Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2013 -00021
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/14/2013
Parcel: 2S113AD01800
Jurisdiction: Tigard
Site address: 16710 SW 72ND AVE B16
Project: Spec Space Subdivision: ROSEWOOD ACRE TRACTS Lot: PTS 5 -1
• Project Description: (1) branch circuit
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
P
PHONE: 503 - 624 -6300
HONE: 503 - 698 -3417
• FAX: 503 - 698 -2486
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 01/14/2013 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/14/2013 $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 in acc. •;nce 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. ' NTION: Ore, =I law - uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are see forth in OAR
952-111-0010 through OAR 9 :- You may obtain a copy of the rules or direct questions to OUNC by callin 232.1987 or 1.800.332 344.
I • sued By: ���� 1 Permittee Signat e:
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' - . ,2:, 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 10 2013 rout 01:1:1(.1 1
City of Tigard ma pyffigrom Permit No.: 46,045—p . ....
--- . 13125 SW Hall Md., Tigavd, OR I r) 5433-599722 rry oFTIG , . i -
' 11 'EEIRIMIIIIIIIII Other Permit Ai -h
ii.
' Phone: 5°3.639.4171 F": 11 LDIN
Inspection Line: 503.639.4175 G DIVISI • raiiii j`wiv Fll sae Page 2 for
! "‘i
Internet: www.tigard-or.gov Supplemental Information
...'-'....;;Iiii)1trts*".iiitiit1t ;`,` 14440:40022: ,.:
Now construction Addition/alteration/replacement Please check all that apply (submit 2, sea of plans wlitems checked belOw):
CI g]
a Service or feeder 400 amps or more 0 Building over three slories.
0 Demolition 0 Other: Mere dm available fiult current 0 Marinas and boatyards.
17.V...;: V-,g. .':oogi1ititijk:5?::.','-,:"1:,:.." exacts 10,000 amps at 150 volts Of El Floating buildings.
less to ground, or °mods 14,000 0 Commercial-use agricultural
11 1- and 2-family dwelling El Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire mime. 17I Installation of 75 KVA or
larger separately derived system.
.v.g,-,.....0000.41000. :,:;.::?.; , - ; .',,.:..',:,..:),\ :
100HP or more. occupancy.
Job no.: Job site address: 16 710 SW 72 rid 0 Six or more residential units. 0 Recreational vehicle parks.
Cit y/State/ZIP: In Health-care facilities. 0 Supply voltage for more than
0 11117.01VOUS locations. 600 vol Ii nominal.
Suite/bldg./apt. no.: I Project name: Vaeatier---- Vi p I=1 Service or leodoi 600 amps Of Mat.
- .i. (lita'.., )••::.,'••:?•,:;:''....„.'".;,':<:.:
Cross street/directions to job site: et teription i Qty. I Poo. Totol I .
' New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or leas 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1 ,
Tax map/parcel no.:
Limited energy. residential 75.00 2
".:1:4041dirri15/4,627"liotok ..:,' ::::::':.'.:- .-;.... ';:::';.. 1.5:;:.:,..7:' (with above sq. ft)
Limited energy. multi-family 75,00 2
Lighting replacement residential (with above sq. ft.)
Services or feeders Installadon,alteration, anebor relocation
200 snips or tees 100.70 2
- -
7.737:',V‘-'-‘75, 0,50.W:'''f-:..:':,!;...•(::;.'..e.tr:'..l.',..';.;:.::::'E.tr.:1:1::'..■/*SOrE;:..ti;:;-,t'.?.1,..7;',...'::7'..": 201 amps to 400 amps 133.56 2
401 MOO 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
Temporary services or feeders Installation, alteration, nntlior
City/State/ZIP: relocation
Phone: ( ) I Fax: ( ) 200 amps or loss 59.36 -
1
201 amps to 400 amps 1 2
T
Owner installation: his installation is being made on property that 1 own which is not
I 12 5.08
401 amps to 599 amps 2
intended for sale, lease, rein, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: . A. Fee for branch circuits with
. • ••' above r foti
.: ;i:::?.,-.'A service or eader ll : :' ; '11: .. . 5",.. q.%;:a ‘ c l OI C 40 . :*04/40- 1 (V ‘ ; "• each bnmch circuit . 742 2
Business name: Johansen Electric B. Fes for branch circuits without
SOrVIO0 Or feeder fee. first 1 56.18 510,1€, 2
Contact name: Charlynn Leifsen branch circuit
Each adtri branch circuit I I 7.42 1 12
Address: 10948 SE Valley View Terr Mir relloneous (arrvice ur feeder not Included)
Each manufactured or modular
City/State/ZIP: Happy Valley, OR 97086 dwelling, service and/or feeder _ 67.84 2
Phone; ( 5 0 3) 6 9 8 - 3 41 7 Fax; ; (503) 698-2486 Reounneul only 67.1t4 2
Pump or irrigation circle 67.84 2
E-mail:
, , Sign or outline lighting 67.84 2
i,%.',...,;',-.;".;''-!4')..,:...:.,Y"':g01014,c,0*: i :•. ; ' , ': : :•: ' '.' - ';: ' ' '- • :. 1 :: .; -.. .::'- .. .',.; ' .‘..:!.:'; n r- : ! .. .,':',. - ';';' . ' Signal circuit(a)or limited-energy
panel, alteration, or extension. Page 2 I I 2
Business name: Johansen Electric Each additional Inspection over allowable In any of the above
Address: 10948 SE Valley View Terr Additional invection (1 hr min) 66.25/ lir
Investigation (1 hr min) I 66.25/ hr
City/State/ZIP: Happy Valley, OR 97086
Industrial plant (1 hr min) 713.18/ hr
Phone; (503) 698-3417 I Fax: ( 503) 698-2486 in.p.uon. fur whiull no ron i. 90.00/1w
, peciftc. listed (ti hr min)
CCB Lie.: 51539 I Electrical Lie,: 3 - 2 4 3 C
I Suprv. Lic.: 2053S .:'". ''''': -
Subtotal: 51
Suprv. Electrician signature., required:
6,,,,e k Plan review (25% of permit fee):
Pri nt name: Carl Johansen D : 1 / 10 /13 starc surcharge (12% of' permit roc): (p 1 4 .1
jok.......„.........._>.• 'VAAL PERMIT FEK 6 A 2,
Authorized signature: it
Mb perndt application expires if a permit is not obtained within 180
Print name: Charlynn Leifsen Dec 1/10/13 days after It Ms been accepted as compkte.
• Number of inspections allowed par pormit
Linuildireermitant.-PennitAtindoe 07/01/10 4404615TO I/OS/COM/WED
8 /9 " aold 9817Z869£09 98n869E0S 'Darla NaSNVHOf NV 99:60 ETOZ'OT'uEr
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
16710 SW 72ND AVE B16, TIGARD, OR, 97224
Commercial - Electrical
199 Electrical final
02/15/2013 00:00
ELC2013-00021
PASS - No C of O
Violation Summary:
Inspector Contractor