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Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2011 -00688 131 25 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/07/2011 TIGARD - 9 Parcel: 2S112DC00500 Jurisdiction: Tigard Site address:- 15895 SW 72ND AVE 250 Project: DaVita Nephrology Subdivision: FANNO CREEK ACRE TRACTS Lot: 40 Project Description: (2) branch circuits for 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: 503 - 624 -6300 FAX: 503 - 698 -2486 FEES Quantity Description Date Amount 2 crt Branch Circuits wo /Purchase 12/07/2011 $63.60 Specifics: Service or Feeder 1 ea 12% State Surcharge - 12/07/2011 $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 accordan - • 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. ATTENTI• Oregon -w requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 t' oug OAR 952-111-00 You y obtain a copy of the rules or direct questions to OUNC by calli563.232.1987 or 1.800.332.234•. Issued By: Permittee Signat i 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' / - I - Date: iA. t ! C 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 Per CEI mit Applica I'(!:: OFFI(l'' 1 sr O\i , City of Tigard Rec°rva1 ',lime PcnnitNo, E�(.GAel /t # 8; • 13125 SW '1- ta11131vd., Ti' nd, OR 2 , piala l; : �� / 6n 6 Datc/D Review ; 0 Other Permit! !� r/ Phone; 503.639.4171 Fax: 503.5 2011 Date/fl: Pi a/ � Gra I I , , A a Inspection Line; 503,639,4175 Date Rcady/ny Lain, n See Pone 2 for Internet: www,tigard•or,gov CITY OF TIGARD Notified/Method! Supplemental Information r'4', i. 1 1 , lrT .� a ,p; 1 s y k.`. - ,.r,. K, I., r A' it q tal.EAe� ., r ;, �: 1 r .., r ., n ., ., .. _r - "r : liY:k �' � 11L .�' , • 4 r ' � : , ' :: 'r � t"+° � � I ,.my ; <, (," ; ' � 0 New construction in Addition /alteration /replacement Please check all that apply (submit j sets pl'plans wNtoms checked below). ❑ Service or feeder 400 amps or morn d Building over throe stories, (] Demolition ❑ Other: where tho available t),ult current ❑ Marina. m,d boatyards. :;S S g, ;, `., P..'� " 6 , gnr4_,•?.�,iy,.., yj 1 `r'T.- . (' Lry�. + J:,, .+•4: �';.i41'rG:�r; >�il`''`' - ' r '^ we:eeds 10,000 amps at 150 volts or Floating buildin s, less to ground, or exceeds 14,000 [] Comnroreial -use agricultural (] 1- and 2- family dwelling ►;t Commercial /industrial ❑ Accessory building amps for all other installations buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Yire pump. ❑ Installation of 75 i(VA or ,..r raq e, :+ w : r.. - +, w , r r , ❑ Emergency s stem, larger separately derivoti system, >� t: fi r 4, ry, '"` yy,, r •01 y i Y Y fl P Y r r „ , , w a + i Sa ;- + o .A #` „ ,,.a{ 1 ;� ❑ Addition of new motor lead of ❑ ,<A„ "E", „I.2^ „1 -3.. 1001 iP or more. moupt Job no.: Job site address: 15895 SW 72nd. p Six or more residential units U Recreational vehicle parks. City /State /ZIP; ❑ Health.carc facilities. 0 Supply voltage fbr more than f ❑ Harurdoea locations. bon volts nominal. Suite/bldg. /apt, no.: 250 I Project name: B} "5' -DA) t-rn- CI Service or feeder 600 amps; � or � more. r 1 i 1.7 ' 1,`a'�9+AJ„ r "'r t �,. , ;tal ?t, :: Cross street/directions to job site: Ikrrri Description pr Fee. i Total New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: 1 Lot no.: 1,000 sq. ft. or loss 168,54 4 tin, ndd'1 500 sq. ft. or portion 3392 1 Tax map /parcel no.: Limited energy, residential , ,,', + . r ti d. ' r y rrr opt 4.4,1.•4, 1 q, r " ' (with above sq,ft) 75.00 2 • l r ` Limited energy, multi - family 75,00 2 Demo residential (with above sq. S.) S ervices or feeders Installation, alteration, and /or relocation 200 amps or less 100.70 2 .` „ : '6'!.' kr''"”' -•r., . "6111 :7"?.';6e ,w;: :" ''..:: : ,r._ :I'i „?' , .:�. ",;:jrr�(rctj),,,�,,.r ,,,; 201 amps to 400 .56 2 1 ay JC4t'Ka ^� r'� r u r 1 mps o 00 amps 133 401 amps to 600 amps 2 00,34 2 Name: - 601 am to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 City /Slale/ZIP: Temporary services or feeders install alteration, and/or relocation Phone: ( ) l Fax ( ) 200 straps or less _ 59.36 I r 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own winch 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 extension, er panel _ Owner signature: Date: A. Foe for branch circuits with 777 . =r; i , � ! .r, r , � nbove anrviva or loader fee ': ., ''UY y ,1 4` , r. ' `. ` _ .:t 1 .. 1 , ; � aeeh branch circuit �nsinees netne: It Fee for branch circuits without , 7,42 2 Johansen Electric service or feeder fee, first 1 56,18 6.18 2 Contact name: Charlynn L e i f e en hraneh uiicuit „, — Each add'I branch circuit 1 7.42 . 42 2 Address: 10948 SE Valley View Tert Miscellaneous (service or feeder not included) City /State /ZIP Happy Valley OR 9 ] 0 8 6 Each ing service or modular 67.84 2 ppy y r dwelling, service and/or feeder Phone: ( 503) 698-3417 I Fax: (503) 698 -2486 Ileioaeect 67.84 , 2 Pump or irrigation circle 67.84 2 T E-mail; 2 ;a, ^,7.r ^, ; 1 tirvs..T.' .., ,, ;_, ^ ; ; , Sign oroutlinelighting 67.84 hr�r r ..„ ..,,n•4, 4 .�.'•, it'' r a ' ]� / ;'' _ • d � % 'd'' �'�� Signalcir °nil(a)erlirrliled- onorpy Business name: Johansen Electric anal alteration or extension. Pan 2 2 Each additional Inspection over allowable In an of the abov - Address: 10948 SE Valley View Terr Additional inspection (I hr min) , 66.25/ hr Investigation (t hr min) 66,23/ hr City/State /zip: Happy Valley, OR 97086 _ Industrial plant (1 hr min) 78.18/ hr Phone: (503) 698 -3417 J Fax: (503) 698 -2486 lnepecti um: for which nn fee it; 40.00/ hr s • •ifcall listed ti hr min CCB Lie.: 51539 [Electrical Lie.: 3 - 2 4 3 C I Suprv. Lie.: 2053 $ /r :: ' , .11''". - ) 77: ' 1 r " Y! x, :,' ;'t. + .' ; � Sn rv. Electrician signature, required: :d Subtotal: 6 3 . . � 0 � Pl re v i ew (25 °•4, o f p fee); _ _ Print name: Carl J ©rl en [Date 12/6/11 sett surcharge (12% of permit foe): 7 . 3 J TOTAL permit I not 71 . 23 Authorised signature: , / / � .� nth permit applJcetlnn expires U s pm'rrdt la not obtained within 180 Print name; Charlynn Lei f s en Date; 12/6/11 days after It has been per accepted as aompiete, Num o inspections allowed p x permit, I: t[ luildin 4Urcrmitatln.c- 1'crmitAppdnc 07 /01 /10 446 4615T(11 /05 /COM(WES Z /T 'HCVa 98VZ869C0S 98VZ869£O9 Ioaria NaSNVHOf Inrd L5:60 TTOZ'90'Dea