Permit CITY OF TIGARD ELECTRICAL PERMIT
il l ' ' COMMUNITY DEVELOPMENT Permit #: ELC2011 -00470
T1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/23/2011
Parcel: 2S112DD01600
Jurisdiction: Tigard
Site address: 15575 SW SEQUOIA PKWY 160
Project: Verizon Corp 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
4 crt Branch Circuits wo /Purchase 08/23/2011 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 08/23/2011 $9.41
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 952 - 001 -0090. You may obt -'• - • • • e rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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.
can 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.
fi II ' . , .1 11: .
1! Li
Electrical Permit Application AUG 2 2 21 foR 01..FicE rst: ()NIA
City of Tigard ..Reeeived .-ii
CM' OF 173f Ivan) , , fiffifirM
' 1=11F.
..,- Bail Blvd. . 13125 SW Ba 1vd. Tigard, OR 97223
D
11 11 -.° ' ' Phone! 503,639,4171 Fax: ' 503.59 M 2
8.1960 BUP G DWI :ri— IIIMIRMIZETio
,,,,;,,,,, Inspection Lino: 503.639,4 75
Eil ' s ' up .5r pt e ta i i=a 2 1 Ir l O ntormotion
Internet! www,riL;oird-or.gov
;:' . .'::,',.."1 . '::. ,',•,.:;]::(:',:`,;:'.'..,;,,,,'.:::.'• :•::•,.'i,i14t *:*4',iii',"t ,','•":.,..:;:',': ':.:; '•'•:':'.:: ::. :.,;•::,:,;::::,...., ; :':!•,:::,•::
1. 'N
--1 N ew onstruction Addition/alteration/replacement
,./''''''. ' Please clicCFc idfthaf apply (submit 2 ittsof plan; w(items chocked below):
t.....I c El
0 Setvice or f V bcdcr 400 !IMP mans 0 Building over three stOries,
0 DOPtoldiliOn 0 Othcr: where the available fault currant El Mares and boatynnIti,
..66 '''1.,44 , .:,,,, ..! oxv,,xis 10,000 amps at 150 volts or 0 Floating buildings,
''' ' ''''' '''''''°' '''' ' ' ''' " ' ' " ' ' - " ' ' ' ' " - '' ' .. L. ' ' ' less to ground, or exceeds 14,000 0 commorcial agricultural
0 1 ., and 2-fainily dwelling n Commercial/industrial 0 Accessor building iunp, (Iv .01 other installations. buildings,
El Multi-family El Master builder El Other: ['Vire pump El hmtallation of 75 KVA or
larger separately dorivnd system,
.14;:olii*s.***44.49190.0')> ::::: ,,:,.,, ., 0 Manion of new motor load of 0"A", "P7, “1-2 . . "1-3",
Job no.: 1 Job site address: & sioikepke,-ger 1001IP or more,
0 Six or mere residential units. 0 occupancy,
Recreational vshid e parks.
City/State/ZIP! n Health-earn fact litia,s, [I supply voltage for mono than
0 limardous locations, GOO volts nominal.
-
Suite/bldg./apt. no.:/690 Project name: ve,41/ . Service or feeder 600 amps or mom.
Cross street/directions to job site: 0..-icription I Qty. i .14Pee. J NIA I
- . New residential tingle-or multi-family dwelling unit,
Includes attached garage.
... -
Subdivision: Lot no.: 1,000 sq, 0, or loss 168.54 4
- Pa. add 500 al, ft. or portion 33,92 1
Tax map/parcel no.: Limited energy, residential
75.00 2
. i!..'?•,','::''''.',';:''i ''/,:' ‘!,':''; '',!'::',..,'!"' . nificiattitilbit4.0 ,...:......,,::., ‘-,.., ,. (with above sq, a,)
. ' ' ' ' ' ' . ' Limited energy. multi-family
*1 a . / IA! 75.00 2
./ residential (with above sq. ft)
-- Services or feeders installation, alteration, audio relocation
200 amps or less 100.70 2
ikoitit.., :',i',.: i :,..:. ,,, ; .,tz . ..ii* N ,,,,ott:, ::,:,.,:,,,,.:,,,:..:.,:...:,,..!.!: 201 amps to 400 amps 113.56 2
401 snips to GOO amps 200,34 2
Name:
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/o
City/State/ZIP: relocation
••
Phone; ( ) Fax: ( ) 200 amps or less i5 1
— 201 amps to 400 amps - 125,08 2
Owner inatidintion: This installation is being made on property that I own which is not —
t
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. go tongs to 599 amps 168.54 2
Branch circuits new, alteration, or extension, pemanel
Owner signature: Date: , _ A. Fee for branch circuits with
-:,•::^:: •- • • ,• • . • ,:,, • . above service or feeder fm,
.,; ''.:',.':':•• `•':'''''' ', ,,•• 001140 ' :'''' '' . each branoli circuit 742 2
_
Business name: Johansen Electric B. Fec for branch circuits without
service or feeder fee, first
I 56.18 9 , ilic 2
Contact name; Charlynn Leifsen _branch circuit
Each ridd'l brunch circuit I 3 7,42 2
Address: 10948 SE Vailey View Terr Miscellaneous (serYice or feeder not included) ,
Each manufactured or modular 67.84 2
City/State/Z1P: Happy Valley, OR 97086 dwellirta and/or feeder
Phone: ( 503) 698-3417 J Fax :(503) 698-2486 Reconnoct only 67.84 2
Pump or irrigation circle 67.84 ,,. 2
E-mail: , sign or outline lighti
' ng 67.84 2
'7 ••:' 001 :' ' •: ; :•,;.: .' ,'•': t•: ,•,'.., '','' .., Signal circuit(s) or limited-on orgy
Business name: Johansen Electric pucol, alteration, or extension, Pa 2
2
Each additional inspection over allow bie In any of the above .
Address: 10948 SE Valley View Terr _ Additional inspection (1 hr min) 66.25/ hr
— . .
luvoiitylliou(Htrinii0 66.25/ he
City/StflteiziP; Happy Valley, OR 97086 Industrial plant ( I hr min) 78,18/ hr
Phone: (503) 698-3417 Fax: ( 503) 698-2486 Inspections for whiCh ne fix is
90.00/ hr
, specifically . listed 04 hr min)
CCB Lie.: 51539 1 Electrical Lic.: 3-243C j Suprv, Lie,: 20535 ,' .':;.:..: ,.':;,.;,:'::.,, ,. ')D' , , oiW, . :4. " at , :144::',.:
Subtotal; wow
Suprv. Electrician signature, required:
eer4 e 4- 4
,0?,044',091r144'■-/ —
Plan review (25% of permit fee);
• –
Print name: Carl LT h nsen be' 8/22/11 State sureharge (12% Of pcnnit feu): 4 7 1//
_,.. TOTAT. PF.RMIT PEE: gri_S/5
Authorized signature: . Thia permit application expires If a perndt is riot obtained wahln 180
Print name; Charlynn Le i f sen Date: 8/22/11 Number days after It has been accepted as complete.
* of inspections allowed par permit,
.. .
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