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Permit Ili CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2011 -00720 'TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/27/2011 Parcel: 2S113AC00101 Jurisdiction: Tigard Site address: 16655 SW 72ND AVE 200 Project: Stash Tea Subdivision: COUNCIL VIEW ACRES (LOTS 21 -44) Lot: 37 Project Description: Emergency lighting. Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES LP 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 1 crt Branch Circuits wo /Purchase 12/27/2011 $56.18 Specifics: Service or Feeder 1 ea 12% State Surcharge - 12/27/2011 $6.74 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $62.92 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 OA • 52- 001 -0090. You may obtain a cor .f th .les or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. s Issued By: /� �� �: - Permittee Signature: J 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. RECEIVED DEC 27 2011 Electrical Permit Application FOR 1'11 .1..1( f. I }I: 0\0. CITY OF TIGARD City of Tiga LDING DiVISIO ("D '�� 1 - 3� — '_ •" l' • 13125 SW Hall Blvd.,'figard, t3R filll ' i Phone: 503.639.4171 Fax: 503.598.1960 I I , , . , 1, i - inspection Line: 503.639.4175 Date Ready /Sy: Mil n See Page 2 for Internet: www.tigard or.gov Notifled:Mothod; SupplrtnentalInformation ..ns, •�r.., �•.: ,:•,,,.� ., .,r 0,..c., � <,`n'. n:,+. .1, knn,u :',.�: •.d;'° � ".?:P, �, , mr,�r,r���a, :.f,,, :' ��Pv f:' Plea ^`r..., �r. -. -:: r0,„-,.. ,�.>-^,., ^ „1,mr;, ^r',•;...'•;?' y ";r. 7,'.• C¢': �±'; - ::•u "' �,,,� ., ! v. ;�� R. tom. �,rS �y ::S'. � v.,.:,y Y+, i iU"::, !�,,�/ :;h, 'kr'', �`•^,• . n.. =;rN:a.; 'h:..r �,n ..K`i4'.'!1',G � ,...1:!:,, ;iV�r;IF" :,lYr;tV NYti. lt•,�.:I >;ct - d ';�Wl!',j %Rr; . :!f`,� ,��:. ;hl`;,;;�yry New construction Addition /alteration /r t Please or feeder 400 elope ar o(0, of Bu idins over three e o c L: ® CplaCenlellt a amok all that apply (submit s w)' © Demolition El Other where the available fault currant 0 Marinas and boatyards. *4!•;:n ; ;:4 � lai ;: t .! j. 4. ' r ' .:ri. '7.,A `; K-.. ;i',. ?, ie:`lt. :;.. . exceed 10,000 amp nI 150 volts or [J Floating buildings. �' '' ', s�ii n' ;, .x�� i"'�r '� i�,:' ;A . ry c. ” i r ..v ;'d ,F a , e "'' „� 000 Commoroial -use a ieulturul '� r,.. � ” . less to ground, or exceeds 14,000 ❑ Br� ❑ 1 - and 2- family dwelling ® Commercial /industnal ID Accessory building amps for all other installations, buildings. ❑ Multi -family ❑ Master builder ❑ Other CI Pier pump. 0 Installation ot' KVA or [] I >,mergcncy system, larger separately derived system. �r t ni, x r,::::.-:,..s:,., i 4�, Y ,'r�wY , 4n . • :,,;(,'',',",41'..1 , ...%.. iho .. 1 . a r 5 4 , ' i,, t 1' '' , ,4 ( I3 Addition of new motor load of ❑ "A " F 1-2 "14 100HP or more, occupancy. Job no.: Job site address: ; r. 72nd /6)). (4 0 Six or more residential unitt, Cl Recreational vehiole parks. City/State/ZIP: 7 p Health -oaro facilities, Cl Supply voltage fbr more than (] hazardous locations. 600 volts nominal. Suite/bldg. /apt.no.: l Project name: St Tea ❑ Servicenr feeder 600 amps or more. �^ . , :,N`,"'77, 40400 rid'':,.. ' , D. ", ` "N` „.: iN•K�'1�.., . , , '�,<,;. �1'C''� : :,- vd' Cross strect/directions to job si I n J T uru Qty, Yee. j Total 1 I f New residential single- or multi- family dwelling unit. includes attached garage. ts. We ;, 1.000aq,11.orloss 168.54 4 Subdivision: Lot no.: Ea. add 500 sq, l'i, or portion 33.92 1 Tax map /parcel no.: Limited energy, residential i, r F , �. , Liu 75.00 2 . 1,, , , ,: td_ r ' .'.1: s 45, ' . ' l � ” t r .' :: (with shove s9. ii) ... Limited energy, multi family 75.00 2 Add emergency lighting residential (with above act, fl) Services or feeders installation, alterat and /or relocation ,pp,� 200 limps Sr loss 100,70 2 1 "`:.�d,`� .,,'i ., k '�"f, `.' r, i '\''�: ;11' ,/ i , 201 amps to 400 amp' 133,56 — 2 401 amp to 600 amps 20034 2 Nance, _ 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 umpt or volt. 552.26 2 Temporary n services or feeders installation, alteration, and/o City / State/ZIP; � r Phone: ( ) I Fax: ( ) - 200 nmpa cr lase I 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, rent, or exchange, according to ORS 447, 449, 670, and 7(11. Branch circuits- new, alteration, or extension, er panel Owner signature: Date: A. Fee for branch circuits with .i: ,r..: � � - I C. •i . ,. ., .: t''!a'i" i .., n ,.,. above Navies or feeder fee, 7.42 2 >, { ! l_ each branch circuit B. Pee fir breach circuits without Business name: Johansen Electric service or feeder fee. first 1 56.18 56 . 18 2 Contact name: Charlynn Tie f sea blotch circuit ,. Each addl branch circuit 7.42 2 Address: 10948 SE Valley View Terr Niiacollancoua (serviceor feeder not included) Each manufactured or modular 67 84 2 City /State/ZIP: Happy Valley, OR 97086 dwelling, service sod /or feeder T Phone; (503) 698 -3417 I Fax: :(503) 698 -2486 Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E- Iltall: r Sign or outline lighting 67.84 2 °i�' } 1 iir:�J.i4..:; "i,' 1 ::n. -:xf;r ''. '�P4'o - .t, r., ,.:, 1 " l ve, : , ; p., y � : , ` , ` ' Cd;r .e•i ee��' , .�7i,•'. " '�W \'.i,' ° ,';Y'r�• ,�,w; �, T, ) "i �.:; , t'.: ,. i�= 'k� ';:.....,.. ,�i "�. ;'t�''����s. i ' ;.ot < Signalcircuit(s)or • onor$Y Busin0asname: Johansen Electric panol , orextaflsiin. Paae2 — 2 Each additional Inspection over allowable in any of the above — Address: 10948 SE Valley View Tern Additional inspection (1 htmin) 66,25/hr City / State/ZIP: Ha Valley, e OR 9 7 0 8 6 Industrial (1 hr min) 68.,23/ hr Happy y r Indusvial plant (1 hr min) II 78.18/ hr ■ Phone: (503) 6 9 8 - 3 417 Fax: (503) 698 - 2486 inspections for which no fee is 9000 / hr f a •evifcall listed y hr min CCI3 Lie.: 515 3 9 I Electrical Lic.: 3 - 2 4 3 C Suprv. Lie.: 2053 2053 `.', . ;i ` ' "'- "%ye'3t-"'"""n,;'f:'r': ''%;- �,i'` > ".. .a..� .�:r�tx Subtotal 5 - Suprv. Electrician signature, required: /� // /f W 6'1 $ 7- . P.^ A A t,.,./ — Plan review (25% of permit fee): Print name: Carl Jo anseri F,ruie: 12/27/11 State surcharge (12 of permit fee): 6.7 'rOTAI. PERMIT FEE: 62.92 AuthOri d signature: ���///""" This penrdt application aspires If a pennil is not obtained within 180 Print name: Charlynn Lei f Sell Datc: 12 / 2 7 / 11 days after n has begirt accepted as complete, . Number of inspection allowed per permit. T: 1Ruilding \PermitnrliLC.PwmilApp.doe 07/01 /10 440.401$T(1 )/05 /COM'Wtiu 9 /T " SOVa 98PZ869E09 98bZ869E0S ZDa'I3 NaSNVHOf NI T9:0T TTOZ'LZ'DeG