Permit rt CITY OF TIGARD ELECTRICAL PERMIT
III a • • COMMUNITY DEVELOPMENT Permit #: ELC2013 -00340
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/19/2013
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 120
Project: Meridian Tech Subdivision: WEST PORTLAND HEIGHTS Lot: 9 -25, PT
Project Description: (10) branch circuits for TI
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: 503 - 624 -6300
FAX: 503 - 698 -2486
FEES
Quantity Description Date Amount
10 crt Branch Circuits wo /Purchase 06/19/2013 $122.96
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/19/2013 $14.76
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $137.72
Required Items and Reports (Conditions)
This permit is issued sub'ect 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 rdance with proved plans. This permit will expire if work is not started within 180 days of issuan o if work is suspended for more the 180
days. A NTION: Oregon la re uires you to follow the rules adopted by the Oregon Utility Notification 'enter. Those rules are set forth in OAR
952 -00 -0010 through OAR 952 -00 09 ou may obtain a copy of the rules or direct questions to OUNC by calling 503.2 jAh:7 800.332.2344.
Iss ed By: Permittee Signature: di..innIll■-
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' — I� Date: (0/ 19 f 2_
LICENSE NO. c37 S
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 Application FOR OFFICE USE ONLY
Received N �� a d y5- z'3
City of Tigard Rete : .. / Permit No.: �, LY JY
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review n
Ili Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit: Q t,1 ',pc/ .. o p/ 1
T I G A R 1.) Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 - 2 ", "I - 3 ",
IOOHP or more. occupancy.
Job no.: Job site address:
12909 sw 68th pkwy, 120 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Meridian ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Torsi I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
Tenant improvement residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps 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
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
ty relocation
Phone: ( ) Fax: ( ) 200 amps or less 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
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: Johansen Electric B. Fee for branch circuits without
service or feeder fee, first 1 56.18 56.182
Contact name: Charlynn Le i f s en branch circuit
Each add'I branch circuit 9 . 7.42 66.78 2
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
City/State /ZIP: Happy Va 11 a OR 9 7 0 8 6 Each manufactured rvice or modular 67.84 2
PpY y r dwelling, service and/or feeder
Phone: ( 5 0 3) 698-3417 Fax:: (5 0 3) 698-2486 Reconnect only 67.84 2
Pump or irrigation circle • 67.84 2
E - mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: 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 (1 hr min) 66.25/hr
City/State /ZIP: Happy Valle OR 97086
Investigation hr min) 66.25/ hr
PPY Y r Industrial plant (1 hr min) 78.18/ hr
Phone: (5 0 3) 698-3417 Fax: ( 503) 698-2486 Inspections for which no fee is
90.00/ hr
specifically listed ('/ hr min)
CCB Lic.: 51539 Electrical Lic.: 3 -243C Suprv. Lic.: 5 3 ' 5 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: o Subtotal: 122.96
Plan review (25% of permit fee):
Print name: Jonath- • • . Date: 6/19/13 State surcharge (12% of permit fee): 14.76
TOTAL PERMIT FEE: 137.72
Authorized signature: % i v , G I 1°11%1
This permit application expires if a permit is not obtained within 180
days artier it has been accepted as complete.
Print name: Jonatha , • hans en Date: 6/19/13
• Number of inspections allowed per permit.
I:' Building \Permits\ELC- PermitApp,doe 07/01/10 440- 4615T(I I /05 /COM/WEB