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Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2011 -00496 1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/08/2011 TIGARD Parcel: 2S112DA00800 Jurisdiction: Tigard Site address: 15115 SW SEQUOIA PKWY 110 Project: Integrated Services Subdivision: PACIFIC CORPORATE CENTER Lot: 2 Project Description: (1) 200 amp service and (10) branch circuits for TI and generator. 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 1 ea Services or Feeders - 200 09/08/2011 $100.70 Specifics: amps or less 10 crt Branch Circuits w /Purchase 09/08/2011 $74.20 Type of Use: COM Service or Feeder Class of Work: ALT 1 ea 12% State Surcharge - 09/08/2011 $20.99 Electrical Type of Const: Occupancy Grp: Total $195.89 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OA' 952 -'' 6090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: 4 7 7: tv_._ Permittee Signature: o/et/ € e / (W — OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease or rent. OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. -"AY' ' 1 Electrical Permit Application t\ °i � i'oI ni•t ice i .si ()NIA A City of Tigard `9v \ DatclBd qO ,�- permitNn.: O rO 7 L'Q7 6 w 1 31 25 SW I11111131vd., Tigard, OR 9722 9 9 Phone: 503.639.4171 Lux: 503.597i1 110 C �Q ` OtherPcnnit�uV� /1'-QO/�, fli'• Inspection Line: 503.63 0.41 75 J � � r. See Page 2for Inc mt t; wWtv.ti$atYl- OL,1jOV _..01 6 � '1 \� Supplemental Information - : r .. • T Al�q1@6 yt vtt i pW "v !L 0 construction ® Addition /alteration /rep`l teetnent nom check all that apply (submit2 sera ot plans w /lien' checked below): I;] Service or fecdcr 400 amps or more 0 Building over three stones. ❑ Demolition ❑ Other where the available fault current ❑ Marilee and boatyards. r" S '. ;:• CI(cceds1Q000&tnp9st150 volts or © Floating buildings. tem to ground, or exceeds 14,000 n Commercial -use agricultural ❑ I.- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps (Or all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other ❑ fire pump. ❑ Installation of75 KVA or ❑ Entergettcy syatrtl. larger separately derived system. , ' I' i0$ g $ ' '�ATIOt4 AW T ' . ❑ Addition nfncw motor load or ❑ "A• „ E ,, , "1_2 • 100HP or mere. occupancy, Job no,: 1 Job site address: 15115 SW Sequoia Se 0 Kiwi-tuitional al vehicle arks. n � _..__... 0 or more residential units, I City /State /ZIP; 0 Health -care fitoilities. 17 Supply voltage tbrtnore than ❑ Hazardous locations. 600 volts nominal. Suite/bldg,/apt, no,: 110 Project name: 1 ❑ Service or Roder 600 amps or more. . r0 : .i .. y ' Cross street/directions to. job site: Description I Qtr i Pee 1 Total . E ' " - . New residential single- or multi - family dwelling unit. Includes attached garage, Subdivision: „ Lot no.: 1,000 sq, A or less 168.54 4 Ea. add'l 500 sq. ft. or portion 33.92 i Tax leap /parcel 110: -'-""" Limited energy, residential 75.00 2 ' p Rlt@l If1tK.;O VVf�I2 C (with above sq. $) Limited energy, y i residential (with multi -family above 9. 75.00 2 " / 'r! si ( aboe II.) Services or feeders installation, alteration, / and /or /t0 relocation g °l ' ( '1 , 200 amps or less _ / 100,70 f .10 2 w; �' ,'1(i'll i:•i Pt i _ 201 amps to 400 snip 133.56 2 Name: 401 amps to 600 amps 200,34 2 _ 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 emirs or volts 552.26 2 City/State/ZIP: Temporary services or feeders installation, alteration, and /or _ reluudlon Phone: ( ) Fax: ( ) 200 amps or less 50.16 1 201 amps to 400 amps 125.013 2 Owner Installation: This installation is being made on properly that I own which is not intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 40 i imp, to 500 amps 168.54 2 Branch circuits -- new, alteration, or extension, per panel Owner signature:_ ate: A. tree for brunets circuits with i 42 � ' r g � A , y a, Lg O shave ervr r ice J 7 , y !?'F! i �' _ °i°'�PWwP1 wwh br ice ci feede /t� (7(, 2 Business name; Johansen Electric 13, Pee for branch circuits without service or feeder fno, first 56.18 2 Contact Charlynn Leifsen branch circuit Each add') branch circuit 7,42 2 Address: 10948 SE valley View 'err Miscellaneous (service or feeder not included) _ City/State/ZIP: Happy Valley, ey, OR 9 7 0 8 6 dw Each manufactured or unoduler 67 S4 2 - - elling, service and /or feeder Phone: (50 3) 698-3417 Pax; : (503) 698-2486 Reconnect only 67.84 2 $- ttiail Pump or irrigation circle 67.84 2- Sint or outline lighting 67,84 2 .'' t s T i"T'OR ., Signal 9ireeit(s) or limited- energy pancl,slicratirnn,orcxtcnairnt. Page 2 Businessnawe: Johansen Electric Each additional Inspection over allowable in any of the abov Address; 10948 SE Valley View Terr Additional inspection (IhrOlin) 66.25/ hr investigation (1 hr min) 66.25/ hr City /State /ZIP: Happy valley, OR 970 8 6 Industrial plant (1 hr min) 78.18/ hr Phone: (5 0 3) 698-3417 Fax; (503) 698-2486 ,Inapcationa for which no do is 90.00/ hr ��7 ��l y / specifically listed h hr min) gCCB Lie.: 51539 Electrical Lie.; 3 - 43C rv. L' .: 2053 S „ „ •: , E (asA J'X ' "tE ',; ':..,: Subtotal: , 7 y, .96 Suprv, Electrician signature, required: Plan review (25% of pennit fee): Print naine: Carl J hams en Date: 9/7/11 / 7 / 11 State s1ucharge (12% of pemtit fee): .eQ, 9 Authorized signature: This TOTAL PERMIT FEE: `�, , Phis permit application expires Ira permit is not obtained within 1110 days aver it bus been accepted as cnmplato. Print name: Charlynn Leif s en Date; 9/7/7_1 + Number of itispections ellowtet nor permit. 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