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Permit ,, CITY OF TIGARD ELECTRICAL PERMIT ` °� 11: CO MMUNITY DEVELOPMENT Permit #: ELC2011 00621 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/03/2011 Parcel: 2S101AD03200 Jurisdiction: Tigard Site address: 12909 SW 68TH PKWY 350 Project: Williston Financial Group Subdivision: WEST PORTLAND HEIGHTS Lot: 9 -25, PT Project Description: TI. 11/17/11, reprinted permit for address correction. 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 25 crt Branch Circuits wo /Purchase 11/03/2011 $234.26 Specifics: Service or Feeder 1 ea 12% State Surcharge - 11/03/2011 $28.11 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: • Total $262.37 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 t. - . - ' opted by the Oregon Utility Notification Center Those rules are set forth in OAR 952- 001 -0010 through O • c 1 2- 001 -0090. You may obtain a co•r direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344 Issued By: � . Permittee Signature: /� �c -/ AIM 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. a CITY OF TIGARD ELECTRICAL PERMIT '= COMMUNITY DEVELOPMENT Permit #: ELC2011 -00621 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Date Issued: 11/03/2011 _ . _! g Parcel: 2S101AD03200 Jurisdiction: Tigard Site address: 12909 SW 68TH PKWY 300 Project: Williston Financial Group Subdivision: WEST PORTLAND HEIGHTS Lot: 9 -25, PT 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 25 crt Branch Circuits wo /Purchase 11/03/2011 $234.26 Specifics: Service or Feeder 1 ea 12% State Surcharge - 11/03/2011 $28 11 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $262 37 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 =or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344 Issued By: . sr" Permittee 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), ey \gt Electrical Permit Applicatio.nao Ns _ + l Olt Oi I I f. l s1•:'»i.1 • City of Tigard ' Received �,. r L� 1 Aatc /]3 . ,- + 131 25 SW Hall 031vd, '1'igard, O 0,7223 ` ill• �t .. .' iZS a ' Phone. 503.(539,4171 Fax, 503,59R 1900JV ' C ClthcrPcnnrt inspection Line 503 639 4175 t ) An Ku Ill tsar j � ® SecPri e 2 fin. Internet www.tigurd - ter goV 1 0 , NouOcd /Method • �V Suppimatntal Inrntmadtn z Please check all that apply (submit j sets of plans w /Itont checked below) ❑ New construction Eg Addition /alteration/rcplaccmcnt ❑ Service or feeder 400 neaps or more ❑ Building twat three stories 171 DCtnpli( +On ❑ Other' whcro the available fholt current ❑ Marinas and boatyards 'C_ '" 4' ' " „' , ; i , y,,, "" , ,i1'0 iA : V O' CON p o ' . ;', ' ;t�'', N - e,' exceeds 10,000 strips at 150 volts or 01ctouting buildings. can to ground, or exceeds 14,000 C] Commercial-use agricultural ❑ 1- and 2- family dwelling El Commercial /industnal ❑ Accessory building amps for all other installations buildings. © Multi- family ❑ Master builder ❑ Other, Cl ears pump D Instniiiim n of 75 KV or [� 1',matgmney system larger separately derwed system. a'•t ' i ' B' sri*'ttom ''tpri';'s X1 +A ti'' , '. :A,, Q Addition of new motor load of ©c'A” c'E" "1 -2" "1.3 ", IOU or mono residential haul Uioy Job no.: l Job site address: 12 9 0 9 SW 68th Pkwy ❑ Six of more rostdcntml units, 0 Itewrua +zonal vehicle parks City /Stoic /ZIP; in Health -care facilities, Q Supply voltage for more than _ 0 Hazardous locations 600 volts nominal Suite/ bldg, /apt. no ;).- 'Do I Project name. Williston Financial D Service or feeder 600 amps or more, Cross street/directions to job site, _ tkacripuon L9 s, t F. r i`ethit j • New residential single- or multi family dwelling unit. Includes attached garage. Subdivision: I Lot no,; 1,000 sq. ft. or less W. 158.54 4 Fa add'] 500 sq ft. or portion 33,92 1 Tax map /parcel no„ 1 lira Led nnerey, resreaeutiul 75,00 2 ,' ' n 'x030,106. tiY: * 1 's (with above sq, ft.) Limited energy, multi- family 75 00 2 Tenant I mrrovement residential (with above Sq ft ) Services or feederslnstatlatlon, alteration, undlor relocation 200 amps or leas 100.70 2 O QW1 i `lliI ''I 201 amps tu400 amps 133.56 2 ref AP h1 401 amps to 600 amps 200.34 2 NaR1C: 601 amps to 1,000 amps 301.04 2 Address, Over 1,000 ampt or soils _ 552.26 2 - Temporary services or feeders lusiallation, alteration, and/or City/Stale/ZIP: relocation Phone: ( ) Fax, ( ) 200 amps or loss I 59 16 I Owner installation; 'I his installation is being made on property that I own which as not zo I amps to 400 amps 125.08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps, 168 54 2 Branch circuits — new, alteration, or extension, er panel Owner signature: Date: A, Pen for branch t,ircuitu with above service or feeder foe, ', IA�11 . �I � l 1,h1't ' .rag , . ca h branch circuit 7,42 2 l3u81ness ntu»e; 13 Pee for branch circuits without Johansen Electric service or feeder fee, first Contact name. Charlynn Leifsen _ branch circa, t 1 56,18 .18 2 Each add'] branch circuit 24 7,42 1 7 8 . 0 2 Address: 10 9 4 8 SE Valley View Terr ' Miscellaneous (service or fecder not Included) - Valley, e OR 9 7 0 8 6 Each manufactured or modular 67,84 2 City /Stale /ZIP: Happy Y r dwelling, service and/or feeder Phone: ( 5 0 3) 698-3417 Fax. , (503) 698-2486 Reconnect only 67,84 2 I - Pump or irrigation oircln 67.84 2 E -mail: - c Sign or outline lighting 67.84 2 , , "' ' ,. ,CO� 0 '' '' ' 1 ' - Signal circuit(s) or limited - energy l�ugttle,SBname: Johansen Electric punei,ultnrniinn , nre Pa 2 Each additional inspection over allowahlo in any of the above Address: 10948 SE Valley View Terr Addit hr sin) 6625 /hr City/State/ZIP: Happy Valley, OR 97086 lnvnstigntion(l GC,25 /hr - Industrtal plant (1 hr min) 78 18/ hr Phone' (503) 698-3417 Fax' ( 503) 698.-2486 Inspections for which no fee is 90 00/ hr y spneuficully, hated hr min CCB Lio.: 51539 I Electrical Lie.: 3 0 Suprv, Lie.: 205 3 5 ('A ; cos ;; .- , subtotal' 234.26 Suprv. Electrician signature, required; 0404144 Plan review (25% of permit fcc) Print name: Carl J arisen ' Auto, 11/2/11 S11atc surcharge (l 2% of lx:nnit fee) 28.11 Authorized signature' `" To I AI. I >IiTtNll'1' FEE' 3 7 � , _ This permit application expires if a permit It tint obtained within 1180 day■ after it has been accepted at complete, Print name: Charlynn Leif Seri m ale: 11/2/11 * Number of inspaclimis allowed per permit. 1V ludding\ParrmtnlELC•PcumuAppdot, 07/01 /10 440- 46151(11105 /t'OM/WPIR - Z /T '3EVd 98172869£09 98TiZ869E05 1.0''1a NaSNVHOr Tad CC:PO TTOZ'ZO'noN