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Permit CITY OF TIGARD ELECTRICAL PERMIT ' ; '- COMMUNITY DEVELOPMENT Permit #: ELC2011 -00691 TIGARD. 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/07/2011 Parcel: 2S112DA01400 Jurisdiction: Tigard Site address: 15350 SW SEQUOIA PKWY 220 Project: Spec Space Subdivision: 1996 -048 PARTITION PLAT Lot: 2 Project Description: (6) 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 - 624 -6300 HONE: 503 - 698 -3417 FAX: 503 - 698 -2486 FEES Quantity Description Date Amount 6 crt Branch Circuits wo /Purchase 12/07/2011 $93.28 Specifics: Service or Feeder 1 ea 12% State Surcharge - 12/07/2011 $11.19 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $104.47 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 160 days. ATTEN i ': Ore... law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules� are set forth in OAR 952 - 001 -00 r through OAR 95 90 You may obtain a copy of the rules or direct questions to OUNC by 344. c n - .2.1987 or 1.800.332 34 Issued = : '\ _ - �� f / Permittee Signature\ IL 4_'_ 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'O� f � Date: L � 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. Electric al Permit Application �� i tau 01.1.1(1.. I tit•: O�l.i III City of Tigard � �� 11157M/M111,1 Nern+it No.: tr4.C / / —DOtio / ' 13125 SW Hull Blvd., Tigard, OR c 2 n Review p . Phone; 503.639.4171 Fill( 503.596. , 6 ' ' Pla Date/ll . giber Permit: pa r- r , t.. ,., u t l Irtspeetion Lille; 503,639.4175 ; C tst Date Ready /11y lads El Soo Page 2 for 'Memel; www,ggatd•or.gov �[�, g C I .. � ifiori/Mothod Supplemental Information y, t - r�. ; ;. t�+.:, , l..; a��qq 41N - " 4� i i < .'w6. i, {''... r , _, ' . i` J.,, ° - r t, r : ;:,,.'+ i / 1 0 New construction El Addition /alteratio3 ., Please chock all lhat apply (submit 2 sots of plans w /items checked below); `` ❑ Service or !Qatar 400 amps or more 0 Building ovor three storios• ❑ Demolition Q Other: ` V where the available fault current ❑ Marhws and boatynrdv. fait Ui,;;r * i+ a. i 'yy /� t�tn 'i {Y( ; " '°•r�'i;.',: +...'• excoods 10,000 amps at 150 volts or ❑ Floating buildings. "'�;;' ",.'_i? . ,t �,, -+, r °r'V�1'•Ma a ', .� , . , ' l I {t R "'` - a ' lass m ground, or exceeds l4,W0 ❑Cummoroial- useagricultural 0 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations, buildings. Multi- family Q master builder ❑ Other: ❑ rite pump. ❑ installation ot'75 KVA or f> tiy�.�,l: „•. � a "�m. r.e..r „ p , 1•.. i 7 , , i.i , /. •,,,,:;m.''r.a.'. ❑Folergcncysystem. larger separately derived systom. , �- , / •,. , , • Y ..'. �., ” *, �' 10 # t ', ' 50 o ,' „: , i, : .;( 0 Addition of new motor load of ❑ ''A". „ „ 2 ..., 1 . 1 ., 100HP or more, :mime °y Job no.: Job site address; 15350 SW sequoia ❑ R Six or more residential units. ❑ Recreational vehicle parks. City /State/ZIP: 0 Healthcare facilities. © Supply voltage for more than 0lh✓ardous locations, 600 volts nominal. Suite/bldg. /apt. no.; ,at Q Project tome: Act.,. ❑ service or feeder 600 amps or more. 777___ ," ����qq , f;'." 5• Cross street /directions to job site: n.nrrlpaoa Qty, t+oe• Total " New residential single- or multi- family dwelling unit. _ Includes attached garage. Subdivision: L Lot no.: 1.000 sq. ft, or lam 168,54 4 . Ea, add'! 500 sq. ft. or portion 33.92 Tax map /parcel no.: , energy, residential 75.00 -,c:�6; :. , ¢r. y i 4yy : . :,; ; "I : (with above sq. ft. Il Limited energy, multi - family 75.00 Add kitchen residential with above s . ft. - ' Services or feeders installation, alteration. and/or relocation 200 amps or less 100.70 2 .;, d ( w •' a' ,•i0 e, tiff e r ;'1 r . t v 0 Ait' i i ),,, 201 amps to 400 amps 131,56 2 Name: 401 snips to 600 amps 200.34 2 , . 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts • 552.26 , 2 City / State/ZIP: Temporary servlees or feeders Installation, alteration, and/or relocation Phone: ( ) L Fax: ( ) 200 amps or lass 59.36 I 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 166,34 a 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. Yea for branch circuits with :,:.:. • v - ; „ y y, above service or fonder fee, 7 42 2 rue � , ',;..�, , i .. 71: , , . r �';� ''� 3 each branch circuit B. Fee for branch circuits without Business name; Johansen Electric Service or feeder fee, first Contact name: Charlynn Leifsen branchuiruuil 1 5.1R 6.18 2 � � IP Each adds brunch circuit 6 7,42 Mgt a� t 2 Address: 10 9 4 8 SE Valley View Terr Miscellaneous (service or feeder not included) y / State/ZIP: Happy Valley, OR 9 7 0 8 6 Each manufactured of modular 67.84 2 Cit _ ppy y r dwelling, service and/or feeder Phone: (503) 698 -3417 I Fax:: (503) 698 -2486 Reconnect only 67.84 2 hump or irrigation circle 67.84 2 E -mail; r ; „,, ,,,.. i ,, Sign or outline lighting 67.84 2 4 r> r. :. r r,r^. -i '. r; „s, - " •0 ':1 : °. i._.., . 'i;' ` - SOul,ircuit(s)orlimited- energy 1 © L3usinessname: Johansen Electric - : +cl allocation or extension, Each additional inspection over allowable In any of the above Address: 10948 SE Valley View Terr Additional inspection (1 hr min) 66.25 / hr City/State/ZIP: Hd Valle OR 97086 to do tr iul p a t 1 min) 78./h' IIII ppy � r tn duxtriul plant (1 hr min) 78.18/hr Phont:: (5 0 3) 698-3417 I Fax; ( 503) 698-2486 Inspections for which no fee i>f 90.00 / hr a. eoifiosll listed 46 hr min CCB Lie.: 51539 I Electrical Lto,: 3-243C I Suprv. Lie,: 2053S ;, e ,g" ni n ` /'`�'%■'`' : r' 4 � . 2g Suprv. Electrician signature, required: / Plan review (25% of penult fe fe e): Print name: Carl Joh n s en ate: 12/6/11 Suite sur'char'ge (l2% of permit fee): 3,..9.• / I • / TOTAL PERMIT FEE: 1 - the" Autliorined signature: . -.. This perndt application expires it a permit le not obtained within 180 f V 'f' days after it has been accepted as complete, r / Print ntnmo: Char Charlynn Leif S en PIT; 12/6/11 + Number of inspections allows{ per permit / CV Aillding /Pcrmitani:C.- PmmitApp.doo 07/01/10 440. 461}'1'(11 /0S /OOMNJi11 9 /5 'aDVa 98VZ869E0S 98VZ869E05 IOTIE N.2sl 'NHOr raa EV =EO TTOZ- 90' °9c