Permit N . CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00714
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/22/2011
Parcel: 2S112DC00701
Jurisdiction: Tigard
Site address: 15999 SW 72ND AVE
Project: VW Mart Subdivision: FANNO CREEK ACRE TRACTS Lot: 39
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
2 crt Branch Circuits wo /Purchase 12/22/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/22/2011 $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 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 AR • 2- 001 -0090. You may obtain a copy oft irect questions to OUNC by calling 503 232.1987 or 1.800.332.2344.
Issued By: 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.
.e
Electrical Permit Applica' , ��� 1.- 01;...FR., 1 s1.O�1 "y
1
City of Tigard ; C., GP��.1 r�� , l�
■ 13125 SW Hall Blvd,. Tigard, OR 97223 " `Cl NI
3. Phone: 503.639.4171 Fax: 503,598.1960 j 0 )• OtherPormh;
:1 f r t 1 Inspection Lin; 50 �` `� Date Ready /[1y: ® See Page 2 for
Internet: www,tigard- or.gov G � " Notified/Method: EMI Supploroentat
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0 New construction ® Addition /alteration /replacement Please cheek all that apply (seta eats of plans whims obaeked below):
El DcmOltt'ion ❑ Other: ❑ where tho avail ble fault current 0 M Budding and over three boatyard
nil
t
'„":; ;v' "4Vg,N , : Sk,3:44 "i , r, ,.,,�,: -,.. e,,., • „, e l! ^; '7. v meads 10,000 amps at 150 volts or ❑ Floating buildings.
f}:t., ,, . �J yw ' ' ` - . y , 'Y; ` `; " 1 ' i = Is to ground, or exceeds 14,000 ❑ Comer :{el.use agricultural
❑ 1- and 2- family dwelling g Commercial /industrial ❑ Accessory building moat fir all other installations, buildings.
0 .Multi- family ❑ Master builder ❑ Other: ❑ I ire pump. ❑ Installation of 75 KVA or
', a,>ti „, ; 1:” .1, ; r: , .+ ':,�, ,.v. a< ... < , .'n .'n'a;.. , :; ,. ; =a ,: ❑1?ntorgonoy ,isw larger Norm - Maly derived system ,
2, 1,1 .,! ; 1, ,., , 7. ,1 y * ,d!«t'v t4* ' �1 ', F � ❑ Addition anew motor load of ❑ "A”, "1:1", "1.2", "1„3 ",
Job n0 Job site address: 1oo111 or more. occupancy"
15 9 9 9 S W 7 2nd ❑ Six or more residential units. ❑ Recreational vehicle parka.
City /Statc/Z1 P: [] Health-care facilities, ❑ Supply voltage for morn than
[] Hazardous locations- 600 volts nominal,
Suite/bldg. /apt. no.: Project name: VW M art I:1 Service or feeder 600 tor or more-
_ ;,; .., °„ L,,<,'. - ,:, ,,y{ t' d . ° , r , 3 „ ; � A/
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Cross street/directions to job Otte: Description i Ohs. 1 Fee. 1 I •. Total I •
” " New residential tingle- or multi - fondly dwelling unit.
Includes. attached garage.
•
Subdivision: 1 Lot no.: 1,000 sq. ft. or loss 168.54 4
Zia. µdd'I 500 aq. ft or portion 33.92 I
Tax map /parcel 110 Limited energy, residential . m
' ' -J (, '' Ir ( above sq,ft.) 75,00 2
Limited energy, multi family 75 "00 2
Light inq work reaidetttial (with above sq. ft.)
Services or feeders inatallatlonolterat ►an, and /or relocation
200 amps or loss 100,70 2
.. ., l , , n;., ;o,,,,. ti : xa ,,. W,�;' i.i':`A''.1
"'2)i �) , 1"y;>' ?:i ;r"i , ":t..; . 201 amps to 400 amps 133,56 2
401 amps to 600 UM* 200,34 2
Nan1C: 601 amps to 1,000 amps 301,04 2
Address: Over 1,000 amps or volts 552.26 2
Ci /Stara /ZIP: _ Temporary services or feeders Installation, alteration, and/or
ty relocati •
Phone: ( ) I Fax: ( ) - — 200 amps or less 59.36 1
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 168.54 2
intended for sale, lease, rant, or exchange, according to ORS 447, 449, 670, and 701, -
Branch circuits — new, alteration, or extension, r panel W
ec
Owner signature; Date: A. Fee for brunch circuits with
;, ;.; ;. n� , �7� n.:yv.' ,
`Ja; 's!,, ' i ; .' :',' ".':' '. '; C p , ,,. '• ,'; r '!', 7,42 2
e''.' .: _ ... ;;r:''1i1#1100,41;,;k4',1( ' ,i;i� ..::. , ' tj? " i, ..,. ... jJ .. , each b ranc h omit .
B. Pee for branch circuits WADI/ Business name: Johansen Electric service or feeder foe, first 1 561856 , 18 2
Contact name: Char], nn Leifsen branch circuit
Eauh add 'I brunch circuit 1 7.42 - 7 .A2 2
Address: 10948 SE Valley View Terr Ivikcellaneout (serviceorfeedernetincluded) . _
Each manufactured or modular 67.84 • 2
City/State/ZIP:
Happy Valley, OR. 97086 dwelling, =vim and/or feeder
Phone: (503) 698 —3 417 Fax; : (5 0 3) 698-2486 W Reconnect only 67.84 2
Pump Or irrigation circlo 67.84 2
F. - mail: Signor outline lighting 67,84 2
;':Y�,. nr{ �.y \ °ii:F, aafr f ":• ; .nv_ ' . .n - .,.), :J... , ' 1•"Y:.' .111. ,'1.: ;747. A'Z':,. -
''^"5`s ,+. -,,:.'•' �1.;.. ,. Alv '. 11, „,
'' ,',' Signal cirouit(s)orlimited.enorgy
Each a linsp neion, Page 2 2
Business name: Johansen Electric
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: Happy Valley, OR 97086 stralp hr min) 66,25/ hr
ppY Y
i ndu Industria p lant (1 hr min) 78.18 / hr
Phone: (503) 698-3417 Fax: (503) 698-2486 Inspections for which no foe is
90.00/ hr
a evificall listed 1 4 hr min
CCB Lie.: 51539 f Electrical Lie.: 3-243C Suprv, Lao,' 2 0 5 3 S ';? . ?li,' i '.,6' ' + fE�T is ? : t -: ";`
I „ IIG , fL subtotal; 6 3 . 1
Suprv. Electrician signature, required: / / Plan review (25% of permit fee);
Print name: Carl hen s e n Date: 12/22 /11 State surcharge (12% of pennit foe); 7,63
TOTAL PERMIT FEF,: 71.23
Authorized signature .. This permit application expires It a permit is not obtained within 1130
Print name: Char l nn Leif sen Date: 12 / 2 2 / 11 daps aver It sea ben accepted as complete.
y " Num b er of p
inspections allowed per pomtft•
I l }3uildina'Permitn\IILC.PeamiIApp dnr 07 440 46IS'f(I I /05 /ctexiliDD
/ T ' HOVa 986Z869E09 98tZ869E09 IOHZH NHSNfHOr rya Z0:90 TTOZ'TZ'oeC