Permit ELECTRICAL PERMIT
pp! CITY OF TIGARD Permit #: ELC2011 -00495
e COMMUNITY DEVELOPMENT
Dat Permit Issued: 09/08/2011
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OGrArt.D, 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 9/08/2 C00101
Jurisdiction: Tigard
Site address: 16655 SW 72ND AVE 400
Project: Micro Interconnects Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project Description: (7) branch circuits for equipment connection
Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES
10948 SE VALLEY VIEW TERR 15350 SW SEQUOIA PKWY #300
HAPPY VALLEY, OR 97086 PORTLAND, OR 97224
PHONE: 503 - 624 -6300
PHONE: 503 - 698 -3417
FAX: 503 - 698 -2486
FEES
Quantity Description Date Amount
7 crt Branch Circuits wo /Purchase 09/08/2011 $100.70
Specifics: Service or Feeder
1 ea 12% State Surcharge - 09/08/2011 $12.08
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
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Total $112.78
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 obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
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Issued By:
�� � Permittee Signature: (W �i / G /C�'7 �/
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
Date:
OWNER'S SIGNATURE
CONTRACTOR INSTALLATION ONLY
Date:
SIGNATURE OF SUPR. ELEC'
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.
,6 r
Electrical Permit Application' c; - `, 1 . & - '° 1 '' FOR 0141( l.Si.:
111 C
, ...-..-- • W H atigBatvrd,, I Tigard, OR 97223 n (.9 Plan Review
1 in it 2 y 5 s of T VW.'
i 2 W — 0
0
1 ' Phone: 503.639.417i Fax: 503,59R,1960 ‘3'•-‘ I 1,0 \ R I Zi i vffrair-v p.i
,. Dato/B ; AO
Other Porni/fe,1
A 1 , I ) Inspection Line: 503,639.4175 'T 4 ,,c,:, , ,r , .....,° •,Rate Ready/13y; , 0 See Page 2 for
Internet: www.tigard-otgov r o k , - , ' -Nzilined/wthad, Supplemental information
?twists check all that apply (Kubm it 2 sets of plans ennuis ' checked below):
0 New construction El Addition/altoratiokreplaccincnt
0 Service or feeder 400 amps or more CI Building over three stories,
El Demolition D Other: Vittero the available. fault current 1:1Marinas and boatyards.
''''' ''':',' ' ''' '.:,' %:;':•:',;'; 60 , ;..'... ,,,,,, ..1:.,7,' exceeds 10,000 amps al 150 volts or 0 Floaling buildings.
less to *Maud, Or ;tweeds 14,000 D conlmcitialtmse agricultural
0 1- and 2-family dwelling V Commercial/industrial 0 Accessory building amps for all ether installations, buildings.
0 Multi-family 0 Master builder El Other: 0 Fins pump. 1:141h0,100i0tt of 75 KVA or
i ' ...,,, iiii . hi ... , ., ... ': . ., ., ['Emergency system, larger separately derived system.
' OP
:'' ';'-' ''''''''''':::''' '' ' '''' ' ,••' 'A 94. 9 1 ; 07 04 14h, h .1:•A hiih
A1W t.' ” ':.•' :. ::..;••••;. IZIAddition of new motor load of rl "A", "I',", "1.r, "1.3",
100I1P or mona. ocmpitmy.
Job no.: Job situ address: 16655 SW 72nd 0 six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: ID Health-care facilities. 0 Supply vol tap 1hr more than
0 Batzardous locations. 600 volts nominal,
Suite/bldg./apt no.: 400 Project namell/g/p /4/elyeilijec•IS 0 Service or feeder 600 otos or more.
,:::'•,. :, ..'' .. ..:' 'f.' 401PIttlPit.":;:;.'. : .. ' ,.''. i
Cross street/directions to job site: mecritemi, 1 qt "I 'Pee . 1 Tod j ^
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision; [ Lot no,: 1,000 sq. ft. or less 168.54 4
' . Ea. add' I 500 ag. ft. or portion 33.92 1
Tax map/parcel no.:
Limited energy, residential
75.00 2
...:, :; :'' ' : ..', -:::!:',.: '•,,'"1 i)kkitiiritoil;;6.1 , ..1 :',:: ',; .': ' ...;::.:: (wills above M I' ft)
,
limited Onersy, I nuli.i•family
75.00 2
424egalttel edit/led e04:0Pen1 residential (with above sq. ft,) _
Services orfeeders installation, alterattol,andior relocation
201) amps or I eNs 100.70 2
I33.56 2
, .
401 amps to 600 amps 200.34 2
Name;
601 aramps ie 1 ,000 amps 301.04 2
Address: Over 1,000 amps or volts 5$2,26 2
- - .
City/StateJZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or leas 59.36
201 totpc to 400 maps 125.08 2
Owner installation: This installation is being made on property that I own which is not
401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits- new, alteration, or extension, der (Mel
Owner signature; Date; A. Fee for branch circuits with
I, ::. , :....., latop; tittO .: .,.:,. ..•" ubove sOrvieep or fouddr cat,
742 2
Business name: Johansen Electric B. Fee for branch circuits rvidicm/ •
service or feeder foe, first I 56.18 Stog 2
Contact narnc: Charlynn Leifsen branch circuit
Each add'I branch circuit _6, 7.42 $4,4 62 2
Address; 10948 SE Valley View Terr Miscellaneous (service or feeder not included) ,.
Each manufactured or inodulnr 67.84 2
City/State/ZIP: Happy Valley, OR 97086 dwel lin , service and/o' feeder
Phone: ( 5 03) 698-3417 Fax::(503)698 -2486 , Reconnect only 67.84 7
Pump or irrigation circle 67.84 2
E-mail:
Sign or outline lighting 67.84 2
' ;t: : : ''''. ''t ; "''' , "t': ' '' :• ''''::' '':.:: : ;:':0: 0 11 40 114: * :: ';' ,2:. 1.• ' ' 1 H ' ' ''''...:'.::'•::::,'; '''',:,," • Signal cirouil(s) or limileti erKy
panel alteration, or extension. Page 2 2
Businessmne: Johansen Electric - '
Each additIonal inspection over allowable in any of the abov
Address: 10948 SE Valley View Terr Additional inspection (I. lir min) 66.25/ hr
6 , ( 2: h
): i, r
Investigation (1 hr mm)
City/State/ZIP: Happy Valley, OR 97086 Industrial plant (I hr min) 78.18/ hr
/ 3 Supry Lic 2053S
hone. (5 0 3) 698
il Fax: ( 503) 698
f .: . ,: Inspections for which no fee i a
specifically iisledS hr min)
(CS Lie.: 515 3 9 Electrical Lao
.'''..latCrtlicAL.;$.
Suprv. Electrician signature, required: ar'eg /90L# - '.444,../ Subtotol:
Plan review (25% of permit fee): /061. 74
P r in t name: Carl ohans en Date: 9/7/11 State surcharge (12% of permit fee); /..2.
Authorized sign(ature _ ...."*"-..„. __
____..-- -...) / ..
- • TOTAL PERMIT FEE: Az gg „./
This permit application nitres lie permit Is not oblidned within liti .
Print name: Charlynn Leifsen Date: 9/7/11 days after It has been accepted as complete.
* Number of inspections allowed per ',emelt.
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