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Permit CITY OF TIGARD ELECTRICAL PERMIT 1111 ' 2 COMMUNITY DEVELOPMEN Permit #: ELC2011 00624 Date Issued: 11/04/2011 T I,GARD 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439 Parcel: 2S113AD01900 Jurisdiction: Tigard Site address: 16640 SW 72ND AVE B10 Project: Veris Industries Subdivision: ROSEWOOD ACRE TRACTS Lot: D Project Description: (10) branch circuits for warehouse machines Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES 10948 SE VALLEY VIEW TERR ATTN: N PIVEN HAPPY VALLEY, OR 97086 15350 SW SEQUOIA PKWY #300 PORTLAND, OR 97224 PHONE 503-698-3417 PHONE: FAX. 503 - 698 -2486 FEES Quantity Description Date Amount 10 crt Branch Circuits wo /Purchase 11/04/2011 $122 96 Specifics: Service or Feeder 1 ea 12% State Surcharge - 11/04/2011 $14 76 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $137.72 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 c f the rules or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344 . Issued By: ��% ��y r G �!� - Permittee Signature: .ice 1 1 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 RECEI V�+ . . . Fc>>t.(ll 1 f( i _ . . , :-1 st tr 0 City of Tigard RI 8'd %/' © � !�a. 11125 SW Ilidl Blvd , 'Tigard, OR 97223 NOV 0 3 2011 ,--• 1 phone 503 639 4171 Vex 503 598 196() iiiiii11111111111111 Other Permit 1 i t,n It li Inspection Lure: 503.639.4175 CITY OF TI A R 1)irle. Ready /Hy ° Sao Page 2 for Internet: www,tigard- or ` �J��Q�A�O � $i / � D �( j��� N ' otified /Method: �yq ��1 Supptemental Information / n' " ' 'i �� rlt ' k.' t '': 0*•'.. • • T Y' ,..., Ott T r ,,.. ' ( _ . • FI.I/TF.1'.�.1 t ,. N ... ❑New construction I Addttion /alteration /replacement Please check all (hat apply (subniil2 sets of plans Whams chocked helow)• ❑ Service or feeder 400 amps or more © Building over three stones ❑ Demolition © Other: where the available fault current ['Marinas and tmatyar'2b. ` r 7 , 7 / : 7 ' '` m r - y "'(''- %:'; • , o' Coeds 10,000 tulips at 150 volts or [] Floating buildings, lens to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ I- and 2- family dwelling Conunercial /industnal ❑ Accessory building amps for all other installations buildings, ❑ Multi - family Cl Master builder ❑ Other: ri Fire pump ❑ Installation of 75 1;V n or a r � (�, ,• i p• , El Emergency ardent larger separately derived system, �r J)B" 1'.i" Mr/OS: A ij 'Li TON' �' ( ❑ Addition of now motor load of ❑ "A" "F" "1 -2" "ha ", 100HP or more, occupancy. Job no.; Job site address, 16640 SW 72nd ❑ Atx or more residential units. t l keen:miens] vehicle parka. City /State/ZIP: ❑ Health-care facilities, U Supply voltage for more than —_ El Hazardous locations 600 volts nominal Suite/bldg. /apt no : I Project name: Ve r i s Industries ❑ Service or Roder 600 amps or more Cross street/directions to job site. uwmrlptinn I Qty, I Pee. L Tu*ni 1 • ' - New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision, 1 Lot no.: 1,000 sq, fl, or less 168 54 4 Ea add'I 500 sq. ft. or portion 33 92 I Tax map /parcel no,: Limited energy, residential 75.00 2 ., "'"'•'','' . '.' .' •,. ' iN,'O W :,': , i• ; (with above sq tt) • T ' , Limited energy. multi -family 75 00 2 warehouse machines - residential with above sq f1) Services or feeders installation, alteration, and/or relocation 200 amps or Ices I 100.70 2 (i I 64 :OW' ER' , ' ; '[ , • r , 7' 7 , ' ? i , t , ., 201 amps to 400 amps 133 56 2 Name. 401 amps to600amps 20034 2 601 amps to 1,000 amps 301.04 2 Address' Over 1,000 amps or volts 552 26 2 ' Temporary services or feeders installation, alteration, and/or City /State /ZIP: relocation - - Phone: ( ) 1 Fax: ( ) 200 amps or less 59.36 1 -- Owner installation: This installation is being tirade on property that I own which is not 201 amps to 400 amps 1xS 08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 67(1, and 701. 401 amps to 599 amps 168.54 2 Branch circuits -- new, alteration, or extension, per panel Owner signature, Date: A. Fee for branch cirotuta with ^„ ,' ;., � ; , . ��' JS . , abuse branch u nr feuds, foe, each branch circuit 7 42 2 13US3IICa9 naMC: B Fee for branch circuits without W Johansen Electric service or feeder foe, first Contaotname' Charlynn Leifsen branch circuit , 5618 r / ��/ � �Clr � r 2 tuich iidd'1 br final, dreeit if I 7 42 44,7r 2 Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not included) Valle OR 97086 Dash manufactured or modular City /Statc/ZIP. Happy I PpY Y i dwdhn service and/or feeder 67,84 2 - Phone: (5 0 3) 698-3417 Fax:: (5 0 3) 698-2486 Reconnect on 67 Aa 2 _. - - Pump or irrigutton eirele 67.84 2 E-mail. Sign or outline lighting 67 84 2 .�, „, °, r,,�� � . ° ^,r ,:. .. . -,�. � & '' ':' �' ' ,t,.; '• ._. ,'t`p1V`x`JVi#i,,.''Oxt., ' 1 , Signal circuit (n) orlinrited•eiergy Busincssnamc: Johansen Electric point ullerahim,urextcniatoi. Papa 2_ 2 Each additional Inspection over allowable In any of the abov Address: 10948 SE Valley View Terr Additional mapcction(Ihrmin) 66.25/hr City /State/Zi P: Happy Valley, OR 97086 Industrr Investigation (l hr nun) 7 / hr Industrial plant (1 hr min) 7A 8 18 IA/ hr Phone' (503) 698-3417 1 Fax: ( 503) 698-2486 Inspections for which no fee is 90 00/ hr specifically hslad 'Y hr rm) CO3 Lic,: 51539 1 Electrical Lie.. 3 L Suprv. Lie.: 20535 1' $ ' ,, I, \ ; Subtotal: a2, Suprv, Electrician signature, required: _d /7 1 n i� _ Plan review (25% of permit fee). Print name: ate: State surcharge (12% o f amt fee): Ca i7 , assn � 11/3/11 >� ) /W Authorized signature: OF � TOTAL PERMIT FEE. �” � �� rhts permit application expires If a permit is not obtained within 180 days after It has been accepted as complete. Print name: Charlynn Leif s en Date. 11/3/11 * Number of inspections allowed per permit 1• 113uildmg \PermitTAT1LC.PermiLApp doe 07/01/10 440 - 46151(11 /05/COMAVEN b /6 •HOKa 98i7Z869E05 98bZ869CO9 I3F7H NHSN.KHO2 Ma 8Z:ZO TTOZ• E0-noM