Permit Support Document CITY OF TIGARD ELECTRICAL PERMIT
!• 1 ' COMMUNITY DEVELOPMENT Permit#: ELC2020-00186
Date Issued: 04/08/2020
TIGARD 13125 SW Hat Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S113AA00500
Jurisdiction: Tigard
Site address: 16100 SW 72ND AVE B18
Project: Moda Subdivision: ROSEWOOD ACRE TRACTS Lot: PT A&I
Project Description: Tenant Improvement. 6/3/20: REPRINTED permit to include(3)branch circuits for Patient Care scope of work.
Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES
16869 SW 65TH AVE, SUITE 311 ATTN: N PIVEN
LAKE OSWEGO, OR 97035 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-747-2503 PHONE:
FAX: 503-972-1861
FEES
Quantity Description Date Amount
8 crt Branch Circuits wo/Purchase 04/08/2020 $108.12
Specifics: Service or Feeder
1 ea 12%State Surcharge- 04/08/2020 $12.97
Type of Use: COM Electrical
Class of Work: ALT 3 crt Branch Circuits wlPurchase 06/03/2020 $22.26
Service or Feeder
Type of Const: 0 ea 12%State Surcharge- 06/03/2020 $2.68
Occupancy Grp: Electrical
6 Plan Review-Electrical 06103/2020 $5.59
Total $151.62
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_asonvn of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: +-8y�./a . Permittee Signature: Pi C/
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or re: .
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 lob site until completion of the project.
Approved plans are required on the Job site at the time of each inspection.
Electrical Permit Application uit-. iti FOR Ohs icr.I SE ONLY
i`
City of Tigard vy.vsl.y (e, Cr' Received Permit H: ' /
1111 u DateB : do r/] ..hr. (Y_
13125 SW Hail Blvd.,Tigard,OR 97223 �fn Plan Review.< �/
g - Phone: 503.718.2439 Fax: 503.598.196r /�� DateBy: ✓ L'J if, ' Related Pernit#:/ /We_�irK�—
Inspection Line: 503.639.4175 �'1 r Ready Date/By. r , kris: /Sias Pagec 2 for 'eJ
-FIG ARP,- Internet: www.tigard-or.gov ' EI _El\I Notified/Method:l/'3/ , �+y'rs•--• I Supplemental Information
TYPE OF }��VQ/O^�RRKRvK a r/1"af ( �'✓J PLAN REVIEW
❑New construction M Addition/alter'ai'Ibtl/�gaag 41 L;t Please chat It t apply(submit 2 sets of plans w/items checked):
f 0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other:
. i TY:U F . where the available fault current 0 Marinas and boatyards.
CATEGORY conipoy(�TttA-hi r s_ exceeds 10,000 amps at 150 volts or 0 Floating buildings.
"u' r a 't� I�► less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ 1-and 2-family dwelling ®Commercial/industria Yib2ssory building
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
of new
Job#: I Job site address: 16100 SW 72nd ❑100 rtion HP or more.motor load of system.
City/State/Z[P: 0 Six or more retidential units. occupancy.
IN Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: el( I Project name: Moda ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
(with above sq.ft.)
add medical plan review to permit#ELC2020-00186 Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
0 PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 _ 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
relocation
Owner installation: This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
® APPLICANT I ❑ CONTACT PERSON Branch circuits—new,alteration,or extension, er panel
A.Fee for branch circuits with
Business name: Johansen Electric,Inc. above service or feeder fee, 7,42 2
each branch circuit
Contact name: Charlynn Leifsen B.Fee for branch circuits without
Address: 16869 SW 65th Ave#311 service r feeder fee,first 1 56.18 2
branch circuit
City/State/ZIP: Lake Oswego,OR 97035 Each add'I branch circuit Z 7.42 2
Miscellaneous(service or feeder not included)
Phone:( 503)747-2503 Fax::( 503)972-1861 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: office@johansenelectric.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: SAME Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy ❑ See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr -
Inspections for which no fee is 90,00/hr
CCB Lie.: 51539 Electrical r: 43C Suprv.Lie.: 53785 specifically listed(V hr min)
y ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required' �'
ab... Subtotal:
Print name: Jonathan Jo en ~ Date: tit Zs I b1,0 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
=1/ ) 42,0 This permit application expires ifa permit is not obtahud within 180
Print name: Charlynn Lelfsen / Date: 4 h days after it has been accepted as complete.
' Number of inspections allowed per permit.
l:\Building\Permits\ELC PermitApp_ELR_ERE_doc Rev 06/17/2015 440-4615T(11/05/COMAVEB
Branden Taggart
From: Branden Taggart
Sent: Wednesday, June 3, 2020 2:02 PM
To: Charlynn
Cc: Dianna Ornelas; Jeff Grove
Subject: Moda Permit: ELC2020-00186 - 16100 SW 72nd Ave B18
Attachments: Branden Taggart2.vcf; TransmittalLetter_Revisions_052512.pdf
Importance: High
Hi Charlynn,
We have completed plan review for your Moda Electrical permit ELC2020-00276; however,we will need to receive
revised plans that reflect the scope of work for all (11) branch circuits. The original permit was created online for(8)
branch circuits, and the plans we recently reviewed were for a total of(3) branch circuits. When you are ready to submit
the revised plans, I have attached our Transmittal Letter above for you to include. Please let me know if you have
questions.
Thanks,
Branden Taggart
City of Tigard
�..� Senior Permit Technician
TIGARD Community Development
13125 SW Hall Blvd
Tigard,OR 97223
(503)718-2449
brandent@tigard-or.gov
1
Branden Taggart
From: Branden Taggart
Sent: Wednesday, June 3, 2020 2:51 PM
To: Charlynn
Cc: Dianna Ornelas; Jeff Grove
Subject: RE: Moda Permit: ELC2020-00186 - 16100 SW 72nd Ave B18
Attachments: Branden Taggart2.vcf
Charlynn,
Yes,thank you for clarifying. However, I am not exactly sure what Jeff has reviewed, especially since we only have (3)
circuits on the application for plan review in the highlighted region. I will clarify with him, but I may not be able to reach
him today. I will try and get this resolved for you this week.
Thank you,
Branden Taggart
City of Tigard
Senior Permit Technician
TWA HI) Community Development
13125 SW Hall Blvd
Tigard, OR 97223
(5031 718-2449
is randent@tigard-ar.gov
From:Charlynn<office@johansenelectric.com>
Sent: Wednesday, June 3, 2020 2:06 PM
To: Branden Taggart<brandent@tigard-or.gov>
Cc: Dianna Ornelas<Dianna@tigard-or.gov>;Jeff Grove<JeffG@tigard-or.gov>
Subject: Re: Moda Permit: ELC2020-00186- 16100 5W 72nd Ave B18
Caution!This message was sent from outside your organization. Allow sender I Block sender
Branden,
The plans submitted are the full plans and show the full scope of work. For plan review 'Health Care'
we only highlighted the patient care areas, but we are doing all of the electrical on the plan. Does that
help?
Sincerely,
Charlynn Leifsen
Secretary-Treasurer
Johansen Electric, Inc.
1
P (503) 747-2503 M (503) 830-2513
Original Message
From: "Branden Taggart" <brandent@tigard-or.gov>
To: "Charlynn" <office@johansenelectric.com>
Cc: "Dianna Ornelas" <Dianna@tigard-or.gov>; "Jeff Grove" <JeffG@tigard-or.gov>
Sent: 6/3/2020 2:02:18 PM
Subject: Moda Permit: ELC2020-00186 - 16100 SW 72nd Ave B18
Hi Charlynn,
We have completed plan review for your Moda Electrical permit ELC2020-00276; however, we will need to receive
revised plans that reflect the scope of work for all (11) branch circuits. The original permit was created online for(8)
branch circuits, and the plans we recently reviewed were for a total of(3) branch circuits. When you are ready to
submit the revised plans, I have attached our Transmittal Letter above for you to include. Please let me know if you
have questions.
Thanks,
UPI Branden Taggart
' City of Tigard
ro.....„_. Senior Permit Technician
TIGARD Community Development
13125 SW Hall Blvd
Tigard,OR 97223
(5031 718-2449
brandent@tigard-or.gov
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2