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Permit • ' � CITY OF TIGARD ELECTRICAL PERMIT ' COMMUNITY DEVELOPMENT Permit #: ELC2012 -00073 'TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/02/2012 Parcel: 2S112DA01400 Jurisdiction: Tigard Site address: 15350 SW SEQUOIA PKWY 300 Project: PacTrust Corporation Subdivision: 1996 -048 PARTITION PLAT Lot: 2 Project Description: Electrical 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: FAX: 503 - 698 -2486 FEES Quantity Description Date Amount 4 crt Branch Circuits wo /Purchase 02/02/2012 $78.44 Specifics: Service or Feeder 1 ea 12% State Surcharge - 02/02/2012 $9.41 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $87.85 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 ac • - - • - 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. ATT' TION: Ore. •n I- , requires you to follow the rules adopted by the Oregon Utility Notific- .• • Center. Those rules are set forth in OAR 952- 001- 0.10th ough OAR - 001 - t -.. You may obtain a copy of the rules or direct questions to OUN : - .03 .2 232.1987 or 1.801.332.2344. •• Issued y: / Permittee Si• •ature: 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' 4 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. Electrical Permit Application - N. V° I (►R c►I L'It. SF (► \l.1 City of Tigard Received Penult '� Datc/By. .1 /; � 0../Z.,...494112 - 3 c1)0 _ + Mono: 503.639.4171 Fax: 5()3.598.19 '� I 3125 SW I'full IIlvd., Tigard, OR '1223 6 C � 1 2 Plan Review '• Date/By: Other Permit ° � " _ b� .{ i , .` )t i a Inspection Line: 503.639.4175 `` D Dees Ready /By: rem 61 See Page 2 fir Internet; lnInternet; www,tiga d- Of,gov � j\Gr RRS ', Notified /Method: , ' ' Supplemental Information C " ,r iY ,• k b e "C )1F41 ), >; r Ai* Tr^ - S . r ` .'k # ID� , ) ,, '" , , ., ) ' ,... / a i a J,,1, :! ❑ New construction ® Addition /alters eplacement Please check all that apply (submit 2 sets of plans w /items checked below) ❑ Service or tbcdcr 400 amps or mole ❑ Building over three stories. © Demolition El Other: whore the available fault current ❑ Marina and boatyards. •i«<(Y$ ," ` t {''1 , ' a n„ `{ yj n ''rr r y a + . i sN , rmi 1 :' ° ''''' Vr A" f `::. exceeds 10,000 snips at 150 VO1t$ or ❑ f � y floating buildings. ' " '�• , ' '`v-;,..,.., ''' -` - , '" •' 0 '' ' " „ K ', - 10,,, to Bromic', fir cactmatzi 14,000 L.I r;,nnitereiat•uaa agricultural 0 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all outer installations. buildings - Q Multi - family ❑ Master builder ❑ Other: CI Piro pump. fl Installation of75 KVA or -+ x {, :,y - ' ,+,,�, *r�r ❑ Emergency system. larger rnperataly derived system. i.�, r ', o ) 5, ! : i s,4, , 1 ? •- i . a r I! n ° ,ik '$ e , ,:,: ` • i r, . “ w ; •'•r' ❑ Addition of new motor load of ❑ .. "I -2,. "1.3 ", Job no.: Job site address: 1001IP mete, occupancy. 15 3 5 0 SW Sequoia ❑ six Orr more residential units. ❑ Recreational vehicle parks, City /State /ZIP; . Li i lealth.carc facilities. © Supply voltage for more than n j g _et__ El Hazardous loos 600 volts nominal. Suite/bldg - /apt. no.: 3 0 0 Project name: • " d�,f e� -la -'_- . J ❑ Servi or feeder 600 a iFs ` a-O ( ;,Y; 1 ^ r ' ' �' J lnl0,•„I'.�, . ',4 �,rf,,',4g"'; Cross street/directions to job site; I •o + i ; '" r ', t w 1 , 'to ial 1 I� rr DoacriDlinn � Qty. � .; Kam- 7 1'o , ' � ^ New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: J Lot no,; 1,000 sq_. ft. or leas ., 168,54 4 Ea. add'I 500 sq. ft. or portion 33.92 1 Tax map /parnol no Limited energy, roaidontial »,,. , y , r � a 75,00 2 > a„ ., �,' - �� .x'3 1C ';', trit ,' r ' :' r ,,,A,I, ( with above sal, 11,) '' Limited energy, multi-family work at new conference room residential (with above sq, ft,) 75.00 2 ----- Services or feeders lnstallatlon,aiteratton, and /or relocation 200 amps or loss 100.70 2 j . t ,. i Y 'a, few+ 77 4k, e ,' NI' " ry,e1j: : ;.:j't�i" 1 1,1,+ � „ �rr ^ 201 amps to400amps 133.56 2 • 401 amps to 600 amps 20034 2 Name; - _ 601 snips to 1,000 amps 301.04 2 Address: Over 1,000 amps orvolts 552.26 2 City/State/7,1P; Temporary services or feeders Installation, alte and/or _ relocation Phone: ( ) I Fax: ( ) 200 tempt or less 59.36 r l Owner installation: This installation is being made on property that 1 o wn wh is not 201 amps to 400 amps 125.05 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps ro 599 amps 168,54 2 Branch circuits - new, alteration, or a>Stension, per panel Owner signature: Date: A. lee for branch circuits with i vG� , ' a«aO �. . i r above service rc feeder fee, 7 `rr." ' � r ��i "n v nr,! �' � a d � #04.00, t �.':: f A 2 a each branch circuit _ _ Business name: B. Pee for branch oireuits w r Johansen Electric - -- . . .. � service or feeder fee, first 1 56.18 5 6 . 1 a 2 Contact amo: u Charlynn L e i f:� en branch circuit Bach add'I branch circuit 3 _ 7.42 22,26 2 Address: 10948 SE Valley View Terr Miscellaneous.(service or feeder not included) Each manufactured or modular City / State/ZIP: Happy Valley, O12 9709 6 dwelling, service and/or feeder 67.R4 2 Phone: (5 0 3) 698-3417 I Fax; ; (5 0 3) 698-2486 Reconnect only 67.84 2 - ('umpor irrigation citcln 67.84 2 E -mail: Sign or outline lighting 67,84 2 ,.ti''.: e :.ix:,V� . r.r..i. .....v ; � ; ;' .... li... ;:.... q;'r;�r. • ,', a� fr, ,r. , f: k i4 1 . d... , ..: '7 ,.- �rtOL '„ , :k ., r, ' r:ct ,- :. \, , ,,, Signal circuits) or limited - energy Business name: Johansen Electric panel, alteration, or extension. Page 2 2 Each additional inspection over allowable in a of the above Address: 10948 SE Valley View Terr Additionalinspection(Ihrmin) 66,25/hr Investigation (1 hr min) 66.25/ hr City /State/ZIP; Happy Valley, OR 97086 industrial plant (l hrmin) 78.18/hr Phone: (5 0 3) 698-3417 Fax: (5 0 3) 6 9 8 - 2 4 8 6 - l n a pnotioas for which no fug is 90.00 / hr s • eei0oall listed 'h hr min CCB Lie,: 515 3 9 Electrical Lic,: 3 - 2 4 3 0 Suprv, Lic.; 2 0 5 3S r:'' ..qc "; V " `:' r t e"•C l µ s:, ; i' vt',r "i;^ zit' ,';`''` Suprv. Electrician signature, required: f� - c.6„ SO fee) 44 { � , Plan review (25% of permit fee): - Print name: Carl Johansen Datc: 2 / 1 / 12 State surcharge (12% of peri fee): 9 , 41 TOTAL PERMIT FEE: 87 . 8 5 - - - Authors ed_slgrl0.ltlre' This pertnICPppneation eaplr if a pert at if not obtained witl0n 180 - - - days atter it has been accepted as complete. Print name; Charlynn Le i f s e '----- - -__„, _ Data; 2/ 1 /12 . Number of inspections allowed per permit. t, 1) tuuding \i'enniuttLO- r'ermlta.pp.doc 9Nai /l0 44o.ut5T(11/03/COM/wED • V /i: - apva 98VZ869E 0S 98bZ869E05 'Darla NHSNVHOr KV VT:60 ZTOZ- TO -qa3