Permit u CITY OF TIGARD ELECTRICAL PERMIT
II I B Y COMMUNITY DEVELOPMENT Permit #: ELC2013 00385
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/11/2013
Parcel: 2S113AA01000
Jurisdiction: Tigard
Site address: 16570 SW 72ND AVE B9
Project: Stay'N Power Subdivision: ROSEWOOD ACRE TRACTS Lot: PTS C,C
Project Description: (30) 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
30 crt Branch Circuits wo /Purchase 07/11/2013 $271.36
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/11/2013 $32.56
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $303.92
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. ATTEN : : • :.n law equires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -00 r through OAR 9 -0•1-01 • 1 You may obtain a copy of the rules or direct questions to OUNC by calli 987 or 1.800.332.24.
Issued = : P ermittee Signature: 4'Ai Ow ew
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 . au �'� / ems _ Date: V
LICENSE NO. 62' s j S
Call 503.639.4176 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 JUL 9 2013 FOIL 01•11( I til roN1.1
City of Tigard Received MffFM■7,11
Datc/B : 7 irlige P.--iN Et_e alto/ 3 - oo 3 :5"
!Pi... 13125 SW Hall Blvd., Tigazd, OR 972C
3 ITY OF TIGARD i 4
' 6 . Phone: 503.639.4171 Fax: 503.59paruil" rui iinwuk : Other Permit: . r
IN.Ni,I. Inspection Line: 503.639.4175 U1111U Ui VIJ fun Date R414VISY: Mir: es See Pone 2 kW
Internet: www.tigurti-or.gov Notified/Method: Supplemental Information
'.'•.: . ". ' ?':,:::;','''''7.::.' ::' -.' : ' : !:': . '• . : : ::,...'' : 'lli"P,t . .,,. ..-...:.,.:,'::.-:•.:... ,.::.
0 New construction RE) Addition/alteration/replacement Please check all that apply (submit isms of plans whims checked below)!
in sorwoo or fewer doo amps or Mom 0 HuildIng over three MOrieq.
0 Demolition 0 Other: where the available Molt currant 0 Marinas and boatyards.
;;..:',.: :'::: 7. 2.`.•:,..; ekrEcitoki,‘ c ,,:;. ...J., ,,.:-< qc..?.-, .,:.;.. , : ,,:: ..:.../. . exceeds 10,000 amps at 150 volts or 0 Floating buildings.
, • - - , • " , .„ - ., . • . , • • - . ..: • : ,
tats to (pond, or exceeds 14,000 0 Commerciel•use agricultural
0 1- and 2-family dwelling Fs.1 Commercial/industrial 0 Accessory building wigs nit all other installations. buildings.
0 Multi-family ci Master builder 0 Other:. 0 Fire pump. 0 Installation of 75 KVA or
0 Emergency system. larger separately derived system.
. , :' •'• 7 . ' , . - .-• ' ''' ,.'.' •■Telt ' ; .
Job no.: Job site address: /k.5)7 8 q:hip 100HP or more.
0 Six or more residential units. 0 mcummy
Recreational vehicle parks.
City/State/ZIP:. 0 licalth-carc facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg/apt, no.: "q Project name: Stay Ai kiuez 0 Seiviec or feeder 600 amps or more.
, ‘•,- ;', ': .:... „...,J',.. '. . '...,:'FEE SeliltDttLit .::::. .:.:..:: . . :: .;• -
Cross street/directions to job site: °mignon I Qty. I Yet. I Total I "
New residential single- or multi-fanilly dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or lest 168.54 4
Ea. add' I 500 sq, ft. or portion 33.92 1
Tax map/parcel no.:
Limited energy, residential 75.00 2
' .,. ':;.- ... -. ''.'::•:'H: .'-,, ' :,,.';'•:;:;.,,.....'.. ;,.;.,.:: .:.1 ......:::7; ,. ...,...:J ;;.::::':,,_:. (with above sq. ft)
' Limited energy, multi-ftanily 75.00 2
Tenant Improvement residential jwith above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or IttiS 100.70 2
... :.'.',.; . $0thilitir:byttOta' ,.. i'.'• -,.:,,: •-„:,.: y :::;!c1:11404;iiify .:','...; 201 amps 10 400 amps 13336 2
Name: 401 amps to 600 snips 200.34 2
601 nips to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/Z1P: relocation
Phone: ( ) I Fax: ( ) . 200 amps or less 59.36 , I
201 amps 10 400 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 snips to 599 stops 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: - - Date: A. Fee tar branch circuits with
Apitiekief-• ,:•';;...:.:.:...:.:: `•::•• .1: • ..,.:-. '• :. .,trojitribie,iegotif6 . .. , ,,, ,-, .:;.' , above serviceor yeeder fee, 742 2
• ' • , euch brtutch circuit
Business name: Johansen Electric B. Foe for branch circuits wIthotii
service ur feeder fee, first
I 56.18 2
•• 2
Contact name: Charlynn Leif a en branch circuit &
Each add'l branch circuit i'll 7.42 245. ig' 2
Address: 10948 SE Valley View Terr Miscellaneous (service or feede noi included) ■
Each manufactured or modular
City/State/ZIP: Happy Valley , OR 97086 67.84 2
dwelling, service and/or feeder .
Phone: ( 5 0 3) 698-3417 I Fax: : (503) 698-2486 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
Sign or outline lighting 67.84 2
:::::‘..,:„,;:: ,..,.:: ,:; .:•COlirtnACEDit.: ;''t...,.• .,:..:.....:- .'1 - .: :' . ,.) Signal circuit(s) or limited-encrgy
panel, alteration, or extension. Page 2 1 ,_ 2
Business name: Johansen Electric Each additional inspection over allowable In any of the abov
Address: 10948 SE Valley View Terr Additional Inspection (I hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: Happy Valley, OR. 97086 Industrial plant (1 hr min) 78.18/ hr
Phone: (5 03) 698-3417 [Fax:( 503) 698-2486 Inspections for which no Ice is
90.00/ hr
specifically listed (IA hr min) _.
CCB Lic.: 5 15 3 9 I Electrical Lic.: 3 -243C I Suprv. Lic.: 2 0 53S ': . .j.:.'7'..'..:1BLECTRICAL.IPIRtditiTEV..; ,. .!.,.:'
- subtotal: .21e :Oh, .
Suprv. Electrician signature, required: ,. ,
Platt review (25% of pertnit fee):
Print natnc: Carl J sen ate: 7/9/13 , State surcharge (12% of permit fee): 42, 661
TOTAL PERMrf FEE: _ 1, ‘12.
Authorized signature: This permit application expires If a permit is not obtained within 5110
.
Print name: Charlynn Leif sen Date: 7/9/13 dsys After it has been seethted as esthltieta
• Number of inspections allowed per penult.
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