Permit •
74 n CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2013 00181
'TtGAAD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/21 /2013
Parcel: 2S113AA00200
Jurisdiction: Tigard
Site address: 16364 SW 72ND AVE B8
Project: Ron's Hotel & Restaurant Service Subdivision: ROSEWOOD ACRE TRACTS Lot: C
Project Description: (1) branch circuit to reconnect rooftop unit
Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES LP
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 03/21/2013 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/21/2013 $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 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 OA 95 00011 -0 0. You may bttai copy of the rules or direct questions to OUNC by calling 503.232.1987 / or 11.800.332.234 1 [ 1.800.332.2344.
�(
Issued By: WI. e "' . i(L Permittee Signature: OA 4f-i� 64 DA-
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.
Electrical Permit Application RECEIVE ! 1..() . ()I Hi I 1.:h O.Ni.
City of Tigard MAR 21 2013 Ruse - . IVIES. Fetid Na.:GLC- a ( 3 -Del Ed
• 13125 SW Hall Hlvd., Tigard, OR 97223 Plan Review
' = Phone: 503.639.4171 Fax: 503.59A.19JQ r op • I G A p it l)ata/I3 : Other Permit:
t inspection Line: 503.639.4175 503.598.19t try I Cu�1J Data Ready/Hy: 0 See Page 2 for
Internet: www.tigard- or,gtw BUILDING DIVISI 11. oil nad/Mcthod: IIMII Supplanadal lnfom.tten
❑ New construct ® Addition /alteration/replacement
Please 0104 ell (hat apply (submit 2 acted plane whims checked below):
❑ Service or lbeder 490 amps or more 0 Building over three strides.
❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards.
Y r " 1 �. r;. wgt3Fitit fitiai iej.t ).° r 'v; •. :':2:;� 1': :; exceeds 10,000 amps al ISO volts or ['Floating buildings.
.r.•.•,''. '.•,.. -,. ;. less to ground, �. • , „ .:. ;- • ^Y:' <w • `. • - • ,- , •• ••• : 6.r 0 Commercial -use agricultural Q 1 - and 2- fancily dwelling igi Commercial /industrial ❑ Accessory building amps for all other installation.. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑Fria Iarger separately derived system.
i .. } . �,. �.. 5 . • ,..r._ �. a{Ca e. .. ., •S P I T`,i geneysyatam, 3 °,
.' •.' • ; . ? + w nor limit of „A„ "B". „ 1 -2 "1
< ". :,��, ;� ;',' y, R ;���.`,��a',. ;! ;� ls : ❑ Additiunofne mr 1
Job no.: I Job site address: 16364 SW 72nd ❑ I Six or more. occupancy.
or more residential unity. Recreational vehicle parka
City /State/ZIP: ❑ Heallh -care (militias. ❑ Supply voltage for more than
❑ Hazardous locations, 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: Rons Service ❑ Service or fonder 600 amps or more.
Cross street/directions to job site:
' New residential single- or multl-family dwelling unit.
Includes attached garage.
Subdivision: _I Lot no.: 1.000
Ea. calcri nr sq. ft or portion 33.92 1
Tax map /parcel no.:
, _ Limited energy, residential 75.00 2
:; s ;.: •. - -: I.; .. z ' : . •.`.i:;.i` (with above sq. ft.)
.. 1 ..:- r . -. •.,'., ... . . . . .. . t . ;' ," Limited energy, multi•fumily
Reconnect rooftop unit residential (with abovo sq. ft.)
75.00 2
Services or feeders installalion and/or relocation
r�.t 200 amps or leas 100.70 2
4•,;YY,::F ;'•� rs.t ? v'IO N I , . -' , '.; .i', :, if :r'.• 6 2
!�N 'iy ",�� � , �i. � 201 amps to 400 amps 133.5
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 152.26 2
— Temporary services or feeders installation, alteration, and/or
City/State/ZIP: I relocation
Phono: ( ) J Fax: ( ) 200 amps or leas l 59,36 1
Owner installation; This installation is being made on property that I own which is not 201 amps to 400 amps I 125.08 2
intended for sale, (case, tent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 1 1 168.54 2
Branch circuits— new alteration, ur extension, r panel
Owner signature: Date: A, Yee for brunch ain:uits with
F�rr��;q� ` ' 0 'tF above service or feeder fee,
• ' ` , ':� . ; \: 'rii*IIS - r.., .. ....: , A, : ff .; '.( j :,:' onah branch eirauit 7.42 2
Business name: Johansen Electric B. Yee fur breech circuits without
service or feeder fee. first 56.18 2
Contact name: Charlynn Lei f ben branch circuit
Each add'! branch circuit 7,42 2
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
Ci /Statc/ZIP: Happy Vall O R 9 7 0 8 6 Each mg, service err r feeder 67.84 2
lY t dwelling, smviw and/or feeder
Phone: (5 0 3) 698-3417 1 Fax:'(503) 698-2486 Reccuuloer only 67.84 2
Hump or inigatien circle 67.84 2
E -mail: �x . , , ( _ F Sign or outline lighting 67.84 2
?''ri < ' =v .S /'i: :41q.s ? >:'''v�+ :.: , :w ..... , , - . , : :n
� _.'. , .. ... Si ci euit(a)or limited•emargy
pan el, alteration, or extension. Page 2 2
Business Hants: Johansen E 1 e ct ri c
.. Each additional Inspection over allowable in any of the above
Address: 10948 SE Valley View Terr Additional inspection (1 hr min) 66.25/lir
Y Happy Investigation (I hr min) 66,25/ hr
Cit /Sta(c/ZI ppy Va 11 a y r OR 9 7 0 $ 6 Industrial plant (I hr min) 78.18/
Phone; (503) 698 -3417 I Fax:(503) 698 -2486 Inspections for which no fee is
90.03/ hr
e illuall listed 3 .5 hr min
CCB Lic.. 51539 I Electrical Lie,: 3-243C [ Suprv. Lie.: 2053 S ,'":: : . , , , .1 CiA�ii-; _ 7� ;w: ;F$ ; ? ,a ”. : ',1.',
Su
Suprv. Electrician signature, required: (ra4d �/ btoa):
I ` ell Plan review (25% of permit fee):
Print name: Carl Jansen Date 3/2o/13 Shrug surcharge (12% of permit fee):
- Audlorirs:d signature; 'fhb PERMIT Pl ,
fhb permit application expires If a permit is riot obtainetKruren Imo
days after it has been accepted as complete.
Print name: Charlynn Lei f s en Date: 3 /20/13 • Number of inspections allowed per permit.
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