Permit CITY OF TIGARD ELECTRICAL PERMIT
$ COMMUNITY DEVELOPMENT Permit# ELC2012 00541
Date Issued 09/18/2012
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 2S112DC00500
Jurisdiction. Tigard
Site address 15895 SW 72ND AVE 120
Project Watson Chiropractic Subdivision FANNO CREEK ACRE TRACTS Lot 40
Project Description (2) 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
1 ea 12% State Surcharge - 09/18/2012 $7 63
Specifics: Electrical
2 crt Branch Circuits wo /Purchase 09/18/2012 $63 60
Type of Use COM Service or Feeder
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 52- 001 -0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503 2 or 1 800 332 2344
Issued By !!��[[t Permittee Signature Oki 14 PPC-u 64-T7 DA.S
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
RECEVE
Electrical Permit Application SEP 18 2012 1.01: "'' "' 1 I ` "'
City of Tigard Penni'No
II
• 13125 SW Hall Blvd , Tigard, Olt 972r r l Ti i AR D �� -via -0
! Phone 503 639 4171 Fax 503 598 IMO t r 011mr Pmmit 4 9, j — 0 O 13
f , l , .,, !, , , Inspection Line 503 639,4175 BOIL;,► lr i Il i S ' t)ula R.ady/Hy UM IZI See Page 2 Air
Internet wwty ttgard - gov Notifled/Method Supplemental Infornsatlon
' ' , ` .,r,'. "'; '
v .' R" 'uto< !f�►�, " ;m,), u ., /y , r.P. ,,•t .I 1 fril e l 't ',/ , r, r •
El New construction ® Addition /altetation/replacemtnt ` Pleaw check all that apply (subnut 2 sets of plans wAtoma checked below)
❑ Rervtue or &Wm 400 amps or more ❑ nadding over throe Florins
❑ Demolition ❑ Other where the available ftttlt emresit ❑ Mamas and boatyards
't ` , _ ,,` ,;, 1 , , d4�..g, _'� ON ( ''`1,x,., ; -, '
', ' ',,,,, n , --'' ;' ', ....d. 10.000 inpsal150 volts or ❑ Floatingbuildings
1 ,, „ ;' leas to ground, or exceeds 14,000 ❑ Commtmainl -use agnwlmral
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations buildings
❑ Multi - family ❑ Master budder ❑ Other' ❑ Fire pump ❑ Installation of 75 KVA or
r .,: •i V i`} ❑ Emesgtmcy sys larger seiwately derived system
i ` ' t' , �I�
* d, -,,. ': O A UU$ ; 4 ' i , '''u. ❑ Addthtu' of new mnkw 10 d of ❑,. „� ..1.2 ",' 1.3
Job no 1 Job "t? address mum>. uceupaney
1 5 8 9 5 S W 7 2nd , 12 0 ❑ Six in more residential units C7 110et'eatteial vehicle perks
City / State/ZIP ❑ tlaallh•carc facilities 0 Supply voltage fur mom tan
❑ Ha[ardout fixations 600 volts nominnl
Swtelbldg /apt no 120 !Propane= Western Chiropractic ❑Serviceorfwder600amptormcce
r1`
Cross street/directions to job site p „ 1 Qt 1 V 1 ( ` Hpi�tMn Kee total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision. f Lot no 1,000 sq ft orleas 168.54 j 4
Tax map/parcel no Fa add' 1 500 sq It or portion 33 92 1
Limited energy, midenoul 75 2
. ii "'v-�,, 'l1 C X ;0,tvohi C•,,,,' (with above sq ft ) 00
Limited energy, multi - family 75 00 2
Tenant Improvement residential (with above sq ft )
Services or feeders installatton und/or reification
y , , 200 amps or ley. 100.70 2
"i 201 I1111pA 1n 4O0 amps 133,56 2
401 amps to 600 amps 200 34 2
Name. 801 amps to 1,000 amps 301 04 2
Address. Over 1,000 amps or salts 552 26 2
Cil `/ State/ZIP, Temporary services or feeders installation, alteration, and/or
relocation _ _
Phone ( ) I Fax ( ) 200 amps or loss 5936 I
— 201 amp/. in 400 amps 121 OR 2
Owner installation: This installation is being made on property that I own whioh is not
401 amps TO 599 amps 168.54 2
intended for sale, !cast, rent, or exchange, according to ORS 447, 449, 670, and 701, Breach circuits — new, alteretM J or eYtenslon, per panel
Owner signature Date A Pa for branch woods ,melt
�ry�,� ` }t
• . t� '., „ n _', , above kerwce or fader tee,
'o; '�ls" "`' ,� p► , each branch circuit 7 42 2
Busineae name B Fee for branch circuit., wdhralr
Johansen Electric service or feeder foe, first
1 56 18 56.18 2
Contectname Charlynn Leifsen brnnohoirwit
Loch DWI branch circuit 1 7 42 • 7 .4 2 2
Address 10948 SE Valley View Terr miscellaneous (service o feeder not included)
Each City /State/ZIP Happy Valley , OR 97 0 86 dwell service, and/or eeeede ` 67 84 ` l `
Phone (5 0 3) 698-3417 I Fax, : (5 0 3) 6 9 8 -2486 Reconnect icily 67.84 2
E Pump or irnganon circle n7 84 2
Sign or outline lighting 67 114 2
' F .? j ,' _ 7 - q` '> 'ldONtb „. � _ ` _ signal circuit(a) or limited-energy
Busincssname Johansen Electric panel, alteration, or extension Palte2 2
Each additional Inspection over allowable in env of the above
Address' 10948 SE Valley View Terr Additional inspection (1 hr min) 6625/hr
City / State/ZIP Ha Va 11 e , OR 97086 0 8 6
Investigation plant ( min) 78 25/ lir
ppy y lndustrialplant(1 /11 Mtn) 78 1A / ltr
Phone (5 0 3) 698-3417 I Fax (5 0 3) 698-2486 Inspections fur which no fee is 90 00/ to
Specifically netted (i/r hr min
CCB Lrc , 515 3 9 I Electrical Lac 3-243C Supry Lie 2053S f-..-.,,,,-;; E Y $�TC' ' pRs" FtZ ;` ,, t •' ` ;(
Supry Electnctan signature, roquirod_ k Subtotal 6 3. 6 Y0
Pion review (25% of permit fee)'
Print name Carl J hansen Date 9/18/12 State suroharge (12% of pomilt fee) 7 , 6 3
--�� TOTAL P M11 FEE 71.2 3
Authorized signature, _ Ibis permit application expires If a permit h not obtained within 180
Printnatue Charlynn L Se Date 9/18/12 days after It has been aaepledaetrixplete
• Number of inspections allowed per permit
111:luddmg\P&nun1OLGlkimttAppdoa 07/01/14 440.4(15 1(11/85470MM1ViIa
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