Permit CITY OF TIGARD ELECTRICAL PERMIT
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s7 COMMUNITY DEVELOPMENT Permit #: ELC2010 -00072
[CARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 02/11/2010
Parcel: 2S112DD00701
Jurisdiction:
Site address: 15800 SW UPPER BOONES FERRY RD, STE# 400
Subdivision: OREGON BUSINESS PARK II Lot:
Project: Watson Chiropratic
Project Description: (4) branch circuits for TI.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 4 crt Branch Circuits 02/11/2010 $78.44
wo /Purchase Service or
PHONE: 503 -624 -6300 Feeder
1 ea Plan Review Electricial 02/11/2010 $19.61
• Contractor: 3 ea 12% State Surcharge - 02/11/2010 $9.41
Electrical
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 $107.46
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. 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: � C 1 CII AS) ( Q j £JL / ) 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 Date:
LICENSE NO.
Cali 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.
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Electrical Permit Applicatio li;t;:�i "'`
�EC�� Y ` " �� ;0It O �.; 1 C 1 1 .1 5 1 . O.1 . 1 _ � _ +i � �
y„ City of Tigard T. permit No.: (....?c,1 �. ��/7
�'=' y g Received
FEB .} n
I ._° 13125 SW Hall Blvd., Tigard, OR 97223r ED 1 1 2010 Date /By: I
Plan Review
t3 Phone: 503.639.4171 Fax: 503.598.1960 Date /B Other Permit. G. ` �� c %
Line: 503.639.4175 Inspection
it G A R D p CITY OF TIGARD Date Ready /By: '• ee Page 2 for
4 *«t* Internet: www.tigard or.gov BUILDING DIVISION Notified/Method: ' I (j Supplemental Information
• TYPE OF WORK PLAN REVIEW
❑ New construction "Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14.000 ❑ Commercial -use 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ - "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: ' r IOOHP or more. occupancy.
e O A J V f' 1 e2O ( ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 44,00 Project name: f /(� r h I , Dpya _ ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Y "
Description I Qry. I Fee. 1 Total
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'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
n� DESCRIPTION OF WORK (with above sq. ft.) 67.84 2
`e 1(l[ I 1 'r r mi
Limited energy, (with above family
residential (with ab sq. fr.) 67.84 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ 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 /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or Tess 59.36 I
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 . 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT ❑ CONTACT • PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: Johansen Electric Inc B. Fee for branch circuits
without service or feeder fee,
Contact name: Charlynn Leifsen first branch circuit 1 56.18 5u , .1 s 2
Address: 10948 SE Valley View Terrace Each add'I branch circuit 7.42 Z2, 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Happy Valley, OR 97086 Each manufactured or modular 67.84 2
dwelling,
Phone: (503) 698 - 3417 Fax: : (503) 698 -2486 Reco nnect t only service and/or feeder
Reconnect 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: 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
Phone: (503) 698 - 3417 Fax: (503) 698 - 2486 Investigation per hour (1 hr min) 66.25
CCB Lic.: 51539 Electrical Lic.: 3 - 243C Suprv. Lic.: 2053S Industrial plant per hour 78.18
. ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: C' -er -f 4 /� � Subtotal: 9 S, 414 -
� Plan review (25% of permit fee):
Print name: Carl Johansen te: ,2,_ j t j State surcharge (12% of permit fee): G t4 1
Authorized signature: �tA_ A / i TOTAL PERMIT FEE: b�, in 180 Print name: Charlynn Leifsen I " _ (f Date: 1( ''ll This permit application expires if a permit is not obtained within 180
1 V days after it has been accepted as complete.
* Number of inspections allowed per permit. C)7 / 1 -4 (o
I:\Building\Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(1I /05 /COM/WEB `