Permit 1 1111 CITY OF TIGARD ELECTRICAL PERMIT
" COMMUNITY DEVELOPME Permit #: ELC2012 00430
13125 SW Hall Blvd., Ti OR 97223 503.718.2439 Date Issued: 07/23/2012
TIGARD Parcel: 2S112DC01400
Jurisdiction: Tigard
Site address: 15865 SW 74TH AVE 105
Project: Cognex Subdivision: FANNO CREEK ACRE TRACTS Lot: 4
Project Description: (2) branch circuits for new heat pump
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Contractor: JOHANSEN ELECTRIC INC Owner: JDS LLC •
10948 SE VALLEY VIEW TERR CRITERION CREEKVIEW LLC
HAPPY VALLEY, OR 97086 ATTN JAMES A MEYER
PO BOX 6525
BEAVERTON, OR 97007
PHONE: 503 - 698 -3417 PHONE:
FAX: 503 - 698 -2486
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 07/23/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/23/2012 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 9 1 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2332. r � 1987 or 1.800.332.2344. ,, /
Issued By: �/ — • Permittee Signature: /v .1 re_-/e 7& V
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 503.639.4176 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.
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Electrical Permit Applicat C VEt P(111 OI 1 t 1'. 1 SI.I) \1.1
City of Tigard
; th _ �i�ii Permit �/ .- ? 1.3 •)
13125 SW Ball Blvd., Tigard, OR 9722311 I 1 9 20 Plan Review ,, �y
Phone: 503.639,4171 Fax: 503.595.1'MQ' Dsto/B ; Other H . / E � °2 p /� ��
i 1 . Inspection Lire: 503.639.4175 Date Ready/By; See Page 2 for
Internet: www,tigard•or.gnv CITY ®F T�GAnD Nnti ied/Method: Supplemental Information ., � . u r Y � .'1 . ` I � ,. v t. J �. : •ii `.0 \` - ".!.7.1A-'',A.:.-1,i':....:: - Y', ..
"' A. 7 ,, a - : y . • 'S ;fit r '.,•' • C . f. , ,' v : c d : -. ;.: ..:� .' : I SM' w ,, �.
83 .5 . 1.., „ ' .:. ' . „, : „ . i ., 'r.. ".,...,, :s i'v ,, . -,. _, r� ':.r=,'r Y,,,.,.'� i a!tit� ,L "., •
El New construction ® Addition / alteration replaoemeet � k all that apply (submit 3 sots of plans Whams chalked below):
Q service or feeder 400 amps or more ❑ Building over duce stones.
❑ Demolition ?if,
1:1 Other: where the available fault current 1:1 Marinas and boatyards.
{;z I'4. 5' n^ '.i' .{ .. ,t '•a s w in e r, q , a ,,..I�y , 4 t"wY 4 , , s rd(: ;:m •, ;: y„ exceeds 10,000 amps at 150 volts IN Cl Floating buildings, •
.` less to grwad, or oxeeode 14,000 ❑ Commercial rte Agricultural
I- and 2- family dwelling ® Commercial /induelrial C] Accessory building amps for all other u,atallations. buildings,
C] Multi-family ❑ Master builder ❑ Other: 0 Fire pump. ❑ Inalalldtioa 01"75 KVA or
r• • ' :r.. .n>4 , ..1: , .r. • •J tiN" • r ❑ F ine:gamy system. larger aepatalely derived system.
cR � �'?` ., = = .•ri 1i i,� -, , • .. �." ,•i ". :4_ , „. ?�.��,, ; , ❑ Addi or�w moat load of ❑ ..A„ .,E„ .,t_2,., "1.3..1
Job no.: Job site address: _ e 100HP or more. occupancy. r
' 7 /0 S ❑ six or mom residential units. ❑ Recreational vehicle parks.
City /State/ZIP: ❑ Health-care facilities, ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. .: /06 Project name: e Jl ike Ire ❑ Service or IL•eder 600 amps or mare.
Cross strect/diro;tl0 site: 'ro • • -
)0 8 le: If
� aerlptlon c' ':'�S .:i'.:A`tr. �:'�' •t ��
New residential single• or multi- family dwelling unit,
Includes attached garage.
Subdivision: I Lot no.: ^ 1,000 eq, R. or loss 168.54 , 4
Ea. add'I 500 sq. f. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential
e:, w . t,.. FJ,.,, ,o ..., v� • t; p`ss (with above R, ?5.00 2
- Limited energy, multi- family 75.00 2
Connect new heat pump residential (with above sq. R)
Services or feeders installation alteration, and /or relocation
200 amps or lean 100.70 2
i >,, :Pa mow : y . r . r " .ir f „y f .--,. : ;c•:$'s; ' e ' • c ar:. 13.56 2
�y , ,y r, : .>••: _;• Its' . u i 201 amp to 400 amps 1.
401 amps to 600 amps 200.34 2
Name:
601 empato 1,000amps 31)04 2
Address: Over 1.000 amps or volts 552,26 2
Temporary r services or feeders installation, alteration, and/or
City/State/ZIP:
Phone: ( ) I Fax: ( ) 200 amps or loss 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amp, to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. sumach circuits— new, alteration, or extension, r panel
Owner signature: Date: A. Foe for branch circuits with
?, �, �,,,: . ^,.S ' v ll , . - •a ( - ♦/M ''yy�� {' ` 7.42 2
^ .'° ` .: ' " :. > :e ;k, , , „ , ,. "o ' above service or feeder fee,
arch bnmab wrwit
Business male: B Fee for branch circuits without
Johansen Electric services or reactor fee, first
Contact name: branch circuit 1 56.18 6.18 2
Charlynn I,eifsen
Each wld'I branch circuit 1 7.42 7. 42 2
Address: 10948 SE Valley View Terr Macellaneous (service or feeder not Incudod)
Each manufactured or modular 67,84 2
City/State/ZIP; Happy Valley, OR 97086 dwoiliom. service and/or feeder
Phone: (5 0 3) 698-3417 [Fax:: (5 0 3) 698-2486 Recooaect only 67.84 2
Pump or irrigation circle 67.84 2
r E - mail: Sign or outline lighting 67.84 2
'. ;.1 . ;yam4(1.1 0 !. ',k-,:2N. :-x “:`,..P.:',1,!, : i .....` r. .,:r
+rt�o- S,i:'4'.`j.i � F',
4 , >_�:i”, >:. iCf „ .,.:.. �� ;., : @: e:.•J:.. Signal elreUlt(8) wlimiwd•a , orgy
Business name: Johansen Electric Panel. alteration. or extension. Panel _ 2
Each eddltlonal inspection over allowable In any of the shee
Address: 10948 SE Valley View Terr Additional inspection (1 lir min) 6625/ hr
City/State/ZIP: Happy Val ley OR 9 7 0 8 6
Investigation (1 hr min) 66.25/ hr
ppy y r Industrial plant (1 hr min) 78.18/ hr _
Phone: (503) 698-3417 J Fax: (5 0 3J98-2486 Inepcctiona for which no fw is 90,00 / hr
/ �; aQacitiral�lietcd 'h its this
ifr CCB Lic.: 51539 3 9 Electrical Lie.: — 2 4 3 C Suprv. Lie.: 2 0 5 3 5
Suprv. Electrician signature, required: ag,t K Subtotal:
Plan review (25% of permit fee):
Print name: Carl J? ansen Date: 7/19/12 / 19 / 12 state surcharge (12% of permit fee): 7.63 /
TOTAL. PftRMIT FEE: 71.23 v/
Authorized signature. - This peyote application expires Ira permit ti not obtained within 180
days alter It has been accepted as complete.
Print name: Charl ynn Lei sen I Date: 7 /19 / 12 • Number of inspections allowed per permit.
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