Permit CITY OF TIGARD ELECTRICAL PERMIT
_ COMMUNITY DEVELOPMENT Permit g: ELC2012 -00135
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/09/2012
Parcel: 2S112DD00200
Jurisdiction: Tigard
Site address: 15862 SW 72ND AVE 100
Project: Remmington Center Clothing Subdivision: 1994 - 006 PARTITION PLAT Lot: 2
Project Description: (10) branch circuits for TI
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
10 crt Branch Circuits wo /Purchase 03/09/2012 $122.96
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/09/2012 $14.76
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $137.72
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 0 952- 1 -0090. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ,, /
Issued By: Permittee Signature: �, t/ l/ 9 77 c v �c
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 603.639.4176 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 ` f 1.01< oFF1( I ' : I tit ( ) . 1 .,
City of Tigard \`L B vc d iQ� Ferran No.; El.C.�/a - 1 0 /3 5
13125 SW Hall Blvd., Tigard, 0I "' A : ci �,
Phone: 503.639,4171 Fax: 503.. •. ' •
Other Permit.
, . , .,, i : i , Inspection Lint: 503.639.4175 `nP� D
(.4 ^ " m m: El lies P 2 for
Internet: www.tigard- ur.guv \V` 'c \J cA Supplemental Information
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,5:::11.•'51:...4.110., ,a ..i'�.,, i' , :; •re- . :'.r�i' '!: ,., ..r :.
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1 :: Please check all that apply (submit 2 vats of plans writema checked below);
CI New wnBtritCtion Addition/Amelia �' ` r •meat 0 Service or feeder 400 amps or more ❑ Building over throe aerial.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
a;•r, t 7 �f yip #a; "� Y' *• , ' ":' -: amps at 150 volts or oaling buildings.
� x l 4 ?:w.F <. I47.OV `�+e' j s.. � c a.lt• x�a; .. exceeds 10,000 am F1 b alts.
),c.„., ,x- 'r ^r :y s. :-Ca rp :'= .
' '`ct"'` :'=' Ion IQ rood, or exceeds 14,000 ❑Osnmereial- useapiculture'
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps fvr all other installations. buildings.
❑ Multi-family ❑ Master builder ❑ Other: ❑F 0 Installation of75 KVAur
Ins :) [W : ! " ,! k H' l et s c 'M` ) ['Emergency system. larger scpa<aid! derived system.
? v,` 1' N , _ ;. p: e w ; ` l� ' 1 / :; :q; : , fi ❑Additirm new mMOrload of 0"6•, g,. .. -2 . -3 .,
Job no.: Job site address; .�t rouHP or mare. rkp y
✓Q .6 ? ) 7 /1)e) 0 Six or more residential unit■. 0 Ropronti vehicle perks.
City/State/ZIP:
/ Health-ewe Mines, ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts numittel.
Suite/bldg. /apt. no.: /OQ ` Project name: 'el vizi/ 19 O Service or tinder 600 amps or mean,
+ F�p: I . „ . .t"tlid : §' _�! \ ' .. net y ” .
=.c ti � : :`} :'� : :� ✓� ` rz� . f '„( . �.•. . j:4 �. r =�eTs
Cross street/dirvcttons to job site: DI IJIIoe I Pee. 1 Total I •
New residential single- or multifamily dwelling unit.
Includes attached garage.
• Subdivision: I Lot rte.: 1,000 sq. ft. or leas 168,54 4
Rn, add' 1 500 sq. ft. or portion 3392 1
Tax map /parcel no.: Limited energy, residential
� W+4's• • :ti: rr r• r w`�'V I..ti >4. :':'� :: �a. above It.) 75.00 '�
�•
5 (with s
-: v
Limited energy, multi- family 75,00 2
7 o f / residential (with above. ft.)
i !! 7r ��l rzyg r p r� r i 7 Services or feeders Installation, alteration, and/or relocation _
200 amps or less 100.70 2
�7� :�1,9 g;t� jyty Ir�• ,q,� N. ... . 9 . Vi i : i
201 amps to 400 amps
?7•,' ' �-.Pi:Strry�,R+orrsf" 1 ''' '1 . "� 4: ' : �`� 7 7 r ~�{}�y� ryi. • 'g,'0.. 13336 2
Name, 401 amps ro 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1.000 amps or volts 552.26 2
Temporary services or feeders Installation, alteration. and/or
City/State/ZIP: relocation
•
Phone: ( ) 1 Fax: ( ) 200 amps or Ices 59.36 I I 1
Owner Installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 I I ` 11 2
intended for sale, lease, matt, or exchange, according to ORS 447, 449, 670, and 701. ao i amps to s99 amp. 16x.54 2
Branch circuits- new, alteration, oreiienebn, par panel ,
Owner signature: _ „ - Date: A. Fee for branch circuits Wilt
� ,l; ,. y vT r above service or feeder fee,
4Yre' R .....a . . `^r =Lf. Kr !. ,✓ i , .. 5., r i'Pn.a ° .r• mah branch circuit 7.42 2
• Sgt • t . •T. service
B. Fee for broach circuits without
Business name. Johansen Electric service or feeder fee. first / 56.18 56 /g 2
Conulot name: Char l ynn Leifsen - branch circuit
b it
Each addl branch circuit 4 7.42 4 71* t 2
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not lnduded) ,
y/State/ZiP: Happy Valley, Eve ning. manufactured or rfeeder 67.84 2
Cit
OR 9 7 0 8 6 1hvolGna. service taller (ceder
Phone: ( 503) 698 -3417 I Fax:: (503) 698 -2486 Reconneut 67.84 2
Pump or irrigation gimlet 67.84 2 ,
E -mail: 67.84 2
r . r..,,. - Signorw
+f :.s ` �;4y i!L;: 41.: �!.x ;r/ :' :: % :si "' � 3.1 77 IIII ...' X: ,:0. • r,c { 14, - i � '',, n.%.. Signal circuit(s) Or llmited.011*T '
Businessaamo, Johansen Electric Pearl.addition,orexpcaion. page2 2
Each additional Inspection over allowable In env of the above
Address: 10948 SE Valley View Terr r Additional inspection(lhrmin) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City/State/ZIP: Happy Valley, OR 97086
Industrial Nutt (Ihrmin) 78.18/ hr
-
Phone:(503) 698 -3417 , Fax:(503) 698 -2486 Inspections for which no fee is
90.00/ hr
ificall listed �h he min
CCB Lic -: 515 3 9 I Electrical Lie.: 3 - 243C 1 Suprv, Lic.: 2053$ „,, " . ;w :153 7.I c,e, - -- ", r — • • - -
Subtotal: /2 x, v(p
Suprv. Electrician signature, required:
� •, ,_
State m Plan review (25% of permit fee):
Print name: Carl J ans en ��. kj ea. uctmrge (12 °i6 of permit fee): I 9,1 4,
Authorized signature: !F!'� .Air *"v' TOTAL PERMIT' Fa: i_3.7, TZ
- ------ Tide Flynt application expires Ira permit b not obtained within ISO
Print name: Charlynn Le i f sen pate: 3 8 12 days k has been accepted n complete.
• Nambw of InspacLition ona allowed pet psardir.
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