Permit (28) CITY OF TIGARD ELECTRICAL PERMIT
11111
COMMUNITY DEVELOPMENT Permit#: ELC2017-00059
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/24/2017
[G g Parcel: 2S 112 DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY
Project: PacTrust Subdivision: 1996-048 PARTITION PLAT Lot: 2
Project Description: (4)branch circuits for third floor common area.
Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES
16869 SW 65TH AVE, SUITE 311 ATTN: N PIVEN
LAKE OSWEGO, OR 97035 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-747-2503 PHONE:
FAX: 503-972-1861
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo/Purchase 01/24/2017 $78.44
Specifics: Service or Feeder
1 ea 12%State Surcharge- 01/24/2017 $9.41
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: - �-�-----.__ Permittee Signature: _47/2----e-
.1/---e-
`
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.
To: Page 4 of 7 ItECFIVP1)9
20:33:35(GMT) 15039721861 From: Charlynn Leifsen
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Electrical Permit Application ..,-,:-,-,•.• - .:, ,.: . . .:,',17OROFFI.C.7E.USE ONLA
JAN19 1017 -_. ......:_: - ..:. ...,. .,:...... .•.:::•.,......• • ... . . .:-. •• . .. • — . ..
....i:':'•.'•....* ••••.t..,,.• City ofTigard Received , L f.
Permit bI:
13125 SW Hull Bird.,Tigard.OR1,493/42-Ai ifw TIC A.1)V1) , Plan'Review '
Phone: 503.718.2439 Fax,: 503.3931101.1 4itlIt -1°-'It‘51-kl'""' DateiBy i Related Permit il:
,..,-.11:i......_...:....::: Inspect ion Line: 503,639.4175-fla TI I nlikir, rhripT,cInfk; Ready-oa,,Ry. 1 Cads.,..,-,........, 1 Fil See Page 2 for
1
Internet: www:tigard-orgor Ill U t ki VIII ILI 4-7-It 7 3,..31-M1' ! NotifiedNethod ____1 Ljo— 1 Supplemental information
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,,,,,..,.„..„,„.....,.. .. ,,, , .. .,.. , .. .. . ,. . . . . ._.,,,,,,, . , „,,.. .. . . , . .
I 0 New construction E Addition/alteration/replacement Please check all that apply tsubmit 2 sets of plans wlitems checked):
0 Service oi feeder 400 amps or more 0 Building over three stones.
[
U Demolition [JOther: ....,._ whore the-available fault ctrreni. 0 Marinas and boatyards.
11111111111201-1111:11 :1111I1.11:127-7.117171-77177,110:VIt11101141,11:101K1k111.09AuCT-10,1V11,111,11-!4:11,11,1:11:1:1:11;a1akl:11 -11:1 exceed5 I O(l00 amps 111 ISO volts or Dl I 0 ali il g buiRlirlP.
.„....,.....,,,... .. . ...„. ..,,, . ....
1
less to ground or exceeds 14.000 Cl Co»uncrcial-use agricultural 0 I-and 2-family dwelling C Commereialiindustrial 0 Aceessciry building
amps or all other installations_ buildings_
1 0 Multi-family 0 Manta bulkier 0 Other: 0 Fire pamp. 0 Installation of 150 KVA or
40*. .iakiA:Siti$4,:g7870.67 .03Y,:,itd,b,i4i.OV. -la,Vi:--,::: ::-:;:',.'.-:.:-r;. :.i::' :6', :,?',E.;E: ,,DEfiletge"eYsYstem' larger sepamtely derived
i...i Addition af new motor load of system.
Job t.: I Job site address: 15350 SW Sequoia Pkwy 1 10011P or more.
1 i
0 Sty ot Inoue residential units. occupancy.
Cit.ViState/ZIP:
I - I 0 Health-cafe facilities. 0 Recreational vehicle parks:
1 Suite/bldg./apt.#:3rd fir T-Project name.Bldg 241 common area rem { 0 Hazardow locations. El Supply volMgc for more titan
1 - ' • • i 0 Service or feeder 600 amps or more. 000 voll,1901millli.
Cross strectldirections to job site: I -
ji q :i Sack j Total 1 "'
1---- 7 lot 1/:
re.sidential single-or multi-family dwelling unit.
1 Subdivision: I tior#: I Includes attached garage.
1---- I
1 L.Ouo sq.ft.or less 168.54 i 4'IlaN map/parcel#: Pa,add..SOO sq.ft'.Or portion 1 33.92 1
PtK.7ttP.O.W.IIi.T4ii5WW:77-77777757Z: ::1,;,::,i.',.:,:,-:,:;i,,-,,,, I tithited energy,residential ..._...._ I _.....1._
75.00 ; 2
I (with above sq.It)
Common area remodel on 3rd floor i 4 ---1
1 Ithnitcd energy,multi-family ;
-- 75.00 1 2
L..... residential(with above sq.fIT 1 ---1
7T —7.. ,, „..ri.. .,-, - -.-.-----....:, 1 Renewable Energy 1 0 See rage 2._±.. i
,‘;::::',•.',:'•::: ','''',:-',Z-i,;#00:11,07Y:41'70:NIFI.k.':;:77.•'i..:7::*....;',!:.::::,. .::,:,, .:...,..:',: ,',:44,":trAN'ik'Nt'-' ':'.1'''''''';'-';'::'::.'''•'' L Services or feeders installatiam'alteration,andfor relocation
Name: , 200 amps or less 100.70 1 2
_....
__ __________................... _........................................________....„___ i
L 21)1 amps to 400 amps I 33 56 2
Address: 1
, 1 401 amps to 600 amps I
r7
-I- 200,34 2
(ity/Stati- 30104
elZlP: ----;-
H1 amps':to 1.000 amps 1 . ..._.1
Phone:( ) Fax:( ) I Over 1.000 amps or volts I 552.26 I 2
- I Temporary services or feeders installation,alteration,and/or
Email: ....... relocation ......
Owner installation:This installation is being made on property that I own which is not ..,30(.)alms or Ion S 59,36 = 1 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670-and 70). 201 amps to 400 amps 125.08 2
Owner signature: Date:_....... 401 amps to 599 amps 168.54 2 i
_.....
r.71ii_iii ,i.:2-: ::',.:,-.n..?;•.:.,••••:,: Branch circuits-new,alteratintlj,ir extension„per panel
.!'.-4:..'`q'9471.*'V.;''' '--t'""F"''''':..,j1'".h'"''"'I''.'"'"''- A.Fee for branch circuits-with
Business name:Johansen Electric above service or feeder fee,
7 42 2
------ each branch circuit
Contact name:Charlynn Leifsen h.Fee for branch circuits without
service or feeder fee,first I 56.18 2
Address: 16869 SW 656 Ave#311 branch circuit 50.18
City/State/ZIP:bike Oswego OR 97035 Each add'I britnch cimuit 1 3 7.42 22.26 1 2
—a Miscellaneous(service or feeder not included)
Phone:(503)747-2503 Fax::(503)972-1861 . -r-
Each manuFactmed or modular I i 1 ,
t i 67,84
dwelling,service andlor feeder
Email:otTicecajohansendectric.com
Reconnect only I I 67.14 is
-
411i-TWACJI:01titi'... t,:tti: 1,7tei7:-.777.777-77:7tit.:ItIi.'..::::'tii'iiI'A. Pump or irrigation circle
i 1 67,84 i 2
- ; ,
Business name:Johansen Electric sign or outline lighting 07.84 I
l
----- ----" Signal circuit(s)or Iimited,enerav ii— ,
I Address: 16869 SW 656 Ave#311 ! 2
;and.,alteration.or extensicia. - i 1:2 See r age 2
- Each additional inspection over allowable in any of the above
CityiStateiZIP:Lake Oswego,OR 97035 ,
I Additional'inspection(1.hr min) i 66.25/hr
'
Phone:(503)747-2503 Fax:(503)972-1861 Investigation(I hrIlli-n) 90 00/hr
1 ........___ ..
- Industrial plant(1 hrmini 78.1 8/hr
Email:offiregjohansenelectric,com
Inspections for which no fee is
90.00/hr i I
CC111 Lie.: 51539 i Electrical I ..: 3-243C Suprv.Lie: 5378S s,pi.le.licrili.,Ltisted.(kM:nm ,,.„,;,: . , ,;,4,,,,..„,,:„..,, ,:,.:,,,,,:,,,.,,....,,,,77..i
!-- )
- . . 1744f040CA.14.1,0011TUI(IfArlt ,:g,,, :..i.,:.,, , ,,:-.(g,v,.,.
- 41k
Suprv.Electrician signature,required: -- . , Subtotal: I 78.44
--- Nilli
---- _
illoo _______ .._______4
Print name: -Jonathan Johanson ' I Date: IT19/11 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 9.41 —
PERM :
Am horized signature: j/ _ _ _.------
TOTAL IT FEEI 87.85
___...........______.......... 1 permit application eNpires if a permit is nut obtained within 180
:
Print name: Charlynn Leifsen I Date: 1/19/17 days after it has been aecepted as complete.
L------- - ,
.----I ' Number of inapections allov.the per permit
1,11LtildingTennitsn,C2m1hApp FIR FRF doc.Riw OW I roots ,140-4,I 5';/1 1.i051CONIAVE3
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15350 SW SEQUOIA PKWY, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Electrical ELC2017-00059
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor