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Permit
CITY OF TIGARD #,• s� ELECTRICAL PERMIT COMMUNITY DEVELOPMENT (0 & Permit #: ELC2011 -00326 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/15/2011 Parcel: 2S112DD01600 Jurisdiction: Tigard Site address: 15495 SW SEQUOIA PKWY 150 Project: Acceleration Chiropractic Subdivision: PACIFIC CORPORATE CENTER Lot: 4 Project Description: Electrical for TI. 6/30/11, reprinted for required plan review. Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES 10948 SE VALLEY VIEW TERR ATTN: N PIVEN HAPPY VALLEY, OR 97086 15350 SW SEQUOIA PKWY #300 PORTLAND, OR 97224 P PHONE: 503 - 624 -6300 PHONE: 503 - 698 -3417 FAX: 503 - 698 -2486 FEES Quantity Description Date Amount 12 crt Branch Circuits wo /Purchase 06/15/2011 $137.80 Specifics: Service or Feeder 1 ea 12% State Surcharge - 06/15/2011 $16.54 Type of Use: COM Electrical Class of Work: ALT 1 ea Plan Review Electricial 06/30/2011 $34.45 Type of Const: Occupancy Grp: Total $188.79 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 a rnrria ce 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. ENTION: Ore..n law :.wires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -0 -0010 through OAR 9' -s 11 -00.0. may obtain a co. of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Iss d By: t '' � _ Permittee 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' OA/C.-Q. g / Date: cp/:1b ( ( C' 3 LICENSE NO. -5 / (( 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. This form is recognized by most Building Departments in the Tri- County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. : City of Tigard ` = ` Buildin g Division TIGARD TRANSMITTAL LETTER TO: ` ( _ DATE RECEIVED: DEPT: BUILDINI DIVISION RECEIVED JUN 2 4 2011 FROM: C,& f, G o' 64 0 K- CITY OF TIGARD COMPANY: 1Y(3 (/RAJ . ENI . c = 0_ (C BUILDING DIVISION PHONE: (c 6q ' S ((J( By: _- RE: ( C c e9C . Sc, J S C c'o(A MttLL ( ELC � I/ -0034 (Site Address) (Permit um er) A- C_cc,z/L A4-t(6 oLJ CU- P/K Cs-VC- (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s) of plans. ,, Revisions: Cross section(s) and details. Wall bracing and/or lateral analysis. Floor /roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other (explain): REMARKS: FOR OFFICE USE ONLY . Routed to Permit Technician: Date: Initials: Fees Due: ❑ Yes ❑ No Fee Description: Amount Due: ck ( a 1 fi - c) {.( ploA) r -44v $ 6, S'c-d c tr- v i(\; 11Akr) - Er$Z , S. $ @te /37- . 1 1. 1 15 - Special Instructions: Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done Applicant Notified: 0 ,0.-- Date: C, /,147/1 I Initials: I:\ Building\ Forms \TransmittalLetter- Revisions.doc 02/08/2011 CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2011 -00326 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/15/2011 Parcel: 2S112DD01600 Jurisdiction: Tigard Site address: 15495 SW SEQUOIA PKWY 150 Project: Acceleration Chiropratic Subdivision: PACIFIC CORPORATE CENTER Lot: 4 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 SW SEQUOIA PKWY #300 PORTLAND, OR 97224 PHONE: 503 - 698 -3417 PHONE: 503 - 624 -6300 FAX: 503 - 698 -2486 FEES Quantity Description Date Amount 12 crt Branch Circuits wo /Purchase 06/15/2011 $137.80 Specifics: Service or Feeder 1 ea 12% State Surcharge - 06/15/2011 $16.54 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $154.34 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 OAR • - 001 -0090. You may obtain a cop f the rules or ect questions to OUNC by calling 503.232.1987 or 1.800.332.2344. \, OP Issued By: Permittee 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 Electrical .Permit Applicatioj JN 1 5 2011 ,'c11 :tittle lc l s,c c)sl,y = City of Tigard CITY OF TIGARD Received : 2 1=211AMPAIIM III -f 'a 13125 SW ICnit 131vd., J igard, E -- PI ens; 503,639.4171 Fax; .TANG DIVISION i .� i ,, uI„ Inspection Line: 503.639.4175 ® x Interne: www.tigard- or.gov Suppl om a'etta antal rolnt formatlon • 'hen Ok WORK •„P4t V EW ❑ Now construction E) Addition /alteration /replacement Pirase uheak all that apply (submit j sets of plans w /items checked below): ❑ Service or fender 400 amps or more ❑ Building over throe stories. ❑ Demolition ❑ Other; - ,,,,, . ,, , ... , , ... .. ..._ fkult current ©Marinas and boatyards. ,, whom the available TTGoRY 'd .( TR1J ( (' exaoeda 10,000 amps at 150 volts or 0 Floating buildings. loss to ground, or exceeds 14.000 ❑ Cammarcial -use agricultural 0 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or ^ , -,., — --, -,, , El i Emergency system. larger separately derived system. ' JOB '' SeritMAT11ON' AN1x •LOC:Af7 .' ` • ^ 1=1 • . Addition of now motor' load of ❑ "A" "F; "I.2" 1 • ve • Job no., 1 .lohsiteaddress : 15495 SW Sequoia, 150 occupation, ❑ Si Sixx a o rc moreoro residential units, Cl Recreational vehicle parka, City /Slate /ZIP: ❑ llenllh -onto facilities, ❑ Supply voltage for more than - - ❑ Hazardous Locations. 600 voll9 nominal. Sttitr,/bldg. /Apt.lto.: 1 I Project name: A ccelerated Chirp - O Snrvienorfendor600 tulips ormore. Cross street/directions to job site: .s »Q nwrrlellua . 1 qty, I Fee. 1 Total f ^ • New residential single- or multi - family dwelling unit. Includes attached garage, Subdivision; I LOl Do,: I, 000 eq, ft, or less 168.54 4 En add'I 500 sq ft. or portion 33.92 Tax map /parcel tit),; limited energy, maiden dal 7 DEs+r~"R1:'I "toot ini WORK ' . (with above sq.11,) 75.00 2 '_ -.•• W,.- Limited energy, multi- family 75,00 2 Tenant Improvement residential (with above sg. ft) Services or feeders installation, alteration, and /o r 200 amps or less 100.70 2 ' :. " O fR "X icier R , t 7t9 fAn . 201 amps to 400 amps 133.56 2 Name: T 200. 2 601 amps to 1,000 amps 301.04 2 Address: avat 1,000 „tops or volts 552,26 2 City/State/ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) 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 - 401 amps to 599 atmpk 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new, alteration or extension panel Owner signature: Date: A. Fee for branch circuits with 41a�� above service or feeder fee, GQINCp C� p F` I 1DN each branch circuit 7 A2 2 Business name: Johansen Electric B. Foe for branch circuitswuhoul service or feeder foe, first Contact name: Charlynn Leifaen brannheirouit 1 56.18 56.18 2 Each add'I branch circuit 11 7.42 81.62 2 Address; 10948 SE Valley View Terr Miscellaneous (service or feeder not included) Each manufactured or modular City /SIaU /ZIP: Happy Valley, OR 97086 dwolliog, service and /or fetter 67.84 2 Phone: (503) 698-3417 Fax :: (503) 698-2486 Reconnect only 67.84 2 E-mail: Pump or irrigation circle 67.84 2 Sign or outline lighting 67,84 2 CK}NXJtACT(Ilt Signal circuit(s) or limited - energy Business name: ,lohan s en Electric , panel, alteration, or extension. Page 2 2 Each additional Inseection over allowable in any of the above Address: 10948 SE Valley View Terr Additional inspection (1 hr min) , 66.25/ hr City/State/ZIP: Happy Valley , OR 9 7 0 8 6 luvcstigatioa (l hr min) 66.251 hr Industrial plant (I hr min) 7R. tR/ hr Phone: (5 0 3) 6 9 8 - 3 417 Fax: ( 5 0 3) 6 9 8 - 2 4 8 6 Inspections for which no fee i , 90.00/ hr Spe ifcally listed,(l6 hr min) CCB Lie,: 515 3 9 Electrical Lic.: 3 - 2 4 3 C Suprv. Lie.: 2 05 3 5 • • ' il+ ' JCA' S. ipstrrItil$.. ' • 1i nit f Suprv. Electrician signature, required /� phut review (25 Ye of pcnsnit cea ) 13 7 . 8 0 : _ Print name: Carl bans en Date: 6 / 15 / 11 State surcharge (12% of permit fee): 16 _ 54 TOTAL PERMT FEE: 15 4 , 3 4 l�ttthoruixxi signature: �• This permlt application expires If a permit fa not obtained within 180 - days after it has been accepted as complete. Print name; Char 1 yen L e 1 f s en Date: 6 / 15 / 11 ■ Number of inspections ollowod per permit. 1 \ milting 1permitalR1,0. -Pr.r itApn,dno 57/01/10 440.40 5'1 /05u`oM/WBH 8 /T - HDVd 986Z869E09 98VZ869E09 ZDH'i NHSNVHO2 iinr 59 60 TTOZ- 9T -unr