Permit ` CITY OF TIGARD ELECTRICAL PERMIT II a
IN S COMMUNITY DEVELOPMENT 1 4 1 Permit#: ELC2011-00560
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.24 .: /Dliariall Date Issued: 10/11/2011
Parcel: 2S113AC00101
Jurisdiction: Tigard
Site address: 16655 SW 72ND AVE 200
Project: Stash Tea Subdivision:COUNCIL VIEW ACRES(LOTS 21-44) Lot: 37
Project Description: TI. 10/25/11,reprinted to correct address from 16270 to 16655 SW 72nd Ave.
1.
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:
FAX: 503-698-2486
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 10/11/2011 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 10/11/2011 $8.52
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 ance with ap• : ed 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. ATTE ION: Oregon law re.uire ou to follow the rules adopted by the Oregon Utility Notifica• -n r. Those rules are set forth in OAR
952-001-001 through OAR 952-001-009 o ma••tain a copy of the rules or direct questions to OUNC by call..t• 13.232.1987 or 1.800.332.344.
Issued By Permittee Sign. ure: �� i'
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.
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00560
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Date Issued: 10/11/2011
Parcel: 2S113AA00400
Jurisdiction: Tigard
Site address: 16270 SW 72ND AVE
Project: Stash Tea Subdivision: ROSEWOOD ACRE TRACTS Lot: C
Project Description: 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
FAX. 503 - 698 -2486
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 10/11/2011 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 10/11/2011 $8 52
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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_pbt:' - copy o - e rules or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
i
Issued By: ,e..% L ��.. !�� A.Al _ Permittee Signature: — Gi7i _
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.
Electrical Permit Application RECEV l OH UfhI( l 1 SI. (.)\I
City of Tigard Re ceived
.. g OCT C I 1 0 2U Date/B ( filril 1 w..... e
` 1 ° 13125 SW 1-tall Blvd , figjsM, OR 97223
l ' Phonc. 503.639.4171 Fax: 503.598,1960
�: , Ulherl'emtii,
t 1 a..c t: I r Inspection Line 503.639.4175 CITY OF TIGAI ; 10 Ste ra 8 e 2 (Or
Internet ww
t ti g qtr Supplemental Information
- -- d -or goy 81)I�DING MI
. OF WOO .., PLAII >irlvl�W
Please check all that apply (submit sour ofplans wiitania chocked below):
❑ New construction Es) Addition /alteration /replacement
f] Service or fbodor 400 amps or more ❑ B uilding over three stories
❑ Demolition ❑ Other: where the iveilable fault Lurrent ❑ Marini. mid honlyanta.
CATEGORY " accredit 10,000 etnpa et I50 volts or ❑ Floating buildings
kin to ground, or exceeds 14,15)0 ❑ C nittterclal•uac agricultural
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installation it buildings.
❑ Multi- family El Master builder ❑ Other: 0 Fire pump ❑ Installation of 75 KVA or
� � LOCATION ❑ 15ntergency.ytilom, larger separately eleriveet'iy'twn
' ❑ Addition Of now rfOlor loud of ❑ "A ", "13 ", "1 -2 ", "I.0 ",
' • I00MPor occu
Job no, Job site address. - 0 sw 72nd ❑ 711x or more n etidenliel units ❑ Recreational vehicle parka.
City /State /ZIP: ❑ Healthcare facilities ❑ Supply voltage for more than
❑ liazardouti locations, 600 volts nominal
Suite/bldg. /apt, no., Project name: stash Tea 0 Service or feeder 600 am ps to more.
Cross streeet/dircctions to job site. ' I
J lxwcrtpuan iris. .
Fa*. rnWl
- New residential single» or multi- fnrnily dwelling unit.
Includes attached garage.
Subdivision: I Lot too.. 1,000 sq. It or loss 168.54 4
Ea. add'l 500 sq ft or portion 33.92 1
Tax map /parcel no.' Limited energy, residential 75 OD 2
DESCItlFTION OF WO (with above sq ft.)
Limited onotgy, multi-family
Expansion residential (with above sq. iL) 75.00 2
' services or feeders Instullation and /or relocation
200 amps or less 100 70 2
t , 8PE , Q W,( R .. I C] Tt1I 201 amps to 400 amps 133 56 2
' 401 amps to 600 amps 200 34 2
Name.
. _ 601 amps to 1,000 amps 301 04 2
Address: Over 1,000 amps or volts 552 26 2
City /Statc/ZIP: Temporary services or feeders installation, alteration, and /or
f relocation . _ „
Phone: ( ) _ J Fax. ( ) 200 amps or lass 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 map. lzs OR 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amp hi 509 amps 108,54 2
Brunch circuits - new, alteration, or extension, per panel
Owner signature' Dale: __ A. Fix for branch circuits whir m' A, abuse service of feeder fan,
CONTACT each branch circuit 7 42 2
Business name: 13 Ice for branch circuits without
tJdhanaaeri Elect service or fonder fee, first 1 56 is 56.18 2
Contact name: Char lynn Le i f s en branch circuit
Hoch ndd'I branch circuit 2 742 1484 2
Address. 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
Each Ha
City /State /ZIP: Val OR 9 7 0 8 6 dwelling, service a or modular
PPY Y dwollinx, aervicn mid /or feeder 67'84 2
Phone. (503) 698 J Fax::(503) 698 -2486 Reuinnectonly 6784 2
Pump or img cirolc 67.84 2
E -mail:
Sign or outline lighting 67.84 2
. . , .... ,. ., 1 „. R . , ,,. ,, , , , Signal circuit(a)or limited- energy
Busmessname Johansen Electric panel, alteration, _ Psgc2 2
, __ _ Each additional inspection over allowable hi any of the above
Address: 10948 SE Valley View Terr Additional inspection (I hr min) 6625/lir V
City /State/ZIP: Happy valley , OR 97086 _ lnvnsltgntivn (l h r min) 64,2$ / hr
] plant (I hr min) 78,1.8/ hr
Phone (5 0 3) 698-3417 Fax: (5 03) 698-2486 Inspections for which no fee is 90.00/ hr
sgecifioully listed (14 hr ntin)
"
CCB Lic : 515 3 9 l Electrical Lie,: 3 I Suprv, Lie,: 20535 ti,X, *am imps,- -'
Subtotal 71.02
Suprv. Electrician signature, required' „ plan review (25% of permit fee):
Print name: Carl ohans en �C Date: 10/10/11 State surcharge (12% of penult Pee)' 8 . 52
Authorized signature. TOTAL PERMIT FEE' 79,54
'rhls permit application expires if a permit is not obtained within ISO
Print name' Char lynn Leif sen Date: 10/10/11 days after It has been accepted as complete.
° Number of inapceticm allowed per permit,
1 113elding \PemmLOO11l 6- PemniLApp dnu 07101/10 440 - 45197(1 l /OUCOM/WPR
Z /1 - asYd 98n86980S 98t' 869603 'Darla MaSIVHOr NV 9E :0T TTOZ'OT -400