Permit 14 CITY OF TIGARD ELECTRICAL PERMIT
1111 COMMUNITY DEVELOPMENT Permit #: ELC2011 00579
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Date Issued: 10/18/2011
Parcel: 2S113AA00300
Jurisdiction: Tigard
Site address: 16330 SW 72ND AVE B3
Project: A Cut Above Subdivision: ROSEWOOD ACRE TRACTS Lot: C
Project Description: (2) branch circuits for restroom remodel.
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
2 crt Branch Circuits wo /Purchase 10/18/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 10/18/2011 $7 63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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
Issued By: Permittee Signature: f'# _.`
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.
t
Electrical Permit Application OCT 17 2011 htilr 1 rl( El 41: uNty - -
City of Tigard Rc onvi l/ Vcm,it No g I TY OF TlGAfRD I'" 11 : o - —(-'66 7
' 13125 e SW Hall Blvd „ 'l5gard > 03, 9722
` a Phone' 503.639,4171 Fax: 503.598
I t e i,�; 1? inspection Line: 503 639 4175 DVI LDII'JG DIVISIO , Date Ready /By, lam fel See Page 2 for
Internet www.tignrd- or..gov At �y /�ypp�y Notified /Method p at � rf�py S y upplemental lnforrnutlnn
^M1:.,:1, ;.f �I `. ;, y� '' dF .*idAit:. •,. r, ., ,, ' oidti�� w A.W ,.r:. I „ :
Please chock all that apply (submit j sets of plans w /beet chocked below):
0 New construction El Addition /alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
0 Delnohtion 0 Other, where the available fault current 0 Marinas and boatyards,
` ,it..''''`' ; „ •CAT }Q3O'R Or, COtV &G ciN o„ ' ,. ` exceeds 10.000 amps al 150 tolls or ❑ Floating buildings
less to ground, Or exceeds 14,000 ❑ Commercial-uae agricultural
0 1- and 2- family dwelling ® Commercial /industrial 0 Accessory building amps for all other In'111ation' buildings
0 Multi-family 0 Master builder 0 Other: ❑ p' pump in Installation of 75 KVA or
may y ❑ Emergency system. larger separately derived system,
:' ( U13 IA'IOl'i A7'D + A a , ; pAddition anew motor load of 0 "A", "E” "1 -2" "1 -1°
na: Job site add ress; tool1l or mom ocoupnney.
Job
to Six or more residential units. ❑ Recreational vehicle parks,
City /State /ZIP' - ❑ I te,dti•caru facilities ❑ Supply voltego for more thus
❑ I btlardeus locations 600 volts nominal.
Suite/bldg./apt. no.; Project name: A ad . VO El Sarviea or feeder 600 amps or tonic.
Cross street /directions to job site: D .,erl p uon I Qty &o. . 1 f Taf " .I •
New residential single or multi - family dwelling unit.
Includes attached garage.
Subdivision' I Lot no,. 1,000 sq, ft. or less 168.54 4
--- Ea add'l 500 sq. ft or portion 33.92 l
Tax map /parcel 11o. Limited energy, residential 75 00 2
'' pEs ,14;l'1o11V o , r OR ' '' , ' .. (with above s ftJ
I •i mtted energy, multi 75,00 2
Y'Q y .r M ruY Q 1 residential (with above sq. R•) _
Services or feeders installation, alteration, andlor relocation
200 amps or less _ 100.70 2
•, , "�" �' F ? ! � Z 4 t'1 . 201 amps G, 4(lfl amps 133 56 2
401 amps to 600 amps 200.34 2
Name. _. an 1 amps io I ,000 amps 301,04 2
• Address: over 1,000 amps or volts 552 26 _ 2
City /State /ZIP:
Temporary service., or feeders installation, alteration, antle
Phone ( ) I Fax: ( ) _ 200 turps or Into 59.36 I
201 amps to 400 amps 125 08 2
Owner installation: This installation is being made on property that I own which is not
401 amps in 599 snips 168 54 2
intended for sale, lease, tent, or exchange, according to ORS 447, 449, 670, and 701
Branch circuits — new, attoratian or extension, tier panel
Owner signature' Dale: — A. 1 -nn for branch oirouits with
'' • 'ts. .q, Ie100. '' �, CoI9'i cT P, so ', , above brunch service or feeder fee, 7 42 2
ouch br unch uiruuil
B, I•ce for branch circuits udthoat
$uriinet:a 4Tohansen Electric ,erv;co fender fat sjYc4 ,y
C nama: Char �teifsen
branch circuit I 56 18 lL
Each add'I branch circuit l 742 "7 , u2 2
Address' 10948 SE Valley View Terr Miscellaneous (sesylce or feeder not inctuded
—" Rach manufactured or modular 67 84 2
City /State /ZIP: Happy Valley, OR 97086 _ d svellinX, serviw andh fnmIor
Phone: (5 0 3) 698-3417 1 Fax: : :(503) 698-2486 Reconnect on iy 67.84 2
- • • Pump or irrigutton eirulu 67 84 2
E -mail; Sign or outline lighting 61 2
.. ,. . ,_ '. ��' �� 1: 1 Signal cireuit(s) or limiled•onergy
panel, alteration, or extension Paget 2
13usiuess Johansen Electric
Each additional insp ction over allowable in any of the shove .
Address 10948 SE Valley View Terr Additional inspection (lhr 66.25/ `
Investigation (1 hr min) (,6 25/ hr
City /State /ZIP. Happy Valley, OR 9 7 0 8 6 Industrial plant (I hr mm) 78 18/ hr
Phone (503) 698 -3417 1 Fax ;(503) 698 -2486 Inspections for which no fee le
speciiitully listed (15 min? 90,00/ hr
CCB Lie' 51539 { Electrical Lie: 3-2 4 3 C I Suprv. [,to„ 2 053S �' , , tP1DM[CiL:P1 '' "nts` : ;.', "-;', „ ; , y
/> k Subtotal: i q, 66
Suprv. Electrician signature, required' / "..�1 P lan review (25% o f p enult fee)
Print name: Carl ohansen Dec 10 / 17 / 11 State surcharge (12% of potmtt tee). !. f 3
me
TOTAL PERMIT FBF I
Authorized signature,
This permit application expires if a permit Ii not obtained within 1110 Q
days after it ham been accepted as complete.
Print name: Charlynn Leif s en Dec 10/17/11 + Number of inspections allowed per permit
L1 Retl \PermitxlE.l•C_perm Opp dec 07/01/10 440.4615T(11105/COMAVS2
/ T 'aeva 98P3869809 9817Z869CO5 ZDHZH NHSNVHOf LsW 9S :OT TTOZ'LT'goO