Permit CITY OF TIGARD ELECTRICAL PERMIT
i COMMUNITY DEVELOPMENT Permit #: ELC2013 00226
T (GA R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/18/2013
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: (3) branch circuits for lighting work
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 - 624 -6300
HONE: 503 - 698 -3417
FAX: 503 - 698 -2486
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 04/18/2013 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/18/2013 $8.52
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 9 1/1)(/.112.1/ 2 -001- 0090. You y obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. TV
A
By: Cyr �`'�t Permittee Signature: DKI T'
/ Pa,/ C+ (:� TVAS
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.
Electrical Permit A lie io EC 1VF f '' 2 (rl l l(I t tit (t■l
City of Tig APR 16 2013
Da
I M Mail PermitNn r . ` . 3 -0 -
13125 SW Hull Blvd., Tigard, OR 97223
M Phone: 503.639.4171 Fax: 503.598.,,� Other permit
i i . i Inspection Line: 503.639.4175 ( OF TIGARD Date Rcady /By rudn % See Page 2 for
Internet: www.ligard.or.goV B1 utptNG'D #UI� Notifed/Methud: l' Supplemental Information
� E
❑ New construction ® Addition /alteration/replacement Meese chock qll that apply (submit acts of plans w /items checked belo,v),
❑ Service or feeder 400 amts or more ❑ Building over three stories,
❑ Demolition ❑ Other: where the available molt current Q Marinas and boatyards.
,CATBii'oRtt of cotistait , : exceeds 10,000 amps at 150 volts or CJ Floating buildings.
less to ground, or exceeds 14,000 in Commercial - use agricultural
❑ 1- and 2 - family dwelling IA Commercial /industrial ❑ Accessory building amps (brad other installations. buildings.
❑ Multi- family ❑ Master builder 0 Other: CI Fire pump. CI Installation of 75 KVA or
Paneryeney rystem,
larger separately derived system
' V S IS E N�'OkMk ION AND LOCATION' [7
.. .- ...• ,•. ., Additioe new motor toad of ❑ "A ", "E„ "I-2", ,. I-3 ",
Job no.: Job site address: 10011P or more. occupancy.
16 3 6 4 SW 7 2nd ❑ Six or more residential units. ❑ ReoreMWnal vehicle parks.
City /State /ZIP: ❑ lioalth-care faeIltttcs• CU Supply voltage for mom than
y ❑ Ilirrnrdous locations 600 volts nnminal.
Suite/bldg. /apt. no.: l Project name: Ron I S Service rV i c e ❑ Sorviut or feeder 600 amps or more.
FEE SC8Eutitat'
Cross street/directions to job site: Oererla - ioa I Qty. 1 Fee. I TOW I
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 aq. ft. or less 168.54 4
Ea. add'I 500 sq. R. or portion 33.92 1
Tax map/parcel
no.: Limited energy, residential 75.00 2
,, (with
shove s . 4,
Limited energy, multi-family
75.00 2
Lighting work residential (with above sO.1l.)
.. Services or feeders Installation, alteration, and /or relocation
200 amps or less _ 100.70 . _ 2
• 1 PRO*RrY OWNEit• 7 r c i ` A f , 201 amps to 400 amps 133.56 2
Name: I 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 services or feeders Installation, alteration, and /or
Phone: ( ) I Fax: ( ) 200 turps Or I099 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
401 turps to 599 amps 1(,R.Sa 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449. 670, and 701. -
Branch circuits - new, alteration, or extension, r1lanei
Owner signature: Date: A. Fee for branch circuits with
. . rya above service or feeder f'e
r tea, AplE+i,(0i1.r4 ,, moioN 7.42 2
each branch circuit
Business name: R. Fee for branch circuits without
Johansen Electric — service or feeder fee, first
66.18 ( r I C. 2
Contact name: Charlynn Lei f sen branch circuit
Each add'I branch circuit Z.- 7,42 j thibil 2
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
F.ach manufactured or modular 67 R4 2
City/State /ZIP: Happy Val ley OR 97086 dwelling, scrvicc and/or feeder
Phone:(503) 698-3417 ] Fax::(503) 6 9 8 - 2 4 8 6 Reconnect only 67.84 2
E mail.
Pump or irrigation circle 67.84 2
• Sip or outline lighting 67.84 2
CI7N1'IZA S ignal circuits) or limited•energy
Business name: Johansen Electric Each alteration, or extension. Page 2
Each additional inspection over allowable In any of the abov -
Address: 10948 SE Valley View Terr Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.2.5/ 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 Electrical Lic.: 3 2 4 3 C S Lic.: 2 0 5 3 5 ELECTRICAL' E` aw,8 , 'Ell'':
Subtotal. .1 1 • Ca.
Suprv. Electrician signature, required: C. {/ �Q Plan review (25% of permit fec):
Printname: Carl Johansen (, � /f�
Date: 4 /16/13 State surcharge (12% of permit fee): / t5 I S
l `,./ — TOTAL PERMIT hGG; �[
�
Authorized signature: (I LA This permit application expires If a permit is not obtained within HO
Print name: Charlynn Leif sen Date: 4 / 16 / 13 daye after it has been accepted as complete.
• Number of inspections allowed per permit.
1:1BnikGnaWenuits \ELC- PenuitApp. 07/01/10 440.4615T(I I/OS/COM/WED
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