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Permit CITY OF TIGARD ELECTRICAL PERMIT 2 COMMUNITY DEVELOPMENT Permit #: ELC2010 -00075 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/12/2010 �TIGARD'' Parcel: 2S113AB00101 Jurisdiction: TIGARD Site address: 16101 SW 72 AVE Subdivision: PACTRUST BUSINESS CENTER Lot: 0 Project: Common Area Project Description: (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 02/12/2010 $197.16 wo /Purchase Service or PHONE: 503 - 624 -6300 Feeder 1 ea 12% State Surcharge - 02/12/2010 $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 95 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: i ! /I - Permittee Signature: fit PG- / off l ZD mil/ 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 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. x i irrA n CITY OF TIGARD ELECTRICAL PERMIT s COMMUNITY DEVELOPMENT Permit #: ELC2010 -00075 j GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/12/2010 Parcel: 2S 113AB00101 Jurisdiction: TIGARD Site address: 16101 SW 72 AVE Subdivision: PACTRUST BUSINESS CENTER Lot: 0 Project: Common Area Project Description: (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 02/12/2010 $197.16 wo /Purchase Service or PHONE: 503 - 624 -6300 Feeder 1 ea 12% State Surcharge - 02/12/2010 $23.66 Electrical Contractor: JOHANSEN ELECTRIC INC 10948 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 AR 952- 001 -0100. You may obtain a copy � ofthe rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: 1 V` 1 �° tl/ `r' / 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' Q p 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. r Electrical Permit ApplicationRECEVED 1:u11;,11: l si.: °N.,l City of Tigard Receives • 131 25 SW Hall Blvd., Tigard, OR 97223 SEB Date /B : .Z Q Perrntt ND " e- 6�Q /Q 00 0 7-5" N 1 1 2010 P1aeReview a Phon 503.639.4171 Fax: 503.598.19 Date/B : Othe P i o7 0/ f/ e 1 : ; , � It f -, Inspection Line: 503.639.4175 Date Ready/By linffil ® See Page 2 for Internet: www.tigard or.gov CITY OF TIGARD Norified,7vlethod: Supplemental information 1 1. 4 ' 11 Sul ; G1 �1 r x i hd sl r '• 1tS It ltG , l, E it &'k "i 1. h 1 t is t 1 t 1 ,�1 7 -, is o p�yl( 1 M 1 r t'! a s fir ,.... + T,. , u!�f ,1_.;11,1 i. ,:.� :, . ,:., , .�<;��'�� , 11 . ;a .. . - .: � If, ;;t .I, '1 , �� ,... ■ ..i .■'..7‘ - '''.2. _: c'; ❑ New construction El. Addition/alteration/replacement Please check all that apply (submit 1 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over duce stories. 1=1 Demon Lion ❑Other: _ where the available fault current ❑ Marinas and boatyards. l 1 `>1 1 , ,� 1 t 1 s} l s , � 1 i i+ w exceeds 10.000 am at 150 volts or ❑ Floating .. '. - �'i�l� ' .. } 1 13. 1'.-� ,� pa 8 buil r ¢ ' �,. 1i .. , ,t. , • less to ground, or exceeds 14,000 ❑ Commcrcial•usc agricultural ❑ 1- and 2-family dwelling �� Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi -family ❑ Master builder ❑ Other ❑Fire pump. ❑ installation of 75 KVA or 'li 1{1)1 , „ �I 3 'Ell VII' t y� i ' m l * ” t� t l c.. 9 ❑ Emergency system. larger separately derived system. , i • -, 1 u ii 11 ,r ti ;tom °" 7:.; ' ,' 14 '?"t. N 4 "'ill :�, ; 1•,- , . ; , , ❑ Addmon of new motor load of ❑ ..A ., E" „ •I 3" Job no.: Job site address: ,�toc 3 -12,14) Io resi occupae y. ❑ Six o or m more restdemia] units- ❑ Recreational vehicle perks. City /State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: jp Q C ° Service or feeder 600 amps or [rare. it it s .; t 1 11t ii•, . i I1 ii is 1,1 ;,, Cross street/directions to job site: nercriptirn 1 oay. I Fee. 1 Total 1 • New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or Tess 1 168.54 4 Tax map /parcel no Ea. add'! 500 sq. ft. or portion 33.92 1 Li �, a. Limited energy, residential i< Ti di 5 Iry 1 1 , '1 'I, 1 c : .I r s,W,�•, �� t �w €r 1 �c irG!1 it i . ,. . _ � . , _ (with above sq. fl.) 67.84 2 Limited energy, multi - family TPA r j 1• r ,�n ,�lVI j r residential (with above sq. ft) 67.84 2 1 Services or feeders installation, alteration, and/or relocation 200 amps or less _ 100.70 2 ., • l i , i ri P 9' :11'14V,.. s< > !I`a t ` - l . 71 is sit : "t. 201 amps to 400 amps 133.36 2 Name: 401 amps to 600 amp 200.34 2 Address: 601 amps to 1,000 amps 301.04 2 Over 1,000 amps or volts 1 552.26 2 City /State/7IP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 I Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps i 125.08 2 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, per panel ,: A. Fee for branch circuits with j i 1 i } 1 , 111 ° 13 10 1 . I It' li '; r , "4 ` r I I ll'1) - above a service feeder f ce o r eeer ee, �.Ji.1._.4.a..st :atilt ' +t t �� g UI ; , $ '' ' 1, .. each branch circuit 7.42 2 Business name: Johansen Electric Inc B. Fee for branch circuits Contact name: Charlynn Leifsen without service or feeder fee. 56 18 54,,.1g. 2 first branch circuit 5 � Address: 10948 SE Valley View Terrace Each add'l branch circuit Iel 7.42 I `IDA% 2 Miscellaneous (service or feeder not included) City /State /ZIP: Happy Valley, OR 97086 Each manufactured or modular 67.84 2 dwelling, service and/or feeder Phone: (5433) 698 -3417 Fax:: (503) 698 -2486 Reconnect only 67.84 2 E -mail: Pump or irrigation circle 67.84 2 t'1,1t lll (` ?L ,. #,1f',: t r1,. u 1 ? : sr ..t t,l,Jii li 1, ti r::: j; : _ Si or outline lighting 67.84 2 Business [tame: Johansen Electric Inc Signal circuit(s) or limited - energy panel, alteration, or Address: 10948 SE Valley View Terrace extension, Describe: Page 2 2 City/State/ZIP: Happy Valley, OR 97086 Each additional inspection over allowable in any of the above Per inspection 66.25 t , .hone: (503) 698 -3417 Fax: (503) 698-2486 Investigation per hour (1 br min) 6625 •� "CCI3 Lic.: 51539 ./ Electrical Lic.: 3 - 243C " - / Suprv. Lic.: 2053S ✓ Industrial plant per hour 78.18 Q ,. ±r I t r. fit t j • ' S.». • ;Si.►s.:. =31 14•«: f1 !' , i 1 11 Suprv. Electrician signature, required: 'lI .•�• �IR Subtotal qi . ti,, ,, e Print name: Carl Johansen D ate: Plan review (25%ofpermit fee) 1 1 1 p State surcharge (12 %of permit fee): 23. (L Authorized signature: C ti Ita t,.�.r -- • TOTAL PERMIT FEE: 2.2..,0, 22 .../...--. fT' , This permit application expires if a permit is not obtained within 180 Print name: Charlynn Leifsen Date: •, yl 11 i This days after it has been accepted as complete. • Number of inspections allowed per permit. 1 lBuildng1 enm31ELC- PemutApp.doc 10/01109 940.4615T(11/05/COM/W1B T - d Xdd 13rd3S1:11 dH Wd2b:2T OTO2 TT clad