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Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2012 -00307 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/22/2012 Parcel: 2S113AD01800 Jurisdiction: Tigard Site address: 16756 SW 72ND AVE B14 Project: Vacancy Subdivision: ROSEWOOD ACRE TRACTS Lot: PTS 5 -1. Project Description: (13) branch circuits for 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 12 crt Branch Circuits w /Purchase 05/22/2012 $89.04 Specifics: Service or Feeder 1 ea 12% State Surcharge - 05/22/2012 $34.85 Type of Use: COM Electrical Class of Work: ALT 2 ea Services or Feeders - 200 05/22/2012 $201.40 amps or less Type of Const: Occupancy Grp: Total $325.29 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 R 952- 001 -0090. You m y obtain a copy of the rules or direct questions to OUNC by calling 4 503.232.1987 or 1.800.332.2344. ��/► i �] �1� Issued By: Permittee Signature: ©lam+ 4 " 80 PLC (- l okt 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. A____. RECEIVED Elect rical PermitA licatio rtlt Orel( I:. (tiI: tINl.1 City of Tigard AY 2 2 2012 Received permit No��� . , 13125 SW Hall Blvd., Tigard, OR N r Phone: 503.639.4171 Fax: 503. 5 TIGARD Filiii ahor permit , , inspection line: 5°3.639.4175 BUILD DIVISION Date ReadY/Ry: ® See Page 2 for lntotnet: www.tigard -or.gov Nulifled/Methed: Supplementallydbrrr*Uon '" ""� ' Please check all that apply (submit 2 Kehl plena w/iterna chocked rt of 64 Cl Ncw construction ® Addition/altcrationheplacement ❑ Service or feeder 400 amps or more ❑ Building over three studsK. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. �� . excecos t0,000 amps al 150 volts or C] Floating buildings, .. .fief i .:�A,•, , .1r 4.ara1!; •... '.:' . _ .' . less to ground, or moods 14,000 ❑ Cotamarcial -trso agricultural ❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings, ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KV A or . .. Ci Fnwgency system. larger separately derived system, T .:1'. 7 4231)Wit191 1 01titte r get . MA) •.... ••: :;., ,- ... ❑ Addition of now motor bad of ❑ -A" '•E" "I -T', "13 ", Job no.: Job site address: 100HP or mare. occulrancy, 16 7 5 6 SW 7 2nd ❑ Six or more residential min. ❑ Recreational vehicle parks. City/State/ZIP: El Healthaae Nullities. O Supply voltage for more than ❑ Hazardo locations. 600 volts nominal. Suite/bldg. /apt.no.: , Project name: Vacancy ❑ Service orfeeder600ampsor mare. Cross street/directions to job silo: neserrpttoa 1 0• pee. 1 Total l • New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: f Lot no.: 1,000 sq. R. or less 168.54 4 Ea, add•l 500 aq, 0. or portion 33.92 1 'fax map /parcel no.: Limited energy, residential ,. 75.00 2 ; . : .. '. � tJNOg''tit! C .- : . : : : . ; . . . .. ( with abovesq.li,) , • - : � � 1--) Li mite d energy multifamily 75.00 2 Tenant Improvement at vacancy residential (with above mi. R) Services or feeders Imtaiationolteration, and/o relocation / 20d t9 £&R ,''(? f / 2 a/1 1fCr/leur/S Fa)- 200 amps OHMS • J! 100.70 201.Yo 2 .. 201 empe to 400 amps 13:1.56 2 ")Ct>38B91Y OM1l 'C8kT9'i _ "' 401 amps to 600 amps 200.34 2 Name: 601 amps to L000 amps 301.04 2 Address: Over 1.000 amps or volts 552.26 2 City/State/ZIP: Temporary services or feeders Installation, alteration, and/or relocation Phone: ( ) Pax: ( ) 200 amps or loss 59.36 I 1 Owner installation: This installation is being made on property that I own which is not 201 saps to 400 amps I 1 25.08 2 401 amps to 599 amps 168.5 2 intended for sale, lease, rent, or exchange, according to OILS 447, 449, 670, and 701. Branch circuits — new, alteration, or extension, eer panel Owner signature: , Dat e: A. Poo for branch eirctits with . - - -� . . — a ve service or [ceder foe, 7A2 2 `��'t,1�tT: ' � . - cauh brunch ciruuil U. l'ee for branch circuits wlrhour Business name; Johansen Electric service or feeder fee, first 56.18 2 Contact name: Charlynn Le i f s en branch circuit heeh udd'l branch circuit 7.42 2 Address: 10948 SE Valley View Terr Miscellaneous (service orfeodar not included) Each nnnufacnued or modular 67.114 2 City/State/ZIP: Happy Valley, OR 97086 dwelling. service and/or feeder Phone:(503) 698 -3417 Fax: :(503) 698 -2486 Reconnect only 6714 2 Pump or irrigation circle 67.84 2 E -mail' Sign or outline lishtins 67.84 2 ... . , . • _ , ...... :' : • : ' ' :' . '! : ' :' Signal drcuit(s) or limited-energy Buaineas Johansen Electric paael,a extension. Psae2 2 Each addltioeallnspectionover allowable in any of the elwv Address; 10948 SE Valley View Terr Additional inspection (I hr min) 66.zs /hr City/State/ZIP: Ha Valley, OR 9 7086 Investigation (l hr min) 66,zs! hr Happy y • Industrial plant (1 hr min) 78.18/ hr . Phone: (5 0 3) 698-3417 1 Fax: (5 0 3) 698-2486 Inspections for which no fee is 90,00/ hr a call listed IA hr min % C B Lie.: 51539 ` _,111 ectrical Lie.: 3— ( s k I Lie.: 2053S 4l v,1,15 Subtotal: 4 yy Suprv. Electrician signature, requer `// R V44_, 1 Plan review (2550 of permit fee): Print name: Carl Johansen ♦` Date. 5/22/12 State s ise(12%ofpen»itfee): 3 41 ' S TOTAL PERMIT PEE: 3 ;24 Authorized signature: G 'Itch penult appicatten expires If a permit Is not obtained within 180 `� days atter It has been a w ccepted es enpteus Print nano: Charlynn Le' s e n Date: 5/22/12 • Numhor o Ingle: ens allowed per permit. 1 :136ildinao'crwit4441.C- PsnaitApp doe 07/01/10 440.46151(11/05/COM/WEN Z / - 3DVa 986Z869E09 986Z869E09 'Darla NaSNVHOr ova 170 :ZT ZTOZ- ZZ'keN