at 150 volts or 0 Fleeting buildings. ° ' • ^ - ,-.,,� leas to ground, or exceeds 14,000 0 Cotnntcreial -use agricultural CJ I- and 2- family dwelling ® Commercial /industrial 0 Accessory building amps for all other installations. buildings. El Multi-am r ly El Master builder ❑ Other; 0 Firs pump. 171 Installation of 75 KVA or . •, , O Emergency system. larger separately derived system. Alip ll+OCAVttIV © Addition of now motor load of © "A" "E" "3 -2" "1.3 ", Job no.; Job site address: 12909 SW 68th, 2 9 0 100HP or more, occupancy, J ❑ Six or more residential units. ❑ Recreational vehiela parka. City /State /ZIP; 0 Healthcare facilities. ❑ Supply voltage 11w more than 0 Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: 290 Project name: V _ _ cy ...4 a f ,, ©Rory re iec or Rieder 600 amps or mo. f : PE'l,;',010043.. ' . ' .. , Cross Street/directions to job site: Description , 1 .qty, 1, Fee, - I Total I - New residential single -or multi- tamlly dwelling unit. Includes attached garage. Subdivision; Lot no.; 1,00(1sq. ft. or less 168.54 4 ' La, add'I 500 sq, ft. or portion 33,92 I Tax map /parcel no,: Limited energy, residential p�01�I or WORK (with above sq. 11.) 75.00 2 Limited energy, multi- family 75,00 Space Improvement residential (with above sq. ft.) Services or feeders installation, alteration relocation 200 amps or loss 1 100.70 1 0 . 702 . ' *a Oki pjl ■ O :... Iii . 4144 " 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 amiss or volts 552.26 2 City/State/ZIP: Temporary services or feeders installation, alteration, and/or relocation _ - Phone; ( ) 1 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 I own which is not 40 1 mope to 599 amps 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits T new, alteration, or extension, per panel Owner signature: Date: A, Fee for branch circuits with ra Cr. • ' • abo serv or feeder fee, • I'c4l�iikil )3 11 6 7.42 44.52 2 each branch circuit Business name: Johansen Electric B.Fcct'orbranchcircuits service or feeder fee, first 56,18 2 Contact name: Char Lynn Le i f s en branch circuit )i'uwh udd'l branch circuit 7.42 2 Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not included) City /Slate /ZIP: Happy Valley, OR 9 7 0 8 6 dwelling, manufactured s a or r modular wile 67.84 2 p�y y r dwelling, service and/or feeder Phone :(503) 698 -3417 I Fax::(503) 698-2486 Rccon noct only 67.84 2 Pump or irrigation circle 67,84 2 E -mail: Sign or outline li4 67.84 2 • ... 6 � Signal cireuit(e)arlimited-energy Business name: Johansen Electric panel. alteration, OrextensiOn, _, p c 2 , 2 Each additional inspection over allowable in any of the above Address: 10948 SE Valley View Terr AdditiniiaJ itramseition (I hr lain) W 66.25/ hr investigation (I hr min) 66.25/ hr City /State /ZIP; Happy Valley , OR 97086 Industrial plant (l hr min) 75.18 / hr Phone: (503) 698-3417 Fax: (503) 698-2486 Inspections for which no fee is - 90.00/ hr r apoeifcsllt listed SFi hr min) CCB Lie.: 51539 Electrical Lie,: 3-243C Suprv. Lic.: 20535 • state 7 llOdi ltd' Suprv. Electrician signature, required: O J / r . / , , Sul: 14 5 . Pltns review (254 of permit it fe fee) Print name: Ca u 7 ans en / Date: 6/15/11 State surcharge (12% of permit fee): 17,43 Authorized signature: TOTAL. PliRMIr b'EE: 162,65 This permit application exparca if a permit la not obtained within 160 days after It has been accepted 11% complete. Print name: Char lynn Leif s en Date: 6/15/11 a Number of insp«utions allowed per vomit, I:13ui1dia \Permita\ELC•PennioAppd 07/01 /10 440.46157(11 /05/cOM/WBLt 8 /C - aoxd 98i;Z869E05 9817Z869CQS s area NaSNKHOr NY 9S :60 TTOZ- 5T -unr