Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2013 00002
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/02/2013
Parcel: 2S112AC01100
Jurisdiction: Tigard
Site address: 7301 SW KABLE LN 900
Project: Lincare Subdivision: FANNO CREEK ACRE TRACTS Lot: 21, PT 2
Project Description: (1) branch circuit to connect rooftop HVAC unit
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
1 crt Branch Circuits wo /Purchase 01/02/2013 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/02/2013 $6.74
Type of Use: COM Electrical
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through 0 52-001- 009 00. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1..8800.332.2344
t , ,/ "�
Issued By: X. L ( t 0.0
) Permittee Signature: t)k P 1 I C I t 1) (/ .'
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
RECEIVED
Electrical Permit Application JAN 02 2013 1 OF Fit t: I tiF O\1.1
Rcecivcd i lreratitxo.� I 3 - _ D
City of Tigard �,,
�,
r 13 125 SW Hull Blvd „ Tigard, OR 97e OFTIG Plan Rcvtow
Phone: w3.639.4171 Fox: ws. ING DNI SIO DatdA . t)m
I 1 e .:t n t 1 Inspection Litre: 503.639.4175 D at e R eady /By; ern fa See Page 2 for
lrtttanet: www.tigard or.gov Nu1if,o thud' 1 � Q Supplemental Information
t t sViS . Z 7, 1. : • :r4 7.7-1 . i ; . f , ,. ., t ,n .•i7a' M !, i •7.w R r, l i..4L r , ,f t1.;. r -. . ; :r. ',. .! ri '$ :r" .._ . y .., , .r r. , 5 !'
Q New COnetruction ® Addition /alteretion/replacement P i1 Mu apply (submit 2 care of plena wfitema checked be
Other; Service or der 400 amps or more ❑ Building over three stories.
CI Demolition 0 Ot � er; %rime the available ta,lt currant 0 Marinas and boatyards.
4?r'a;`- `a''`f 1 y,`+'i� "•$), ” s:"+CS, ,')S "t +;`'t,f: cr711. ' 000 amps aI 151) tolls or Moabngbuildings.
• �l l>Ntd 2 fatni dwelling ®Commercial/industrial l : '.. exoa lo
; > z .. l � y , S : p ,..: , • t; �.. , " ;'.'• ° �'tix : • t +� +� Iessto ground, or exceeds 14,000 Commarcl agricultural
_., ❑ al•u a ice i
❑ Accessory budding amps for all otter installations, buildings.
❑ Multi- family Master builder ❑ Other; ❑ I-ire pump 17 installation of 75 KVA or
. r' .,, Y , 1 , -' y ,,, r1 tr . ❑ Mdi l imo f new minor system. largtyaoperatclv 3
'l ' ` .k r, �, F!w Ik'�'liol� L�i�� ,1 ❑ ,lddificmonuw []..A "F "1�2• •`i_9
Job too.: Job site address: Iool lP or more. occupancy.
7 3 01 SW Kab l e Ln ❑ six or mom residents units. ❑ Rocreationai vehicle parks.
City /State/ZIP: 01-IgnallucaralltiAlilitx. ❑ Supply voltage Immure than
❑ 1latardous locations. 600 volts nominal.
Suite/bldg. /apt.n0.1 Project name: L incare ❑aerviae feeder 600tmtpaotwire.
, .•< :1`„`'<Antt:s raint'L1I ,.'., a „:
Cross street/directions to job site' Desertouan ) -- Qa. 1 r« 1 Taut I
New residential singe or multi - family dwelling unit.
Includes attached garage
Subdivision 1 Lot no.: 1.000 sq. ft. or lore 168.54 4
Ea. add'I 500. ft_ nr portion 33 92 1
Tax map/parcel no.: '
_ a limited energy, residential 75 00 2
'', - :,- i a .... Cv _ ..... - `. •? `> _:Grf: ,..{st': I (Wltllal+oVl se. t1.)
Limited energy, mult•family 75 00 2
Connect rooftop HVAC unit residential (with abovc sq. R.) _
Services or feeders Installation alteration. and/or relocation
200 amps or less 100.70 2
Y r . ' .c 4 . "' •t ~' 201 400 .56 2
, x s r';i:! � . ray a ' "'`11 bg .,;:L,• }..:,w.,y1sd,4 2U amp. to amps 133
401 amp to600 amps 200.34 2
Name:
601 amps to 1,000 amps )01.04 2
Address: Over 1.000 amps or volts 552,26 2
City/State/ZIP: 'temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or loss 59.36
125.08 1
201 amps to 400 amps 2
Owner installation: This installation is being made on property that I own which is not - 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701, -
Branch circuits - now, alteration, or extension, r panel
Owner signature; ...,_ Date: - „,, - •. , _ A. Pet for ',wok circuits with
.., above service or faster fee, ,
:a: _ `�-:3T'_ =.`.err OI? '•,.,• , . . . • : ' : ' :,: - ?.
' :; 7A- 2
each branch circuit
Business name; Johansen Electric B Pee for branch circuits swim/
service or feeder fee, first 1 56.18 6.18 2
Contact name: Charlynn Leifsen branch circuit
Each add'I branch circuit 7.42 2
Address: 10948 SE Valley View Terr Miscellaneous (service or feedern_ot
City/State/ZIP: Ha Valley, e OR 9 7 0 8 6 Each manufactured or modular 6784 2
ppy y , dwelling, service and/or feeder
Phone:(503) 698 - 3417 I Fax::(503) 698 - 2486 Reconnect (sly 67.84 2
Pump or irrigation circle 67.84 } 2
E -mail:
sign or out lighting 67,84 2
''.: ..., : s% .. ^� w :? :j. v C •'> :'A:r t :. ,2 • s '.. -
A ,,' :, - Signal circuits) or limited-energy
Mairtess name: Johansen Electric Rand. alteration, or extension. Page 2 2
. Each additional inspection over allowable in any of thc abov
Address, 10948 SE Valley View Terr Additional inspection (1 hr min) 66.25/hr
- City /State/ZIP: Happy Valle OR 9 7 0 8 6 Investigation (1 hr min) 66.25 / hr
ppX � � industrial plant (1 hr min) 98.18 / hr
Phone: (5 0 3) 698 Fax. (503) 698 Inspection! for which no fee is
a . 6wll listed 1 ,4 hr min 90 00l hr
CCB Lie.: 51539 I Electrical Lie.: 3-243 C Suprv. Lie.: 2053 5 . k` k. , ” "" i7",•9'U" ` r, ^ r 'r =tr • `. .
Supra, Electrician signature, required:
a,4" 1 ° r,J
, 4 1,6!,r. ,/ Plan review (25% of permit fee):
Johansen at e; 1/2/13
Pnnt name: Stare surcharge (12 %, of permit fee): 6 . 7 4
- IO7 AL PERMIT FEE: 62.92
Authorized signature: TM. permit appicaaoa *sprees tr a permit is not oMalned within 180
Print name: Char 1 Lei f s e n ate: D
yn n • Number of inspections shorted par permit.
1 I1nu :d:ng PermdApp.doe 0 7/01 /I0 440.40151'(11/05/(:GMAs/RR
Z /T 'HDVd 98VZ869CO5 9817Z869EOS zD3'a NHsNVHOf lid 50:170 ETOZ'ZO•uur