Permit
n CITY OF TIGARD ELECTRICAL PERMIT
ss COMMUNITY DEVELOPMENT Permit#: ELC2009-00532
. 0 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/08/2009
Parcel: 2S112D000500
Jurisdiction: TIGARD
Site address: 15875 SW 72ND AVE
Subdivision: OREGON BUSINESS PARK III Lot: 40
Project: Calypte
Project Description: Add/alter (20) branch circuits for TI.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 20 crt Branch Circuits 10/08/2009 $197.16
wo/Purchase Service or
PHONE: 503-624-6300 Feeder
1 ea 12% State Surcharge - 10/08/2009 $23.66
Electrical
Contractor:
JOHANSEN ELECTRIC INC
10984 SE VALLEY VIEW TERR
HAPPY VALLEY, OR 97086
PHONE: 503-698-3417
FAX: 503-698-2486
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $220.82
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 952-001-0100rYou may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Q CS ~ ri I xG4 -.4.A.A I f /1,0 o Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property 1 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 an inspection that business day.
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 A licat-
City of Tigard Received
Date,B 777 yio Q 4 rv J
• 13125 SW I tall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.59871960 rI O~ Daoe'B Permit
C P Q aQ
Inspection Line: 503639-4175 Date Ready/By: ~ ®See Page 2 for
Internet: www.tigard or.gov Notified/Method: \ Supplemental Information
6 ` e F . Fit wadi F,. ilk;-rr
❑ New construction ❑ AdditionialterutioninepIaeement Please check all that apply (submit j sets of piam wiitems checked belowp
❑ Demolition ❑ Service or feeder 400 amps or mare ❑ Building over three stogies
❑ Other' where the available fault current
_ ;y-,.~, ❑ Marinas and boatyards.
Sri exceed 10,060 amps at 150 volts or ❑ Floating buildings.
less to
ground, or eKCeeds 14,000 ❑ Commercial-use agricultural
❑ I- and 2-family dwelling ❑ Commercial/industrial ❑ Accesserv building
amps for all other installations. buildings-
Multi-family ❑ Master builder ❑ O-her. ❑Frlepamp. ❑Installationof751CVAor
x : ❑ Emergency system. larger separately derived iystem.
l Mitf~ ,p1E 1<1VtlC3[rLTl01.'+i't;iA~71} IE(~A7~1~ I
❑ Addition of new motor load of ❑ "A "E", "l 2","l-3
Job no.: Job site address: I j6 SqA-) -7 2r-kD I00HPormore, occupancy,
- ❑ Six or more residential units ❑ Recreational vehicle parks.
City/State/ZIP: ❑ Health-care facilities. ❑ supply voltage for more than
t ❑ Hamrdolrs locations. 600 volts nominal.
5uite/bldg.lapt. no.: Project name: C a 1 ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: 9Cllai+l 1„ dt r ml a
oe:e.; don Fee. Tear
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'1 500 sq- ft. or portion 33.92 1
Tax map parcel no Limited energy, residential
1#k ;Ilftll?T+C11ti t?ft"V1lf}R gill}I, =3a<,rr 't i•
with above s . fl. 67.84 2
l Limited energy, multi-family
residential (with above . ft. 67.84 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
Pflx'1s1t I„~:; rr ~I~ a 'r, t 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/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59 3b l
Owner installation; This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 1
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits - new, alteration, or extension, er panel
A. Fee for branch circuits with
, i 1(h'. ;i ell above service or feeder fee, 7.42 2
each branch circuit
Business name: Johansen Electric B. Fee for branch circuits
Contact name: 109148 SE Valley View Terrace wrthout service or feeder fee, 56.18 2
first branch circuit
Address: Happy a ev Each add'] branch circuit
1 7.42 2
Miscellaneous service or feeder not included
City/State/ZIP: Each manufactured or modular 6784 2
dwelling, service and/or feeder
( ) )
Phone: Fax:
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
5ign or outline lighting 67.84 2
Business name: o ! ansen ectrle signal circuit(s) or limited-
energy panel, alteration, or
Address: 10948 SE Vanivy view I r extension. Describes Page 2 2
Happy Valley. Oregon 97086 -
City/State/ZIP: CCB # 51539 Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone-( Fax: lmestigation per hour (i hr min) 66.25
CCB Lie.: 5L :3 O1 Electrical Lie.: 3-Zg3c Suprv. Lie.: Industrial plant per hour 78.18
W,i ;711
Suprv, Electrician signature, required: Subtotal:
Print name: ar Tpi nee n pate: 1616 AR Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature TOTAL PERMIT FFF.: 'a -so
Print name: n4 e Date: /p This permit application expires ifs permit is not obtsuned within 180 ~J
[J _ days after it has been accepted as complete.
Number of inspections allowed per permit.
I tBuile.ine~Pu"islELC-PertnkApp.doc 10,'01!09 "0.461ST(I I'OSiCO>vL'W H
5 - cl XUA 13C21~]SWI dH Wd T T :0 T 6002 90 400
ELECTRICAL PERMIT
J J CITY OF TIGARD
` Q COMMUNITY DEVELOPMENT Permit #: ELC2009 -00532
r :
<r ,= D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/08/2009
7iGARD Parcel: 2S112DC00500
- <rd7 t� x rr{q
Jurisdiction: TIGARD
Site address: 15875 SW 72ND AVE
Subdivision: OREGON BUSINESS PARK III Lot: 40
Project: Calypte
Project Description: Add /alter (20) branch circuits for TI.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 20 crt Branch Circuits 10/08/2009 $197.16
wo /Purchase Service or
PHONE: 503 - 624 -6300 Feeder
1 ea 12% State Surcharge - 10/08/2009 $23.66
Electrical
Contractor:
JOHANSEN ELECTRIC INC
10984 SE VALLEY VIEW TERR
HAPPY VALLEY, OR 97086
PHONE: 503 - 698 -3417
FAX: 503 - 698 -2486
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $220.82
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- 0100 may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 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' C� Q
�_ \wAl. J ) Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
lig
fi....
Electrical Permit Applicati u EIVED FOR (lb/ I ~;1t l i\l,\
City of Tigard
` ed
Receiv ' 09 Date/B b , Permit �: •0Q. 41 GS
° 1'9
I • 13125 SW I tall Blvd., Tigard, OR 97223 20 Plan Review
Phone: 503.639.4171 Fax: 503.59 6 O 5 Daoe/B Other Permit: ` , P • si Q • d0 r ,,
I I G .L <. a Inspection Line: 503.639.4175 c p� ��� S Date Ready /By: ® upplem Pacofge al 2 ln for fo ahon
Internet: ol . www tigard - or goy l° Notified/Me hod:
rm
tai rt r 1: 1 . vd r l •a''i :11 .;
L , , 4 , QF' i ' i�l -� .P . e p 11 I s t 7 _ t.:, rt 1 ii r { - J3.rs'1t11 J3 f .:. { t ' ! It
....,. ! t ,. i.' ,... ,. t -. •,. I tt +I .i .a >is � �'� 1 ��.,m 4 .,1
❑ New construction ❑ Addition/nerd ion/replacement Please check all that apply (submit j sets of plans w /items checked below).
❑ Demolition ❑ Service or feeder 400 amps or more ❑ Buulding over three stories
❑ Other: where the available fault current ❑ Marinas and boatyards
1't . i', "` i !'I' -'r I af"S" lf� ki: ,YS '`q1S t+ �^� 0 s ,r" -1.h i 1 =1 r h ;, exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
'`'�"l jr less to agricultural
I:: 1 and 2 dwelling ❑ Commercial/industrial ❑ Accessory building amps for o exceeds - use
all ll o othea r installations ❑ Commercial
- use
buildings
❑ Multi family ❑ Master builder ❑ Other ❑Fite pump. ❑ Installation of 75 KVA or
« t ,47.1,,,p1...-L., . il' i t " rr i r ,l t Le t9(1f , ,y. r t •t t ,,. Emergency system. larger separately derived system.
fi..; � i 'lf.. 7. ,+7"*?Sr�l , p El Addition o new motor load of ❑ A E t_2 , ` l •3
Job no.: kb site address: 1 ' 1 & 51,0 - 7 2 yo 100HP or more. occupancy.
❑ Six or more residential units ❑ Recreational vehicle parks.
City /State /ZI ❑ Healthcare facilities. ❑ Supply wiltage for more than
❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: Project name: C Q-1 i ,/) f ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: `,;.;41:1i:;:.-'1,1-1;1! q 1 I t 1 r
I Description 1 Qty. 1 Fee, 1 Total l •
New residential single- or multi - family dwelling unit.
Includes attached garage
Subdivision: Lot no.: 1,000 sq. ft. or Tess 168.54 4
Tax map /parcel no.: Ea. add'l 500 sq_ it. or portion 33.92 1
�p
... I,:, rt k , ,, -.! 4 I _ ' .� 4 r ,LF , ,�.. !A BWf�,.� q . ., . :1�19 t - t ti ;n residential 67.84 2
Limited energy,
>,r. t ¢ (with above sq. tl)
\ fl ,(Sr t Limited energy, multi - family f
'c r n t� 1 P e residential (with above sq. ft.) 67.84 I 2
Services or feeders installation, alteration, and/or relocation
p „ , t r 200 amps or less 100.70 2
'pl t 4' ti l4 ,+ i I ; , i, 1. ; •_ t ,,,`' ',:' Q r 'CEKA'1�' 1, .. 1 a "r; j 201 amps to 400 133.56 2
Name: 401 amps to 600 amps I 200.34 2
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
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59 36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 1 168.54 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel I
A. Fee for branch circuits with
. I . 0 hf'Q' ' 4 i;ii:,;.,'i,"l,s m E . tr, `I ,.�{ '( t x 'T ' t is .,t' above service or feeder fee, 742 2
each branch circuit
Business name: Johansen Electric ' B. Fee for branch circuits
Contact name: 10948 SE Valley View Terrace without service or feeder fee, ` 56.18 2
Ha Valle Oregon 97088 fast branch circuit
Address: PPY Y , 9 Each add'1 branch circuit
Iq 7.42 , 2
Miscellaneous (service or feeder not included) _
City /State /ZIP: I Each manufactured or modular 6784 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) I r Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
,.
4 r r, w r ;.Kt ��. t :: ' r e� ] ,, a 1, .. . t 1. il,., t '', r ,i il Sign or outline lighting 67.84 2
Business name: Johansen Electric Signal circuit(s) or limited -
energy panel, alteration, or
`a
Address: extension. Describe: Page 2 2
I4Rppy Vallauy, Oregon 97086
City/State /ZIP: CCB # 51539 Each additional inspection over allowable in any of the above
,.� / ' _Per inspection 66.25
Phone: ( 03 421 - 3 - 1 1 Fax: ( ,) (� e_ 24 9c, Investigation per hour (1 hr min) 66.25
CCB Lic.:5 e, Electrical Lic.: 3-Zy3e Suprv. Lie.: 2.O53S Industrial plant per hour ,i ,'{, 78.18
=t 1 1 i't. ,E�
'l : tc0 1.011 JI ' 1 4'.i 'i 1
Suprv. Electrician signature, required: / Subtotal:
Print name ( tzr� Tokonse -) Date: /6 /6,A,1
112
Plan review % of permit fee):
j State surcharge (12% of permit fee):
Authori signature 2.
TOTAL PERMIT PEE: 0 Q, 8 a ‘.S)
Print name: � � (J 1r n � J / // ; P� /07(0/4g This permit application expires if a permit is not obt V aned within 180 � 9'r D ate:
days after it has been accepted as complete,
' Number of inspections allowed per permit.
1\ Building \PcrmitslELC- PerminApp.doc 10'01 440 - 4615 T(I1 /05 /COMLNEa
S Xdd 13C213Sd1 dH WETT :OT 5002 90 qo0