Permit CITY OF TIGARD ELECTRICAL PERMIT
■ • ' COMMUNITY DEVELOPMENT Permit #: ELC2012 -00384
T [GA R O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/27/2012
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 190
Project: Vacancy Subdivision: 1996 -048 PARTITION PLAT Lot: 2
Project Description: (4) 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 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 06/27/2012 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/27/2012 $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 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 952 -001 -0 90. You 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: Od A �u �0'Y \ y
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.
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Electrical Permit Application RECEIVE 1.t11iOFri(1 I Sl' t1.1.1
RaeeIced P arent No.: i
City of Tigard DntdB : A Z (....C.-- A9/.1- op ' � i
t. 13125 Tigard, 505.5981960 JUN 2 2 201 Da�B . OlherPermit:
Int ?net: w w w . 503.639.4175 for
Inte CITY OF TI seep Page 2 fit
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New construction ® Addition/ alteration /replacement Planae shoed all that apply (submit z sets of plans *items checked haloes):
❑ service or rose,. 400 ems CM more O Building over throe stories.
0 Demolition 0 Other: where the available fault amain ['Marinas and boatyards.
"o d" )4 ^C' • `e : :b;',-v 000 ton al 150 volts or Floating build'
�`3' 4 .4. , ;.lye 1 i .; : .y r j • ri r. » ,`�i y , ..l ' ' ` :',7 ' , :' l's: ',.. len to a ou Ps 8 tn6 s.
!� :; •••:.:.:',..;;;',':',., . _ :.. :._ `'_..i:.. :,a j,;:•.,,rrl•,.. :; :.:v.: ['Commercial-um agricultural
' ' •� p o - " �' lees t0 ground, to wmaads 14,000
0 1- and 2- family dwelling IN Commercial/industrial 0 Accessory building amps for ail other installations. buildings,
0 Multi - family r 0 Master builder 0 Other: ❑ Pim pip. 1:1 Installation of75 KVA or
k « . � , � ❑ Prnerytmcy system. larger separately derived system.
F . x +H.MV. i ti '. 2f S " > "!?. ;. ;. : : : ^r'r s ❑ Addition ofnow moll? load or ❑ A „ „E "1-2 - 1.3`
Job no.; [ lob site address: 153 5 0 SW Sequoia * uo i a Pk six or more moro. R e cre
q Pkwy ❑ six or more residential tinier. ID Recreational vehicle parks.
Cily/Slate/ZIP' ❑ Ha lthr m a aci hies. ❑ Supply vo tsge for more than
❑ Hazardo Iouuliom. 600 voth nominal.
Suite/bldg. /apt. no.: 19 0 I Project name: vacancy ❑ Bowies or reader 600 amps ft more.
Cross street/directions to job site: { Dar
...ipso ' `` ?� '
oa Pic } : � . a
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New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. tl or Icaa 168,54 4
Er.. add'! son 4q . a. o rpordon 33.92 I
Tax map /parcel no.: • Limited energy, residential
. ; s ::
y :.... r,. .., - ,, .,: ,• � , . 75.00
:, : 2
Limited energy, multi - family 75.00 2
remodel of vacancy for leasing residential (with above so. R) _
Services or feeders lnrtallatlon,alteration, and/or relocation
200 amps or leas 100.70 2
c
£nM : . jy1tf d ` 's x � . ,;"'n :.V <'.0 :_. . , ti kx
;� ''. •,' : - <: r �lN , ,,. ?.' , f7 + , -_ d, , Y , .. ;" ' ','''• . ,Kitt .: Fes :° ; ,,,,. • sl ': 20 1 amps to 4W amps 133.56 2 • 401 amps 10 6011 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1.000 amps or volts 552.26 2
Temporary relocation
services or feeders installation, alteration, and/or
City/State/ZIP:
Phone: ( ) I Fax: ( ) 200 amps or lass 59.36 I
Owner installation: This installation is being made on property that I own which is not 201 amps lo 400 amps 125.08 2
intended for salo, lease, rent, or exchange, according to ORS 447, 449, 67(1, and 701. 401 loops to 599 amps 168.54 2
Branch circuits - new alteration, or extension, per panel
/ Owner signature: Date: A. Iteo for branch einmits with
A ,. ntx. . ,...v ; .,., w +,. , above Service or kV:10f fan 2 2
v.E. � } , I . i 1:, T ' 1 .,- Y"T i.,„,,,,.: { r r :�F �''7w+i�l ir'1{!1 7.4
..,,, _ • •, r , �.: � ; . -... .', : ... : ,'.. ; ° �•. web branch cirwit ,
Business name: Johansen Electric l3•serarutits
,rarvicene o or ( fc Pa, tire[ I 56.10 .51,.. 18 �p o 2
Contact name: Charlynn Leif sen branch circuit
• PAch add'1 branch circuit 5 7.421 -3e. r 4 -E-24
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not icluded)
Each manufactured or modular r
67.84 2
City /State/ZIP: Happy Valley, OR 97086 dwelling, service and/or feeder
Phone: (5 0 3) 698-3417 I Fax:: (503)698-2486 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
•.r.: s.., y t o- r .• ...�, - .- ,,.,.., ,,, _ .. S ign or mane lighting 67.84 2
;e;:1:5y,5 o .' 7i: :',..� :t. :n' .,�...� . • r + . =;, ,ti:' -,V ...'f
K;.f:;L , rte- � : f :; °� : �•;: a,F :,,i >'n.; :..t? {�-�f 4. _``.i? -�:� -., ; : • e ` :`'',�u� ;.r, .v.; ^ „ si circuits) or limited-0nergy
Business name: Johansen Electric panel, alteration, or extension. _ Page 2
Each additional inspection over allowable in an of the above
Addross: 10948 SE Valley View Terr Additional inspection (1 hr min) 66.25/hr
Valle , OR 97086 Induatr 1 mo 66,25/ hr
City / State/ZIP: Happy Y Induetrielplent(lhrmin) 78.18/ hr
Phone(503) 698-3417 1 Fax: (5 0 3) 698-2486 Intpoulions for whiuh no fee is 90,00/ hr
s • ificell listed 't4 hr min
12 B Lio.. 51539 I,EIocttical Lie.: 3-243C I Lic.: 20535 ::'... ... ,„ ts.; i ' "r " '' '�; %"` ' -;,:„i.
Subtotal: - y IS ,
Suprv, Electrician signature, required: /� _ /f k a(
[ ,Qi(,� t'� ,�to_/ Plan review (25% of permit fee):
/l .
Print alone: Carl J ant; en - Dec: 6/22/12 Suite surcharge (1 2% of permit fee): I y
� TOTAL PERMIT F)Sft.: B 7 , 5
Authorized signature: its 1 f aros penal[ application expires If a perndt b not obte within 180
name: Charlynn Le Ben Date: 6 / 2 2 12 inspections Lions a lowed per accepted as emplace.
Print name:
I / • Number of inspoetiona allowed pa pemtit,
t: nBui taingnpermits40L.c.PermiIApe. 07/01110 440-4615Th 1/09 OMnvR.A
9 /T - 3OVd 9862869£05 986Z869£0S 20373 NaSNVHOr wd 0£ =Z0 ZTOZ•ZZ -unC