Permit •
CITY OF TIGARD ' ELECTRICAL PERMIT
0 COMMUNITY DEVELOPMENT Permit#: ELC2012 -00604
T t G A D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/13/2012
Parcel: 2S113AC00102
Jurisdiction: TIGARD
Site address: 7272 SW DURHAM RD, STE# 100 -
Project: Indio Spirits Subdivision: COUNCIL VIEW ACRES (LOTS 21 -44) Lot: 25 -27.2;
Project.Description: (10) 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 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
•
PHONE: 503 - 698 -3417 PHONE:
FAX: 503 - 698 -2486
FEES
Quantity Description Date Amount
10 crt Branch Circuits wo /Purchase 11/13/2012 $122.96
Specifics: Service or Feeder
. . 1 ea 12% State Surcharge 11/13/2012 $14.76
Type of Use: COM Electrical
Class of Work: ALT 1 ea Plan Review Electricial 11/13/2012 $30.74
Type of Const:
Occupancy Grp: •
Total $168.46
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 OAR -001 -0 0. You may
jo obtain / a � co y�of the rules or direct questions to OUNC by calling 503 987 or 1.800.332.234 . g �y
Issued By: � -ti'/t Permittee Signature: i // 1 l ( �i�Li
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 503.839.4175 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.
v
Electrical Permit Applicalgie EIVED ftllt OFFICE :l_ (ISE ONLY
!CIA City of Tigard fi Received /�
:�T 2 2 2012 Date/By.. io /aa /a Permit No.: � nif—'t� Q 0
II 13125 h n SW Hall Blvd., Tigard, OR '9n 3 plan Review 1 t J Z /� Q cepoio �'��y7
C Phone: 503.639.4171 Fax I �^ � p� DatrJBy: ( b Other Permit: /d
'I' �� It D
Inspection Line: 503.639.41 1 tGARD Date Ready/By: '�/ / 'ms s : El See Page 2 for
Internet: ww .,.tigers -0r.g ° $UII.DING DNISION = °;; �� �, S� / ' �L Supplemental Information
..
' TYPE OF WORK ' O , • ,PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current
❑ Marinas and boatyards.
' CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
1- and 2-family dwelling less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
El y g Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ' CI Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "l - ", "l - ",
Job site address: IOOHP or more. occupancy.
Job no.:
I 7 2 7 2 S W Durham , ,Y6 I � ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: ❑ Health-care facilities. ❑ Supply voltage for more than
IgFlazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.:)0K/09 I Project name: Indio Spirits ❑ Service or feeder 600 amps or more.
- - FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
' New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
• ' .DESCRIPTION OF WORK '. (with above sq. ft.)
Limited energy, multi- family 75.00 2
Tenant Improvement residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation _
200 amps or less 100.70 2
❑ PROPERTY. OWNER • '1" - ; ❑ TENANT' : 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 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
' IN APPLICANT . I ❑ CONTACT PERSON above service or feeder fee, 7.42 2
• each branch circuit
Business name: Johansen Electric B. Fee for branch circuits without
service or feeder fee, first r 56.18 54.4 2
Contact name: Charlynn Lei f sen branch circuit
Each add'I branch circuit I 7.42 64 2
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
City/State /ZIP: Happy Valley, l e OR 9 7 0 8 6 Each manufactured or modular 67.84 ' 2
PPY Y r dwelling, service and/or feeder - _
Phone: (5 0 3) 698-3417 Fax:: (5 0 3) 698-2486 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
. CONTRACTOR • . .. Signal circuit(s) or limited - energy
Business name: Johansen Electric panel, alteration, or extension. Page 2 _ 2
Each additional inspection over allowable in any of the above
Address: 10948 SE Valley View Terr Additional inspection (I hr min) 66.25/hr
Investigation (1 hr min) 66.25/ hr
City/State /ZIP: Happy Valley, OR 97086
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 698-3417 Fax: ( 503) 698-2486 Inspections for which no fee is 90.00/ hr
specifically listed ('h hr min)
CCB Lic.: 51539 I Electrical Lic.: 3-243C Suprv. Lic.: 2053S ELECTRICAL PERMIT FEES "
� / Subtotal: /AR. 9'6
�-
Suprv. Electrician signature, required: Plan review (25% of permit fee): . , 74‘
Print name: Carl J hansen Date: 10/22/12 State surcharge (12% of permit fee): (g. 76
Authorized signature: /yq
TOTAL PERMIT FEE: /60 ' • 4{(p
�_ GLti ! This permit application expires if a permit Is not obtained within 180
days after it has been accepted as complete.
Print name: Charlynn Le,' sen Date: 10/2/12 • Number of inspections allowed per permit.
1:\ Building \Peimits\ELC- PemlitApp.doc 07/01/10 440-4615T(I1 /05 /COM/WEB