Permit CITY OF TIGARD ELECTRICAL PERMIT
11111- ; COMMUNITY DEVELOPMENT Permit#: ELC2013 00502
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/22/2013
Parcel: 2S113AC00102
Jurisdiction: TIGARD
Site address: 7250 SW DURHAM RD,STE#900
Project: Universal Tea Co Subdivision:COUNCIL VIEW ACRES(LOTS 21-44) Lot: 25-27,2;
Project Description: Electrical 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
5 crt Branch Circuits wo/Purchase 08/22/2013 $85.86
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/22/2013 $10.30
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $96.16
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 952-001-0090. You may obtain a cop e+ s or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By� Permittee Signature:
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 ApplicationAUG 2 2 2013 1'(111(l1.I l( 1:t si.:°N1.1
City of Tigard Received
• 13125 SW Hall Blvd.,Tigard,OR 'Y OFTIGARD 0 I
III 1. EMIPMEgigffli
Plat Review
Phone: 503.639.4171 Fax: 50 E1NG DIVISION latc/13 I
.a
1 i,:A u i, Inspection Line: 503.639.4175 Date Ready/11y: lil Sec Page 2 for
Internet: www.tigard-or,gov Notified/Method: IFMI Supplementallnrormallnu
TYPE OF,WORI( . ' . .. . NAN•REVIEW;, ..
❑New construction ®Addition/alteration/replace
ment Yleasa check all that apply(submit awe of plans w/itrma checked below):
['Service or feeder 400 amps or more ❑Building over Micro stories,
❑Demolition ❑Other: where the available Malt current ❑Marinas and hnayards.
CATEGORY OF CONSTRUCTION, . . • exceeds 10,000 amps at 150 volts or ❑Floating buildings,
less to ground,or exceeds 14,000 ❑Conunereiod-use agricultural
❑1-and 2-family dwelling E Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-futnily ❑Master builder ❑Other: ❑Fire pump. ❑Installation ot'75 KVA or
JOB SITE INFORMATION AND LOCATION • ❑Emergency system. larger separately derived system.
. ❑Addition of new motor load of ❑"A","0","1.2"."1.3",
Sob no.: Job site address: 7 8' SW Durham IOOHPor a residential Recreational
❑Six or atom:residential units, ❑1(ecnrstionel vehicle parks.
City/State/ZIP: ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg,/apt.no.: 900 Project name: Stash Universal Tea ❑SUN=or feeder 600 amps orMore.
FEE SCfIEDDLE '-:
Cross streeVdirections to job site: nerereptlen I QV. T Frt. I guru I •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.R.or less M — 168.54 L 4
- En,add.'500 N.Il,or portion 33.02 1
Tax map/parcel no.: Limited energy,residential
DESCRIPTION AF Vvoa (with ubuve sq.Il,) 75.00 2
Limited energy,multi-family 75110 2
Tenant Improvement residential(with above sq.ft.)
— "` — Services or feeders Installationtalteration,and/or relocation
200 turps ur less 100.70 2
_L PROPERTY.OWNER I . .0 TENANT .... "201 amps to 400 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/7IP: Temporary services or feeders Installation,alteration,and/or
relocation
Phone:( ) Fax:( ) 200 ampo or less 59.36 I
201 amps to 400 amps 125.05 2
Owner installation:This installation is being made on property that I own which is not
401 amps to 599 amps 168,54 2
intended for sale,tease,rent,or exchange,according to OILS 447,449.670,and 701. 401 amps
Branch circuits—new,alteration,or extension,per panel
Owner signature: Date: A.Fee for branch circuits with
• APPLICANT above service or feeder tee,
. .® [ 0'CONTACT'PERSON, each branch circuit 7.42 2
Business name: B.Fee fur branch circuits without I
Johansen Electric eerviu:or feeder te.first 56.IR 2
Contact name: Charlynn Le i f sea brand'circuit
Each add'l brunch circuit i 7.42 .(i$ 2
Address: 10948 SE Valley View Terr Miscellaneous(service or feeder not Included)
■
City/State/7_I la: Happy Valley, OR 9 7 0 8 6 Each mg,service or modular 67.84 2
ppy y r dwelling,service and/or food=
Phone:(5 0 3) 698-3417 Fax::(503) 6 98—2 4 86 Reconnect Only 07.84 2
Pump or inigutiuln circle _67.84 2
E-mail:
Sign or outline lighting 67.14 2
CONTRACTOR Signal circuit(s)or limited-energy
Business name:
Johansen Electric pa,el,altcratimn,orextension. Paget 2
J
Each additional Inspection over allowable in any of the above
Address: 10948 SE Valley View Terr Additional inspection(I hr min) / 66,25/hr
Investigation(I hr min) 66.25/hr
City/State/ZIP: Happy Valley, OR 9 7 086
lntlttslriul plant(l hr min) 78.15/hr
Phone:(5 0 3) 698-3417 Fat:(5 0 3) 698-2486 Inspcctldns for which no ft c is
90.00/hr
specifically listed('t4 hr min)
CCB Lic.: 51539 Electrical Lie.:3-243C Suprv.l.ie.: 20535 ELECTRICAL.'PERMIT.FEES' : . ,
Subtotal: eaS i per
Supra.Electrician signature,required: Plan review(25%of permit fee):
l ► State surcharge(12%of permit fcr
Print name: Carl Johan /� �. `� . 44.2a/13 R p ): /C7•;
TOTAL PERMIT FEE: 4(v/ 6
Authorized signature: 1'hls permit application expires Wit permit I.not tllrtuinrd within IRO
days after It hes been accepted as complete.
Print name: Charlynn LeifSen Date: 8/21/13 • Number orimpea sinne allowed Oapermit.
1:Vl nilding\Pannils1FIC-PrnOApp.duc 07/151/10 440-44171'11 l/OS/COM/WEB
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