Permit CITY OF TIGARD ELECTRICAL PERMIT
�'1 a • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00575
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/02/2012
Parcel: 2S113AA00800
Jurisdiction: Tigard
Site address: 16460 SW 72ND AVE B6
Project: GMA Construction Subdivision: ROSEWOOD ACRE TRACTS Lot: PTS C,C
Project Description: Installation of (1) branch circuit for ceiling fan.
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: 503 - 624 -6300
FAX: 503 - 698 -2486
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 10/02/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 10/02/2012 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 i• - ordance q 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. • TENTION: Oregon - quires you to follow the rules adopted by the Oregon Utility No .• on enter. Those rules are set forth in OAR
952 •01 -0010 th •ugh OAR • 101 -4091. You may obtain a copy of the rules or direct questions to OUNC by- callih • = ... ,._1987 or 1.800.332.23.4.
Issued By: /� ter= Permittee Signatu L�
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' " ��d — Date: /6/g..4.---
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.
AE
Electrical Permit Application rill; (lrri( is 15F ONI-1
OCT 0 2 2012 Roeeltmd
City of Tigard Date /B , /o i A. _.a.i Permit No.: F 2 '0)0,2 —DO 57
4 13125 SW Hall Blvd., 'figard, OR 72-;-3"-"m t • • - cw
Phone: 503.639.41 71 Fax: 503 1J6U `i" r ( " -R ril1 �t D e/B � Other Permit:
11, Inspection Line: 501639,4175 ;7j!11 .r'l•,1 ( plu! „tnii.,R DateReady /By, fa see Page 2 for
Internet: www.ligard or,goy ” '' Notified/Method; Supplemental Information
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�A. , \, 'il' • .��,. � - - yah. J.., �.:�i.i' m' $aa4l re, p Y. , x , atin ,
.
,. . ,.a :: t ..r,v,yp. . ..'F e��: . %r..�., = 1�:t45N',.'.v ".�a �< ",,'9'f�'. F.n '.a.. ..:l.; .,:� ;;.ui,. \..r, ,
❑ New construction ® Addition /aItcratlollflCplaccsne ll Please " cheek all that apply (submit z s eta of plane w /looms chocked below);
❑ Service or feeder 440 amps or more 0 Building ova three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
�?i?c¢. ; ?' "';; 1 ..'kid g.', k.4 itl ;a.'. , f r.'° ". " "" ' "';a ' e ., i'y,i • r b . exceeds 10.000 amps at 150 volts or ❑ Floating buildings
:::: ''.'''..n. ...:�r..i { : 4 . \1 Y Ti l:.i': :: .. ` , ' ;: '�.... 1'' :. '. i .:1 " • IONS to grwnd, or exceeds 14,000 0 Cocnmenoial - use agricullurAl
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other Installations. buildinga.
0 Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
T d' "d `' ' c : y' i o b i `, c w • • "' wr ', ; r ❑ Emor tawy system, target separately derived system.
,;;, ,, , ,;,' L , r� `y .. " ,. i . , n , t ❑ Addition of new motor load of ❑ "A" "5" "1 -2" "1 -3"
ION 1P or more, ccoupartoy.
Job no.: Job site address:
16460 SW 72nd , ❑ Six or more residential units. ❑ Rwreational vehicle parks.
Cily/Stole/ZIP: d lloalth -taro facilities. ❑ Supply voltage for more than
❑ Berardino; Inuttlims. 600 volts nominal.
Suite/bldg. /apt. no.; I Project name: GMA Construction ❑ Vice or feeder 600 amps or mono.
ppr . ... . .*,, , .,i "�� yy. Y' : r , r':: ( � ' . ,., � ;;F. �.� i o.
D uuc
Cross street/directions to job site: rlaaon qty. Yea, r�: Total 1 •
Now residential single -or multi tamlly dwelling unit
Includes attached garage.
Subdivision; I Lot no,; 1,000 eq. R or less 168.54 4
Ea. udd'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.:
'i "r`, , yy; .,. ; •:,w��,:1 .1 . . , - r : .,, <; As - ;,�c�: }'w , ^yacw,}r,.. Limited energy, residential 75,00 2 • Limited energy. multi - fancily 75 00 2
Add ceiling fans rosidcnliul (with above sq'. R,) ,
Services or feeders lnstallatlon and/or relocation
200 amps or less _ 2
it. .k f .,,. 14 6 R ' i 117,1 as Y ;;- 011.4 ± , ?i 'o,fp .i'5i�lt' , Yr4: ".j�'!',tii'r. 201am sto404am 133.56 2
fl;Y'Yc'r - y ?r = ..':I x "::F �7, . \wr.t. p .
Name: 401 amps 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/State /ZIP: Temporary servi or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1 I 2 1
Owner Installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08
intended for salt, lease, rent, or exchange, according to OILS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
',''''3 i:: ..; i �`. : ?+..e' '; .. ^ - ,:, abev0 anrvin csr feeder foe,
: " i - ' I ' ° ^ ?, °; '`!• i iwj " s. :V , i 1 3 41 0, ' 1 r
? i'::'' - ! ; eac b i _ 7,42 2
A . s Fee viceo branch
feede rstrlroar
Business name: Johansen Electric
aerviceorfeederfee, first I 56,18 �,)� 2
Contact name: Charlynn Le i f s en branch circuit
Each add'l branch circuit 7.42 2
Address: 10948 SE Valley View Terr Mlseell one ous (service orfeeder not included) -
City/State/ZIP: Ha Val OR 9 7 0 8 6 Each mannfacltlrcd or modular 6784 2
Happy alley, dwelling, service and/or feeder ,
Phone; (503) 698 -3417 I Fax:: (503) 698 - 2486 Reconnect only 67,84 2
Pump or irrigation circle 67.84 2
E - mail:
i1 ,1.:1 , t;ro-tr ...tih,.'n j.g:,,, ,; ^: ,.y i , , ,n,. :`t` 'r. F: �.; , i :. Sign or outline lighting 67.84 2
:
ura , , :73.. ;,.u: : i. , : . . }.. : 4 :Ir,:' ;7a ,: ' w lt, ":'•s": ;' ; ¢, . , • ..' 1 e , ,.» ,•" ' • , , ., Signal circuit(e) or limited energy
Ixutel, alteration,orextension. Parte2 2
l�usiness Johansen Electric
Each additional Inspection over allowable In any of the above
Address: 10948 SE Valley View Terr Additional inspection (1 hr min) 66.25/hr
City /State/Zl P: Happy Valley, OR 97086 lndu Ind alriaria l plant ant (t hr m (1 hr mm) 66.25/
78.11 hr 8 / hr
_
Phone: (503) 698 I Fax: (5 0 3) 698-2486 .. lnspections for which no foe is 90.00/ hr
a}teciticall,fisted 1 4 hr mm
cal Lie.: 51539 I Electrical Lic.: 3 -243C j Suprv. Lie,: 20539 ; .:'it,' :'`a '= , ;a'c' , ';�n � tt° ' �c, 4 s;�'"` , ii % ti
L :. . 5 .
Subtotal/.
Suprv, Electrician signature, requid,ce AZ A _N Plan review (25% of permit fee): -
Print name: Carl t7 ans en Date: 10/2/12 4tatc surcharge (12% of permil. fee): (e .14
Tarot. PERMIT FED rred '
Authorized signature:( _ This perndt'ppacation expires If a permit Is not o htnti wnidn 180
Print name: Charlynn ' f s en I Date: 10/2/12 • daps after it has been r ermit, as templets
Numbs of allowed per permit,
L'\ Buildina'Patnin\BLC- PermitAppdoe 07/01 /10 440-4615T(I1105 /COMIWt11
Z /T 'aDVa 9817Z869C09 986Z869C09 ZxxZH NasNvHOr rya OT :CO ZTOZ.ZO'gco