Permit CITY OF TIGARD ELECTRICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00614
Date Issued: 11/03/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Parcel: 2S113AB01201
Jurisdiction: Tigard
Site address: 16290 SW UPPER BOONES FERRY RD
Project: Dow Agrosciences Subdivision: COUNCIL VIEW ACRES (LOTS 21 -44) Lot: 30
Project Description: TI
Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES LP
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
1 ea Services or Feeders - 200 11/03/2011 $100.70
Specifics: amps or less
7 crt Branch Circuits w /Purchase 11/03/2011 $51 94
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 11/03/2011 $18.32
Electrical
Type of Const:
Occupancy Grp:
Total $170 96
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 , oft r ct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
�/ - C
Issued By: / Perm ittee Signature:
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.
` i
Electrical Permit ADDlicati" lit, C�� t t► OH- it 't: I Si.: O 1.1
14 City o Tigard � Rceoive<,
Y natnllt . of �_..._
13125 SW flail Blvd., '1 igard, OR 9722 » 1 Plan Review
I ' Phone: 503 639,4171 Fax: 503 „5981 t)'`' %t. " v
. ilJax/B , MZMIIIMIIIII
, t (,,-;\ It:l'n Inspeclion Line 503.639 4175 � ti v ' ,. i 1 Pate Ready /By, ( :5 Sec Page 2 err
Internet www.ligard- or,gov �`y W11�y v VI Nonliud/hiethod: Supplemental information
`' i'; 1 , - '' :4, `
'h',4'F';T- . ;,'„ f , , 'y' ; ; . • ,y+ _ 4 A04* '
El New Construction Addition/alteration /replacement Fiance cheek all that apply (submit acts of plans wlilb r t chocked blow)
❑service or fetdor 400 mops or more 0 Building over three atones.
0 Demolition 0 Other where the available fault current ❑ Marines and boatyards
i : : + '; I•'2.' °'• " �` * o „r ' 1(vr0 , ' 1 ” ; exceeds 10,000 amps at 150 volts or ❑ Floating buildings,
% less in ground, or oxeoeds 14.000 ❑ Comnreratal -use narie-WHural
(] 1 and 2- family dwelling IN Commercial /industrial El Accessory building amps for all other insta,lntinna. buildings,
CI Multi - family p Master builder ❑ Other: ❑ b iro pump ❑ Installation of 75 KVA or
Ernargun¢y swam larger separately derived system.
•'i'', 't't 4 ‘ ' r x*' Lek
x�a, �ir a *�' «AklOil • , "' , • a Addition of new motor load of ❑ „ „ 2 .. .. 1 ;..
lob os, Job site address: //^ p/, �j � Q, � j 1.11P or outarpumy
/ -/ /� - � C/ �� /�G¢/Y(y ❑ tii .x more rosidetuiel amts_ ❑ Recreational vehicle parks
City /State/ZIP, ❑ Health.ear¢ facilities CI Supply voltage tbr moro than
0 ]lsiardoua locations. 600 volts nominal.
Suite/bldg, /apt, no.: Project name: pow ,- 4 i L1 Service or feeder 600 amps or snore.
Cross street/directions to job site: Description I Qty. i Frt.. I 'rot,.t ,,.
New residential single- or multi- family dwelling unit. 1
Includes attached garage.
Subdivision' I Lot no.: 1,000 aq. ft. or foss 168 54 4
P,a odd'! 500 sq ft or portion 33 92 1
Tax map /parcel 110.; Limited energy, residential
•�•' r. 1 �. � 75,00 2
iDEs RAITC1!T' 'WOW' . ; , ..., ; (with above ft)
f/ n l,imitn energy, multi-family 75 00 2
/Tad � rea /j 1 - A j / y„ t '/ f" ✓ residential (with above sq, fly)
!! GG�GG CC �` Services or feeders installation, alteration, and/or relocation
e/ / /Mee 200 amp, or les% I 100,70 /46. 1U 2
" s 133,56 2
201 am s to 400 nm
Name, 4(1 t amp, to 600 amps 201) 34 �
601 amps to 1,000 amps 301,04 2
Address' Over 1,000 amps 0r volts 552,26 w 2
City/State/ZIP: Temporary services or feeders Installation, alteration, and/or
_ relocation
I
Phone, ( ) Fa ( ) 200 amps or less 59 36 1
201 =pa to 400 slops 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 extens erpnrlel
Owner gignattiro,_ Date; A, Pee for brunch circuits with
b, . 0' k; G 'l''.', ' 0 GO TACT w> ' 1 sO1,t( . above service or feeder fee, 7,42 �')� 2
,r uch bruna circuit
Bursinesestatue: Johansen Electric 13 , aer for
serves or (odor fco, first 56 18 2
Canteen name, Charlynn Le i f s en branch circuit ,
Each odd'I branch circuit 7.42 2
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
Each manufactured or modular 67 84 2
City /State/ZIP: Happy Valley, OR 97086 dwelling, service tin d/or feeder
Phone:(503) 698 --3417 I Fax::(503) 698 - 2486 Ruuutnet 67 84 2
Nl m p Or trr+(tatian circle 67,84 , 2
E -mail; run Sign or outline lighting 67 84 2
,.. „:,.,, '' , . ti3Oorilt4 TQR ',!'- ,, „ . .. Signaleireuil(s)oillimited- energy
panel, alteranon,orextension, Page 2
Businesstivxce' Johansen Electric
Each additional inssrection over allowable in any of the above
Address, 10948 SE Valley View Terr Additional inspection (I hr min) 66,25/ hr
City /Stato/ZIP. Happy Valley , OR 9 7 0 8 6 Investigation (1 hr min) 66 e,5 / hr
Industrial plant 0 hr mm) 78.18 / hr
Phone, (5 0 3) 698-3417 Fax, (503) 698-2486 in apectlntla for which no fee is 90 00/ hr
sgceifically listed (,th hr min)
CCB Lie.: 5153 9 I Electrical Lie„ 3 - 2 4 3 C Suprv. Lie.' 2 0 5 3 S ' . •,' g'l ' e tt * 1-,., - "' :' ' ' •• „E;'' : '
� Sub t otal / � � . ( v q
Suprv, Electrician signature, required: C k /, / ,,. , r Plan review (25% of permit fee
Print name: Carl Johansen /bale: 11/1/ State surcharge (12% of permit fcc) /E5,-.3e.
T, hi
TOTAL PERMI ?.. / 76 , /4,) Authorized signature: This permit application expires it a permit li not obtained within 181)
days after It has been accepted as complete,
Print name: Charlynn Leif sen Dale: 11/1/11 • Number of inspections allowed par permit
I Inuddmg \Pcrmns■Ft,C- PermLApp due 07101 /10 440- 4615T0I IIIOICOMI'WOD
Z /T 'EDVd 98T7Z869CO5 9817Z869CO5 IDE'IH NaSNKHOr wd OZ :T70 TTOZ'TO'noM