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Permit n CITY OF TIGARD ELECTRICAL PERMIT ' COMMUNITY DEVELOPMENT Permit #: ELC2013 00255 T WARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/06/2013 Parcel: 2S112DA01400 Jurisdiction: Tigard Site address: 15350 SW SEQUOIA PKWY 195 Project: Houston Insurance Agency Subdivision: 1996 -048 PARTITION PLAT Lot: 2 Project Description: (1) branch circuit to clean up space Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES 10948 SE VALLEY VIEW TERR ATTN N PIVEN HAPPY VALLEY, OR 97086 15350 SW SEQUOIA PKWY #300 PORTLAND, OR 97224 P PHONE. 503 - 624 -6300 PHONE: 503 - 698 -3417 FAX' 503 - 698 -2486 FEES Quantity Description Date Amount 1 crt Branch Circuits wo /Purchase 05/06/2013 $56.18 Specifics: Service or Feeder 1 ea 12% State Surcharge - 05/06/2013 $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 9 2 -001 -0 90. You c ` maayobtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2 D/\ 344 f Issued By: -C . _ t Permittee Signature: Oki i-Pr `-t`• ' 34 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 1'1)1( 01.1.1( 1 : ON1.% 'v N.....-. City of Tigard 0 6 2013 oa«Bed sr Permit No.. Cl.Caal 3. ocgs" 13125 SW Hall Blvd., Tigard, OR 97223 plan Review I Phone: 503.639.4171 Fax: 503. �ij� OF T Ir± Doteta Oilier Penmt, � ,v/3. oat op i 1 t . ', n I , Inspection line, 503.639,4175 B UI LD I A� ITI5 ® See Page 2 for Internet: www.tigard•or.gov NO DIVISION I (`/ o Supplemental Information ',, ,. ;, i80 •' ' ,• „ ., ,, , ,_ • , , ', h i ck Please check below), 1 ' Q New construction El Addition/alteration/replacement a ll that apply (submit $ sets of , vhtems oho ed ❑ Service or feeder 400 nmps or more Ll Building over three stones. ❑ Demolition 0 Other: whore the available flout current ❑ Mnnnat and bomynrda. -`;;', ^,- Y $'i i+'i�l , ' ' ` " � exceeds 10,000 amps at 150 volts or 0 Floating buildings. '; less to ground, or exceeds 14.000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling ® Commercial /industrial © Accessory building amps for all other installations. buildings ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ installation of 75 KVA or "•,- ' ' r y ❑ 6mergenvy system, larger sepnrntely derived system, : „i.','G 144t11IQN'1�1�1`)11i1 .,, .`, '. ' "'`' ❑ Addifiea0l'newmo tor kaadof ❑ „ A” „ E" 1.2 "I -3 ". 10014P or more, occupancy Job no.: Jab site address: 15350 SW Sequoia, 195 ❑ Six or more residential units, ❑ !emanational vehicle parks, City /State /zrP: ❑ Heulth•care facilities ❑ Supply voltage for more than ❑ l lacanlOus locations. 600 volts nominal, Suite /bldg. /apt. no.: 195 Project name: Houston Insurance 0 Servise or feeder 600 stops or more Cross street /directions to job site: Dmt,t od a ' I Qty. I Fee. i ( Totui l • - New residential single- or multi- family dwelling unit. Includes attachedgarage. - Subdivision: Lot no.: 1,000 sq. ft or less 168 54 4 Ea. add'l 500 sq. 11. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential 75,00 2 ., -.., . , , �„ `? , "., , '; .,,,; �, t1�C>gIIP'1C)I£�'�!1F'',tiY, ;.'.;''� ;, ,;',.' r, with above s'� ,.W.r_ �. Limited energy, multi•fitmily 75,00 2 clean up space residential (with above so, ft.) Services or feeder's Installation , alteratinn, and /or relocation 200 amps Or less 100.70 2 ia ll 1P '- ' *W 3", '010404 201 mop% to dO0 amps 133.56 2 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 552.26 2 - City/State /7 „1P; Temporary services or feeders installation, alteration, and /or rclocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 I 1 201 snips to 400 amps 125.08 I 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168,54 1 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new, alteration, or extension, er panel Owner signature: Date: _ A. Fee for branch circuits with a service or feeder fee, 71 ;r, `' , '4l j Goon .r,,, . , ' , 'f � ` 11Y' A ' : .sib",' ilf�; ' 7,42 2 each branch circuit _ Business name: Johansen Electric B. Fee for branch circuits without service or feeder te, first ( 56./8 SZ, . 1 2 Contact name: Charlynn Leifsen ^ branch circuit Each ndd'I branch circuit 7.42 2 Address: 1_0948 SE Valley View Terr Miscellaneous (service or feeder not Included) C i /State /ZIP: Happy Valley, OR 9 7 0 8 6 Each dwelling, service manufactured or modular 67,84 2 tY Ha Va 11 e r dwellin , servic and/or feeder Phone: (5 0 3) 698-3417 I Fax::(503) 6 9 8 - 2 4 8 6 Reconnect only 67.84 2 Pump or irrigation circle 67 84 2 E -mail: _, , . Sign or outline lighting 67.84 2 ' "5-''',;,''',' " ' j ' , , ' ` '•” , , ' Signal circuits) or limited-energy Rusinessname: Johansen Electric panel, alteration, or extension. Paget 2 . Each additional inspection over allowable In any of the above Address: 10948 SE Valley View Terr Additional inspection ( I hr min) 66 25/hr City/State/Z1P: Happy Valley, OR 97086 Investigation (Ihrmin) 66.25/lu industrial plant (1 hr min) 78 18/ hr Phone: (503) 698-3417 I Fax: ( 503) 698-2486 Inspections for which no fee is 90,00 / hr sl,ecifically listed ('t hr min CCA I.Ic.: 51539 Electrical Lic.: 3-243C Suprv. Lic.: 20533 : ; itECI*Olif , pERM1T' F s '' " ' Suprv. Electrician signature, required: r > Subtotal: 5 . /g ^�4 Plan review (25% of perm fee): Print name. Carl j ansen /late: 5/ 3 /13 State surcharge (12% of penult fee): , 7 ei Authorized signature: TOTAL PERMIT FEE: 2 • /2_ rats permit application espl res if a permit is am obtained within 180 Print name: Char Lynn Leifsen Date: 5/3/13 days aver It hex been accepted as complete. * Number of Inspectons allowed per permit. 1. 1adildingWamillu\hLC.FemntApp 07/01/10 44046157(11/IS/C(1M /WFR Z / T • a€Vd 98T7Z869C09 98tZ869C09 Zoarla NaSNVHOr wti 9T:60 CTOZ'CO•keW 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 15350 SW SEQUOIA PKWY 195, TIGARD, OR, 97224 Commercial - Electrical 199 Electrical final 06/28/2013 00:00 ELC2013-00255 PASS - No C of O Violation Summary: Inspector Contractor