Permit • 111 ;� CITY OF TIGARD ELECTRICAL PERMIT
1 1 COMMUNITY DEVELOPMENT Permit #: ELC2012 00241
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/26/2012
Parcel: 2S113AA00700
Jurisdiction: Tigard
Site address: 16420 SW 72ND AVE B5
Project: Miratron Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: (2) branch circuits
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Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY TRUST
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 04/26/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/26/2012 $7.63
Type of Use: COM Electrical
Class of Work: ALT •
Type of Coast:
Occupancy Grp:
Total $71.23
Required Items and Reports (Conditions)
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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 -009 . You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. n,� /
Issued By: Permittee Signature: ow ��G /6���"' "
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.
RECEIVE)
Electrical Permit Application 1.0R t 11 I i t I 1 `: 11 \ IA
N...-• City of Tigard APR 2 3 2012 t° o/ y r it No C, 24 /? //ore,/ A
tr��
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revio Other Permit
Inspection Line: 50 .639 Fax: 5 Y OF TIGARD Da y ,/B y:
Phone: Internet: wtnv.tigara- or.gov
BUILDING DIVISIO . Nu6fied/Madrod:
'',,, n 7, 1G i. e .,`� ��ir ,.. &,• . +.1'i bhv y,� 'n4 �..-.,, '.si'T, .'r . off ' ;%! :f .. •
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.., � :4'r • : it J'� p , , �• :�'�� - . .0 ��' x: .. �� �� :+: •. f'' : �• w -:�.� `)§.� : ..NC(ir: .. " v
i4 i n..,.. �....�. .:., •..,,w i bis.. ♦ :�..!' .. , p. �,
❑ New construction ® Addition /alteration/replacement Pleeao cheek all that apply (submit j seta of plan: w/ltems checked below):
0 Service or (bolos 400 amps or more 0 Building over three stories.
El Demolition ❑ Other: where the available Ault entreat D Marinas and boatyards.
y�"Si S 2H,. 5 gg :;F:a .K.-- . y f ii e '•'t^ i ♦ 'r3= ,0;s y s.. ) ^z�•si ...:d. 'moo not at 150 %nits or 0 Floating buildings.
vrt4,. ,: .. T
•.:• ,,,.. .,: . .-'....4- 1.z`.. .1tir.•., 2 e.'i';• less m ground, or exceeds L4,000 O Commereial - uxeagriwltural
❑ 1- and 2 -family dwelling ® Commercial /industrial ❑ Accessory building „ tar all ndtQ installations. buildings.
❑ Multi -family ❑ Master builder ❑ Other; p tore pump. 0 Installation of 75 KVA or
:;t -- : a',;,:,& L tic ?av ro re� 1 a a ..,..; t . r. ., CI ematgenay sy68tm, larger separately derived system.
,,t..t �..i 94 ` , , ,a::i,.a e ' ii2O daiiiii ' : , S ^i 'r v `. ` " °: < :. • 0 Addition anew traitor load of 0.• ..E„ "1-r, "1-3”,
Jobno,: Job site address: 16420 SW 72nd 100HP ormoro oae
p Six or more residential emits. 0 Recreational vehicle parks.
City/State/ZIP; p Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg, /apt. no.: Project note; M i ra t ron 0 service or feeder 600 amps Of mole. : �-�
` : ! ;.•err ii.4 .1 :/,i, :{t�4 '•'
Cross street/directions to job site: 1Miewpuaa _ • INFIIIIMMIZZSOIIIMI
New residential single- or mold- tstmily dwelling unit.
includes attached garage.
Subdivision: Li.ot no.: 1,000 sq. t1. or less 168.54 4
Be. add'l 500 eq. ft. or portion 33.92 1
Tax map /parcel no.;
Limited energy, residential 75.00 a
sq.
r,�, -.. > (with abo
•r.`•',- �: u ;" • ut ti.)
: " ' Limited energy. multi- family
Quote residential (with above sq. R) - 75.00 2
Services or feeders installation, alteration. and/or relocation
200 amps or less 100.70 _ 2
;,.'a '?t SK ' :.' .�, ;r:. z , `_ ;;: I.A: t ... 4', 11,7; • 1 ; ` e , 1. . � :! -rii $.K 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps nr volts 552.26 _ 2
Temporary services or feeders Installation, alteration, and/or
City/State/ZIP:
Phone: ( ) [Fax: ( ) 200 amps or less I I 59,36 I I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps I f` 125.08
611 54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 4 01 amps to 599 amps t sion, 2
Branch circuits - new, alteration, or extension, r panel
Owner signature: Date: A. Fee for branch circuits with
. P" .,, ;•.'.•'; "r' ' 9:4 ': .v. •q• above service or feeder fee,
1: fy , • • i =,';73 a e, a y� n ' . ;., ,. -; •., each branch circuit 7.42 2
I''.i':!i r .. 'GY 7a811aa7 - haM3�1�L
Business name; Johansen Electric B . Fee for branch circuits withent
service er feeder fee, nest 1 56.18 6.18 2
Contact name: Char Lynn Lei f sen branch circuit r
Each nal branch circuit 1 1.47 7 . 4 2 1 2
Address; 10948 SE Valley View Terr Miscellaneous (service or feeder not lnduded)
Each manufactured or modular 67.84 2
City /State/ZIP: Happy Valley, OR 97086 dwelling, service and/or feeder
Phonc:(503) 698 -3417 I Fax: :(503) 698 -2486 Reconnect only 67.84 2
- Pump or irrigation circle 67.84 2
E-mail: '
s r r ., - ,� , . -. " , Sign or outline lighting 67.84 2
.,s.�; 5 -v ... -S .:; . ;. s:';. ,,• -. ,. ;:.... .... '.. � ' - ! : r. : ;• < _ ,�<.. y . w !a :k,x'n:; :i; :,�.� :;2• "r Signal airouil(a)or limited- enaraY
Businesgname: Johansen Electric l, alteration, Paget 2
Each additional inspection over allowable In any of the above
Address: 10948 SE Valley View Terr Additional inspection (1 hr min) 66.25/hr
Investigation a ( t l min) 66,25/ hr
City /State/Z1P: Happy Va11ey, OR 97086
Industrial plant () hr m in) 76.18/ hr
Phone; (5 0 3) 698-3417 I Fax: (5 0 3) 08-2486 Inspections for which no fee is 9000 / hr
a •rural! hated 'f, hr min
V GCB Lie.; 515 3 9 'I Electric ic.: 3 - 2 4 3C Suprv. Lie.: 2 0 5 35 :,ie'- :ir;:.....: ,i - " "'
Suprv. Electrician signature, read • i Subtotal: 63.60 •
Plan review (25% of permit foe);
Print name: Carl J nsen J Date' 4 / 23 / 12 State surcharge (12% of permit fee): 7. 6 3
Authorized signature: TQTAI. PERMIT FEE: 71 . 2 3
g . . This permit appihation expires Ira pe n It Is not obtained wNldo 180
Print name: Charlynn Leifsen I Dale: 4/23/12 days alter Ithas natee
• Number of inspections allowed par permit.
i uildiplNermit.lELc -P mitApp.daa 07/01110 440.461ST(11/051COMAVr>D
? /T "30Va 9862869£09 98tZ869£09 Ipaaa NaSNVHOr lad 90:TO ZZOZ
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