Permit q CITY OF TIGARD ELECTRICAL PERMIT
' . ' COMMUNITY DEVELOPMENT Permit #: ELC2011 -00329
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TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/16/2011
Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 250
Project: Spec Space Subdivision: TIGARD TRIANGLE CENTER Lot:
Project Description: (1) service and (6) 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
1 ea Services or Feeders - 200 06/16/2011 $100.70
Specifics: amps or less
6 crt Branch Circuits w /Purchase 06/16/2011 $44.52
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 06/16/2011 $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 a e—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. AT NTION: Oregon la requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 010 through OAR 95: 1111-109', You may obtain a copy of the rules or direct questions to OUNC by callin . 32.1987 or 1.800.33. 344. f
Issue By: - �.: .4 _ � _4 Permittee Signat re: # All _.� / (0 - ■._ _--'
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 II STA LLA ONLY
SIGNATURE OF SUPR. ELEC' �// / Date: 6,4///
LICENSE NO. 090573 s - � l
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.
RECEIVE )
Electrical Permit Application 1:01(,(A4 Icy t. 5i: o.1.1
City of Tigard JUN 1 5 2011 D B • MN I LWM MN put" il No.: f , / / -D3a
� - e 13125 SW Hall Idled., Tigard, OR 97223 plan Review 4�
Phone: 503.639.4171 Fax: 503. Q TIGARD Dato/B : Od nr ?van il: tL" - 60-15
t i 1 0 1 Inspection Lim: ,503.639.4175 ' �G DIVI SION Datc Ready/By: ®see gage 2 Cot'
Internet: www.tigatxl- or,gov BUILDIi Notilied/Mnthod: Supplemental Information
'T,'Jt O & pT.�Ist R V 9 ' •
New Construction O hetioti/elteration /replacement Please that apply sumit 2 Service the 400 amps
ps o r m 0 0 Marinas '.:
b sets of plans w /(tens chocked below):
Demolition
em s nr me aver three mode',
Imd boatyards,
' ' C,°o .1 o �ratityi t Gl l Me 06 1 0,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 ❑ Commarcisl.usa agricultural
[] .i- and 2- family dwelling IN Commercial /industrial 0 Accessory building amps for all otter installations. buildings.
0 Multi - family ❑ Master builder 0 Other: C] Fire pump. Q Installation of 7S KVA or
itri 4.
tC1tI • �.morgonoy sysem, larger separately derived system.
rb Nth C xClCr! 111!I
•• • .• - [] Addition ofnaw motor load of Q "A", "E", "i - 2" "I -3
built by more. occupancy.
Job no.: Job site address: 12909 SW 68th, 2 5 0 0
r Six or Imo residential units 0 Recreational vehicle parks.
City/State/ZIP: 0 Health -care facilities. 0 Supply voltage for more than
Hazardous localisms. 600 volts nominal.
Suite/bldg. /apt no.: 250 1 Project name: Vacancy 0 Service or tender 600 amps or more.
Cross street/directions to job site: . .. 0
i err e>sa I tltv.) tre I Trial I •"
- a -"" '-"' New residential single or multi- family dwelling unit.
Includes attached garage,
Subdivision: LOt no.: 1,000 aq. R. or less 168.54 4
Ea. add'l 300 sy. ft. o r i r,rlinn 33.92 I
Tax trap /pare el no,: energy, residetial . Linutod
. DEIt"lklt;4~1li61 • ok IVVOR.i (with above 59, 0..) 75,00 2
limited energy, multifamily 75.00 2
space Improvement residential (with above sq. tt.)
Servicea or feeders installation, alteration, and /or relocation
rr--�t 200 amps or less 1 100,70 10 0 . 7 02
la JAPER OWt'l a "M`libl`YAi� I ... . 201 Imps to 400 amps 133,56 2
Name:
401 untps to 600 amps 2(10,34 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 Instal/allots, alteration, and/or
... remotion
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 l l own w is not
401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 67(1 - - -
Branch circuits — new, alteration, or extension, per panel
Owner signature:, Date: A, Fee for branch circuits with
APPLItk I dry: a TA , .PIA,Stik : above service or feeder fee, 7.42 2
L "*+ mwhbrunehcircuit 6 44.52
Business name: Johansen Electric
B. Fvefoe hrunehois,mits +vtllruui
service or feeder fee, first
56.18 2
Contact name: Charlynn Le i f sen branch circuit
Each add'] branch circuit 7.42 2
Address: 10948 SE Valley View Te rr Miscellaneous (service or feeder not included)
City /State /ZIP: Happy Va j-1 e , OR 9 7 0 8 6 Each iservice manufactured or modeler 67.84 2
��y � _ dwelling, service and /or feeder
Phone: (503) 698 -3417 [Fax::(503) 698 -2486 Reconnect only 67,84 2
E -mail:
Pomp or irrigation circle 67.84 2
Sign or outline lighting 67,84 2
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Signal circuit(s) or limited - energy
Business name: Johansen Electric punol,ltlteration , orextcnaiat. Paget 2
Each additional inspection over allowable in any of the above
^ Address; 10948 SE Valley View Terr Additional inspection (1 hr min) 66.25/ hr
� Investigation (I hr min) 66.25/ hr
City /State /ZIP: Happy valley,. OR 97086
- Industrial plant (I hr min) 78,18/ hr
Phone: (503) 698 -3417 Fax: ( 503) 698 -2486 Inspections for which no fee is
specifically liste hr min) 90.00/ hr
d '4
CCB Lie.: 51539 I EIectrical Lic,: 3- 43C [ Suprv. Lic.: 20538
(
(J
Suprv, Electrician signature, required: jJJ Subtotal: 145,22
Plan review (25% ofpermit fee):
Print name: Carl J ten Date: 6/15/11 State surcharge (12% of permit fee): 17
r ! TOTAL PERMIT FEE: 162.65
Authorized signature: This permit application expires Ira permit is not obtained within stilt
days after It has peen accepted as complete,
Prim name: Char lynn Le i f sen Date: 6 /15/11 • Number ofinspactions allowed per permit,
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