Permit CITY OF TIGARD ELECTRICAL PERMIT
$ COMMUNITY DEVELOPMENT Permit #: ELC2013 00219
T f G A q. D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/15/2013
Parcel: 2S112DB00300
Jurisdiction: Tigard
Site address: 7257 SW KABLE LN 800
Project: Western Outdoor Subdivision: HERN PACIFIC TIGARD INDUSTRIAL I Lot: 5
Project Description: (2) branch circuits to work on warehouse lighting
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
2 crt Branch Circuits wo /Purchase 04/15/2013 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/15/2013 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OA 9 2- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: tilt/ Permittee Signature: /9 II 1 1ppefe -/`► P0t!
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
RECEIVED
Electrical Permit Application
of Tigard
City U 9 2013 Received
3 l ermit Nn. d
�' Date/By: �S I � E� .� � --00,2, 13125 SW Tian Blvd., Tigard, OR(�� ^�C Pigs Review
Phone: 503.639.4171 Fax: 503.Sek *'Jb&) TIGARD
Date/By: Permit' Tina: Sp3,fr39.d11$�ILDIIVG DIVISION
luau Reedy/Hy: kith 1 See Page 2 for
Internet: www.tigard V IOL NouAed/Mcthod: - "T / � Supplemental Information
i 1vrit Or'wow IlL.AN,REVIEW
❑ New construction ® Addition/alteration /replacement
Please check all that apply (submit sets of plans Weems e1,n eel belo
❑ Service or tbcder 400 amps or more ❑ Building over three stories.
Demolition ❑ Other: where the available flult current ❑ Marinas and boatyards.
exceed 1 0,000 am ps at 150 volts or Floating buildings.
, . . - ; :. cAa'i�ct�IeY talF- OF . , ,, ❑
Ins u, ground, or a xmeds 14,(0x) ❑ commercial -use agricultural
❑ 1- and 2- family dwelling ® Commercial /industrial - Cl Accessory building amps lbr all other installations. buildings.
Multi- family ❑ Master builder El other: 0 I'irc name ❑ Insullatlon of 75 KVA or
. IM Fmergeney system larger separately derived system.
JOB SITE I AND LOCATION ❑ Addition of now motor toad of ❑ - A" "E"."1-r, •I-3
Job no.: ` Job site address: 12 31 `� v" r oV t ¥ of � yfV ` . tooth or more. occupancy. ! (a ❑ Six or more residential units. Rnxreatkmnl vehicle parks.
City/State/ZIP: ❑ Hcalth-carc facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal,
Suite/bldg. /apt. no.: Project name: ri Q,a Olrt- Obf ❑ Service or itcdcr 600 amps or more.
' FE& SCHEDVL E
Cross street/directions to job site: liesrriadua "'— - .'r Qty l ra. I Total t
• New residential single- or mull- family dwelling unit.
Includes attached garage.
Subdivision: [ Lot no.: 1,000 sq. Il. or less 168.54 4
Tax map/parcel no.: Ea. add'i 500 sq, ft. or portion 33.92 1
Limited energy, residential 71.00 2
DESCRIPTION - OF WORK (with above sq. R.)
limited energy, muitl flunily 75.00 2
Work on warehouse lighting residential (with Move sq. A.)
Services or feeders instellntion,,alteratlon, and /or relocation
200 amps or less 100.70 2
> 0 PROI'RTY,'OWNF R .' } b ,TENANT, 201 annps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 maps to 1,000 snips 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/StatcrLlP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
Owner installation: This installation is being made on property that I own which is not 201 maps Io 400 ahnps 125.08 2
intended for sale, lease. rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps w 599 ramps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner Signature: Dale: A. Fee for branch circuits with
- � I above service or feeder fee,
„ A PPLICANT - 'CONTACT Pl&RSON each branch circuit 1.42 2
Business na me: Johansen Electric B. Fee for branch circuits wiihaul
scrvtcc or fccdu' (cc, first
. 1 56.18 5 � g 2
Contact name: Charlynn Leifsen branch circuit b.l8 °
Each add'l branch circuit 1 7.42 1 , `f5 2
Address: 1 0948 SE Valley View Terr Miscellaneous (service or feeder not included)
City/S1ate/ZIP: Happy Valley, I e OR 9 7 0 8 6 dwelling, service and/or feeder Pesch manufactured or modular 67.84 2
PPY Y r
Phone: 698 -3417 Fax::(503) 698 -2486 Kw:knrheelonly 67.84 2
E-mail: Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
.. CONTRACTOR ' Signal circuit(s) or lim ited-onergy
Business name: Johansen Electric
psi ulteratiun, or extension. l'aq e 2 2
Each additional Inspection over allowable In any of the above
Address: 10948 SE Valley View Terr Additional inspeclion(1 hr min) 66.25/ hr
City/State/ZIP: Happy Valley, OR 97086
Industrial (1 hr min) 66.25 / hr
Industrial plant (1 lir min) 78.18/ hr
Phone: (503) 698 -3417 Fax:(503) 698 -2486 Inspections for which iu fee is
90.00/ hr
speciticallyJistcd ('L, hr min)
CCB Lie.: 51539 f Electrical Lic.: 3 Suprv. Lie.: 2053S ELECTRICAI4. `P'RMIT FEE -,- ,
Suprv. Electrician signature, required: Sub �d?5.
eeri /�iIo n tr+d e i Plan review (25% of permit fee):
Print name: Carl t ip hansen ate: 4/9/13 / 9 / 13 Slate surcharge (12 %of permit fee): '•1, (
Authorized signaturt : Il TOTAL PERMIT FEE: '�� '
l j ` T his permit application expires it■ permit is not obtained within In
Print name: Charlynn Leif sen Date: 4 / 9 / 13 days after It has been accepted as complete.
' Number of inspections allowed per permit
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