Permit CITY OF TIGARD ELECTRICAL PERMIT
" COMMUNITY DEVELOPMENT Permit #: ELC2012 -00442
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/25/2012
TIGARD 13125 2S113AA00700
Jurisdiction: Tigard
Site address: 16436 SW 72ND AVE B5
Project: Testa Motors Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: (10) branch circuits for TI
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: 503 - 624 -6300
FAX: 503 - 698 -2486
FEES
Quantity Description Date Amount •
10 crt Branch Circuits wo /Purchase 07/25/2012 $122.96
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/25/2012 $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 OA 52 -0 0 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. �1 //
Issued By: Permittee Signature: OA/ /77 / 4 /
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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.
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Electrical Perm it ApplicaN ' `D rclli 0wi:ii l: I tit.: O.I.,
City of Tigard JUL 2 3 2012 natuB� "2211,40W Permit No.: E(�� /� .-19,g A
SW Hall Blvd.,'figatd, OR 97223 Plan ltovia
P 503.+39.4171 Fax: 503,5 � O FTIGARD Data/
RD Other Permit
i; t , Inspection Line: 503.639.417.5 Date ItandyIBy:
I I� , " ntemot: www.tigarbor.gov J 1INGDIVISION Notified/Method: , ,
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❑ Ncw construction ® Addition /alteration /replacement Please check all Met apply (submit a sets of plans w /items checked below):
Other: ❑ Service or reader 400 amps or more ❑ !balding ova throe stories.
❑ Demolition
❑ whore the available fault current I] Marinas and boatyards.
V75. ;5 , ' C :.f # : "x;.' ;' i/; "+` :s .. : ` e ' . ttV.1 x,1•;t g _; exceeds 10,000 amps at 150 volts or 0 Muni* buildings.
:;-:,41•:,':...(4....:1,1;;,.: ' S `
• +' t less to ground, or exceeds 14,000 ❑ C:ommereaal -uac agricultural
El 1- and 2- family dwelling ® Commcrcial/industrial ❑ Accessory building amps for all other installations, buildings.
❑ Mulb- family ❑ Master builder ❑ Other: ❑ Fhv pump. 0 Inatallatlon of 75 KVA or
r - M ;f^ ,.,�.y ., ; . „ .. _ ❑ t mcgea system. tvae temrately eta ived system.
•+iF 1; ::=s ; l "�� ! 7 1 al: t.•:' '°..?"ik r. ; :
_ . "a'!, Q; � ,w .,,� . 'r '�• :� •'.��•° ".•..�.":. • :a�.. ❑Addi fionafnewmotaloadof 0-A-, -F.-, "1.2 ", ..1.9'•
Job no.: Job site address: !�. ' AJ �4 100HPormom, occupancy.
• 5 1 ❑ Six ear more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: 1 (0 i/ 3 (6. ❑ Heuuhm+tre facilities.
0 Supply voltage ter etas than
r ID Hazardous locations. 600 volts nominal.
_
Suite/bldg. /apt no.: 1 Project name: , e. `� � S ❑ Service er feeder 600 mnpa or metro.
.
Coss street/directions to job site: Dratrietron ' ' 1 Qty. Pm. 1 Total (+
New residential single- or multi - family dwelling unit
includes attached garage.
Subdivision: j Lot rap.: 1,000 sq. ft. or leas 168.54 4
J l:a. add'I S00 sq. R. or portion 33.92 l
Tax map /parcel no.:
Limited energy, residential :4 :A/..s..`'- d7,, : ^i:ti r nrP•. C : ; , TE: ;; . c�` . ,, 75.00 2
7 ; °.;t,.../r >- ',l. :F': •r " : : : ±' :? :�c� 'Q1►''�YF, ,a:.;.. a :rs;; : , >t: ��- . :; %n'k °. .'.r (with above IQ. it)
Limited energy, multi-family
75.00 2
Tenant Improvement residential (with above aq. f.)
Services or feeders Installation alteration, and/or relocation
200 umpa or lean 100.70 2
',r,. :; r.r..+rm+,�. u' hYr�: ,. :'� a a"wf` v t' :.i '• r e( :a :' "::P `` : : : . N.i.'. : . :j: 1 , 4 , t 'fit'. 31
' { :'
'.e:3 a;. 2(11 amps tu 400umpa 133.56 2
:..`IFCC ■i, :�,'w�
Name: 401 amp, to 600 amps 200.34 2
. 601 amps to 1,000 amps 301.04 2
Address: Over 1.000 amps or volts 552.26 2
City /State2lP: Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or leas 59.36 1
Owner installation: Thib installation is being mode on property that I own which is not 201 amps to 400 amps 168.54 2
intended for sale, lease, tent, or exchange, according to ORS 447, 449, 670, and 701, 401 amps to 599 am 166 , 2
Branch circuits - new, alteration, or extension. Cler panel
Owner signature: Date: A. Foe for branch circuits with
' .� t ',, ° °r ' l ; : a : , = above service or feeder fee 2 2
q �, a 4 rail .4
°a `.. .... •,'� :';'•. .: 3� is "?.S :c :.d ,a, : G': � ' r � i.7�.NSrwn� .. ,.. each branch circuit 7A2
Business name: B Foe for branch circuits wlrhoar
Johansen Electric service or feeder fee, fiat
Contact name: Charlynn Le i f sen branch circuit / 56.18 �( 2
Each add'1 branch circuit 7.42 t 71& 2
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not lnctuded)
Each mtmufocb ,ed ur nodular 67.84 2
City/State/ZIP: Happy Valley, OR 97086 dwelling, service and /er feeder
Phone: (5 0 3) 698-3417 J lnax:: (5 0 3) 698-2486 Reeon000t only 67.84 , 2
■ Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
a. it:. r � t �'r �± {:; 'X ., aa , n: p,4•;.. '
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ib : ' °,f t L. I,' ^I: rt. y': ( y il 1:Vii.Y• v .
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' . :...�. r ... - :.,, -�., �,ar_ -.� 14�� : :• >' r .b� :• :}ri � Signal eircuiQs)or limited-energy .
panel,. alteration. or extension. _ Page2 2
Buairneasuame: Johansen Electric
Each additional Inspection over allowable in any of the above
Address: 10948 SE Valley View Terr Additional inapuction(1hrrein) 66.25 /hr
City/Statc/ZI.P; Happy Valley, OR 97 086 Investigetion(ihrmin) 66.28 /h
ply Y + industrial _ plant (1 hr min) 78.18/ hr
Phone: (5 0 3) 698-3417 ! Fax: (5 0 3) 698-2486 Inspections far which no has is
90.00/ hr '
alkali listed H hr min
: -
CCB Lie,: 51539 I Electrical Lic.: 3 - 243C I Suprv. Lie.: 20535 ;'z:: -. ^ �'ir'5 =�,; MZ,;q"" k: • :
; J i��p, �;i�cc�,f�:�: ,:�' %�'zr c��2 , .
Suprv. Electrician signature, required: Subtotal: ( .. L
Plan review (25% of permit fee):
Print name: Carl Johansen I Date: 7/20/12 Stale surehtuge (12% of permit fee): / t/ . ?6
Authorized signature: ,- TOTAL PERMIT FEE: / 3/7 » 72 i
.4 i -. an
This peanut application expires If a permit Is not obtained within 180
days ater It has beet accepted as complete.
Print name: Char ' Le . s tan Date: 7/20/12 • Numbs of heapauinna allowed per permit.
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