Permit CITY OF TIGARD ELECTRICAL PERMIT
' - . COMMUNITY DEVELOPMENT Permit #: ELC2009 -00235
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/22/2009
Parcel: 2S112AD01000
Jurisdiction: Tigard
Site address: 7,00,7 SW- CARDINAL
Subdivision: Lot: 0
Project: Vacancy
Project Description: Reconnect only
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY 1 ea Reconnect Only 05/22/2009 $66.85
#300 1 ea 12% State Surcharge - 05/22/2009 $8.02
PHONE:
Electrical
Contractor:
JOHANSEN ELECTRIC INC
10948 SE VALLEY VIEW TERR
HAPPY VALLEY, OR 97086
PHONE: 503 - 698 -3417
FAX: 503 - 698 -2486
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $74.87
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 , R 9 2 -0011-- 100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. '
Issued By: ' lU K ._ Permittee Signature: ,N 6. /9/W L C`�770' - /
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'N Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
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Electrical Permit Anpl i .i n p � � ', r <iii t►I l.,f I t �1:.�,� 1 � `
„ ' : P, ir • 9 16 ---n Received
ry ,. C of Tigard n >�te B : �L.Nr CO' 0_ _.
%' 13125 SW Hall blvd., Tigard, OR 9
t 1 20U9 Plan Review • t Phone: 503.639.4171 Fax: 503.59 0 Date./By: Other Permit:
Inspection Line: 503.639.4175 / Date Ready /By: luri5^ Supplemental See Page Z for
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❑ New construction ® Addition/alteration/replacement Please check all that apply (submit l sets of pians w /items chocked below).
❑ Service or feeder 400 amps or more ['Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
= "a' z" qPl 3 t t 1 d E € r, C N >"�' n i 1 1. ai ` " i' qi'''1 ' 1 exceeds 10.000 amps at 150 volts or ❑ Floating bindings.
A a
,! li4 ro 4 11:11 i , 3 Nt +,
I _ . .. a a 44 -it - . ' r ,,,5, 11.:
ti + M less to ground, or exceeds 14 ,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ® Cornntercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi -family ❑ Master builder ❑ Other: ❑ Fire p1fnp. ❑ Installation of 75 KVA or
rl t „ n 1.,i t - . ■ i..._1 ; ❑ Emergency system. larger separately derived system.
. .'::IN i-li ftr '`i ∎� 'A . l • )
, ` ti od ` & �'vLI E ; ' d . t t , r U . , f aer' } f . 1.t . 21 r 4 w I u ❑ Addition of new motor load of ❑ .� ,. • 1 _2., ., ( - 3_
IOOHP or more. occupancy.
Job no.: Job site address: 7 0 07 SW Cardinal Ln ❑ Six or more residential units ❑ Recreational vehicle parks.
I=I Health-care facilities. ❑ Supply voltage for more than
City/State/ZIP: ❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: 1 Project V a c a n cy ❑Service orfeeder600ampsormore
J r;4 . e. 6"
r. `
txr +o - a ,t
��w i#Ytttl�- �•au8u `(1 -.t,Ei d �l .t ! 1;..2f1� ixc ° �! ` f .i -� . I r
Cross street/directions to job site: nescriatbe I Qtr. I fee. I Total r •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. f. or less 145.15 4
Ea add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
w ¥+s�r� 2 ;l t s . 75.00 2
k:1':A . I, a .''tflls ) ga t ,, I , i 4 �'' ' } : i�_ I1 t�ll! , �.� 'ld x. - - . ,,• , i (with above sq. ft.)
/L Limited energy, multi- faintly 75.00 2
/ ( Add service for vacancy residential (with above so. ft.)
a Services or feeders installation, alteration, and/or relocation
µµ 200 amps or less 80.30 2
Tip,' r - A t)!. i - . t it i.. � I'
li t 04'_ �' r a -... & ., i l l r !69 . , ; > ®u isle l 201 amps to 400 amps 106.85 2 .
t uet uea� .asar
.r.', 401 amps to 600 amps 160.60 2
Name:
601 amps to 1.000 amps 240.60 2
Address: Over 1,000 amps or volts 454,65 1 2
Ci /StatetZ1P: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 10030 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, er panel
Owner signature: Date: A. Fec for branch circuits with
r, 4 ' 4 a J t ' " ' a serv o r feeder fee
� .1.. i T v i kl it s s 1a v '4i�' 665 2
each branch circuit
Business name: Johansen Electric Inc. B. Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: Charlynn Leifsen first branch circuit
Address: 10948 SE Valley View Terrace Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /StateJZIP: Happy Valley, OR 97086 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (503) 698-3417 Fax:: (503) 698 -2486 Reconnect only / 66.85 6G, 2
E-mail: lobansenelect@msacom Pump or irrigation circle 53.40 2
1 ':. ': `tall l F ' r .• _'? ' s, 1 1- 1E'tit i1 n ',e ;,,'l rl‘i . hill 1.t" 'j Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: Johansen Electric Inc. energy panel, alteration, or
Address: 10948 SE Valley View Terrace extension. Describe: Page 2 2
-
City /State/ZIP: Happy Valley, OR 97086 Each additional inspection over allowable in an - of the above
Per inspection 62.50
Phone: (503) 698 -3417 Fax: (503) 698 - 2486 Investigation per hour (1 hr min) 62.50
CCB Lic.: 51539 Electrical Lie.: 3 - 243C Suprv. Lie.: 2 0535 Industrial plant per hour 73.75
�{/ p .! ,',0it i 1.1 m aE. . _t..:: i' ,.. m..$1. ' iirr
Suprv. Electrician signature, required: /N t 'r Subtotal: • (,, . ...5
Date: 5 / 14 / 0 9 Plan review (25% of permit fee):
Print name: Carl K. Johansen State surcharge (12% of permit fee): 0,2
Authorized signature: (,----- TOTAL PERMIT FEE: 7y k 7
This permit application expires if a permit is not obtained within ISO
Print name: Charlynn J. Leifsen Date: 5/14/09 days after it bas been accepted as complete.
• Number of inspections allowed per permit.
I.\ auildtaglPernitslE LC- PermitApp.doe 05/23/06 440.46157(1. 1/o5.COM/VJEB
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