Permit CITY OF TIGARD ELECTRICAL PERMIT
q COMMUNITY DEVELOPMENT Permit #: ELC2011 -00630
TtGAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11(08(2011
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 380
Project: Spec Space Subdivision: 1996 -048 PARTITION PLAT Lot: 2
Project Description: TI
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
1 ea Services or Feeders - 200 11/08/2011 $100.70
Specifics: amps or less
4 crt Branch Circuits w /Purchase 11/08/2011 $29.68
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 11/08/2011 $15.65
Electrical
Type of Const:
Occupancy Grp:
Total $146.03
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 a• • • - • 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 les or direct • estions to OUNC by calling 503.232.1987 or 1.800.332.2344.
1
Issued By: Permittee Signature: . _,.Lr
•WNER 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.
RECEIVED
Electrical Permit Application roR 0[1.1(1.: 1 tit. I /N1.1'
City of Tigard NOV 0 7 2011
�r g �
131 25 S W I'Ia11 Blvd., Tigard, OR 97223 s '� Man Review II/f. Permit No.: t
Phone; 503.639.41 71 Fhx: 503.59fi,196i�, OHM Dntd DataD H
r 1; .7% jr g . Inspection Line: 503.63 0.41 75 BUILDING DIV ISI Iliiiiiiimi la sea Page 2 r .
Internet: www,tigard.or.gov Supplemental information
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� ' `` ` � � ` (submit t corn of lane w /items checked below
uslruction ®AddiUOn /alteration /rcplaCCxitenl Ple Sse check ell thar 4 ( . p )
❑ Service or feeder 4(W amps or more 0 over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and bonlyards.
C:'!,S.?': ',i5' {: ^.': & ?? ;it; t" r ' P''.., ±z� �y y�y� S yr `'7 ; ` ';/ ''�i;''; exceeds 10 , 000 amps at 150 volts or ❑ Floatingbuildings,
- ' ' J lean to ground, or exceeds 14,000 0 Commermal -u a agricultural
❑ 1- and 2- family dwelling IK1 Commercial /industrial ❑ Accessory building amps fbr all other installations. buildings,
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. 11 Installation of 75 KVA or
�'• " /,: kF''tit; : 1;' i�.t;� : : "`. ; i:t� ' „,�&,” _ ,.,, ,r' :' i.'w' .` t 1`. 3-
,; ❑ l`' ,merg eo y c larger separately derived 'video. ;.: 4 . ' 7l !I i :2 ; ,t' w , ! , ,.B„ "1-2", ..1-x.,
35? �' ° `i "'.! . r- � , _ :ai "... (] Addition of taw motor load of ❑ A
• I00HP or morn. occupancy.
Job no.: Job site address: _ - SW Sequoia pkwy ❑ Six or more residential units. 0 Recreational vehicle parka.
—
City / State/ZIP:
❑ Health -earn facilities, 0 Supply voltage for more than
600 volts nominal.
inal.
❑ 1.192ard0119 locations,
Suite/bldg. /apt. no.: 3 8 0 I Project name: 2_.....Tscarly s.ee s/�.�, n ❑ service or feeder 600 amps or mom.
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wy' ."',i` ;} ' + 1 '
Cross street/directions to job site: V Ir�rtvtlony. I Pew. 1' 'Total 1 ' I "
New residential single or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq, ft, or leas 168.54 _ 4
Ea. addl 500 sq, fl. or portion 33.92 I
Tax map /parcel no.; _ Limited energy, residential
n?:: si i ;:'r'�.,.c r;',f,'i %. , . r ,. .,.. Oy�#y4�,; y;tµ r ;4;:'. +,. r i:.i r r.:•:'•r 75.00 2
n ial+?M Fii�>m i!di�: (with above sq. f . Limited energy, multi-fumi 75.00 2
Clean u for lease rosidentiai (with above sq ft)
Services or feeders lnataltatlonoiteratiun, and /or relocation
200 amps or less I 100.70 JUp - 7D 2
y.: T:; ∎.': _':•.,. ! '; ;. k, `.I �y[�,1 :.6y .'.� : iti,' 't r ?,� %' �r `:.: ,,,Y;_.� el ;� , . , '''1 . ,',A;'!•!0:1:!,' - ' . „':; - :, • 2
• 201 amps to 400 amps 133.56
.,., , , . ^ wit' . '.� .. c ,
401 amps to 600 amps 200.34 2
Name;
2
6 amps to 1,000 amps 301,04
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) I Fax; ( ) 200 amps or loan 59.36
• 201 amps to 400 amps 125,08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
401 ,nap,, to 599 stops
168.54 2
Branch circuits -new, alteration, or extension, er panel
Owner signature: Date; A. Poo for brunch circuits with
,3.:. •ti �` � �, = :l4., ,.� P'1 aboe v
serice or der fee,
`;i`4�; ' a bsz^ � " .:..lt>�i..�l���`t:�``��',_,... ,..�i�....1' ('' -M.�..040 . -. a oachvbranchcircuit fee � 7.42 / / 2
Business name: Johansen Electric ' li Eat vi for
eor branch circuita
service or feeder too, first 56.18 2
Contact name: Charlynn Lei f s en _ bntn°b e'rcutt m
Each add'I branch circuit 7,42 2
Address; 10948 SE Valley View Terr miscellaneous (service or feeder het included)
• Each manufactured or modular 67.84 2
City /State/ZIP: Happy Val ley , OR 9 7 0 8 6 dwellinfy service and /or feeder
Phone: (5 0 3) 6 9 8- 3 417 I Fax:: (5 0 3) 6 9 8 - 2 4 8 6 k000nnacl on l 67,84 2
Pump or irriyntion circle 67.84 2
E -mall: Sign or outline lighting 67.84 2
� , +.,�..c,,. ��k(;;/u; �,;, °i7�rr•.. / r /.'r ..�.:: ` ;j.;tF'�( %ij .�s rin.�i�i; r ..,y ,,,,/ '. .:'' � y & . , ., „i iha `. e ' ' .t �glAIG ;' a r.,/{....:3 ,-/,•. - Signal circuit(e)or limited-energy
Ousinessllame: Johansen Electric panel, alfnndinn,ornxtetaion. Page _ 2
Each additional inspection over allowable In any of the above
T
Address: 10948 SE Valley View Terr Additional inspection (lhrmin) 66.25/lir
Investigation (1 hr min) 6613/ hr
City /State /ZIP: Happy Va 1 ley , OR 9 7 086 .
industrial plant (1 hr min) 78.18/ hr
Phone: (503) 698 I Fax: (5 0 3) 698 inspections for which no foe to 90,00/ hr
- -if cal l listed 14 hr min
CCB Lic.; 5153 9 Electrical Lic,; 3 -243C P , ; '; 7 i': „ �': : g5 ” " ' 1 "` `
'''' :" '
� <i�C Suprv. Lie.: 2 0 5 3 S �. i , .- , ; : +::,,:..; 1{ <y:
Suprv. Electrician signature, required: A' C� / it ice):
Subtotal: / 3b- �
Plan review (25% of permit fcc
Print name: Carl J nsen } : 11/7/11 State surcharge (12%of permit fee): /5, (p s"`
TOTAL PERNOT FELL: / y, _ n3
Authorized signature: This permit applcetlon expires if a permit Is not obtained within 180
Print name: Char l ynn Le i f s en Date: 11/7/11 days sear a has been per a permit. at complete.
• Number' of allowed per prnnil.
I:taaildirtaTerm'dNi.0 PermiiApp.doe 07/01/10 445- 4615T(11/05/COM/Wnt3
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