Permit .''''''.1.:''-.. CITY OF TIGARD ELECTRICAL PERMIT
` COMMUNITY DEVELOPMENT Permit #: ELC2010 00189
13125 SW Hall Blvd Tigard OR 97223 503.639.4171 Date Issued: 04/21/2010
,71* g Parcel: 2S112DD00700
Jurisdiction:
Site address: 15780 SW UPPER BOONES FERRY RD
Subdivision: OREGON BUSINESS PARK II Lot:
Project: Professional Eye
Project Description: Tenant Improvement
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 1 ea 12% State Surcharge - 04/21/2010 $9.41
Electrical •
PHONE: 503 - 624 -6300 4 crt Branch Circuits 04/21/2010 $78.44
wo /Purchase Service or
Feeder
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 $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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.233
Issued By: JA--e--02-- Perm ittee Signature:
0 air Le ` m ,
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.
Electrical Permit Application CEIVE r(ilt (trrl< 1.: Ls,: ONI.1
Received o — 00 / 8R
Date/g City of Tigard Receiv ; Perrnit No.: �(�
• 13125 SW Hall Blvd., Tigard, OR 97223A P R 2 ®2 2010 Plan Review
G Phone: 503.639 4171 Fax: 503.598,1960 DJe/B : Other Permit:
I ,. ., t, L - , Inspection Line: 503.639.4175 Date Reedy/By: Jura RI See Page 2 for
Internet: www.tigrrd-or.gov
CITY 11 ®F TIGARI� Notified/Methad: Supplemental Information
1 t t 4,,T..";. ., ,..th ' w , y x . s ,1 1 A ir Vi ii'' 3t i . ,,.
I 1lrltill { ^8i4N E 4 f e I : j ' as v , l't ) :i..0 it t(l t :-
t l . N:it ., :. v , ..;! Ii F • , I .. = .. : 16., g. t ` y7 1° k; i r
❑ New construction glddition/alteration / replacement Please check all that apply (submit l 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 ❑ Marini and boatyards.
iN rp t i t l' {t t r , It i a , eH` r ' f L s' j; Q a rI r , `irlt j , I exceeds 10,000 amps at 150 volts or Floating buildings.
• r^ r >.. , , 7i ; T s ..( less to ground, or exceeds 14,000 El ❑ Commercial -use agricultural
El l - and 2- family dwelling rC ornrnercial/industrial ❑ Accessory building amps kcal! other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pimp. ❑ Installation of 75 KVA or
f8�? i 8 �3 Y u r u u r as r s e a . 1 # i' I , , � ;j( • Emergency system. larger separately denved system.
u.aret '10 : :` l +, n 4 -eci rl ihTi • > x , r ' : ' '� .b - 41;:t,# idrr. „s,.r* a it ❑ Addition of new motor load of ❑ "A" "E" •'t -2" "1 -3"
Job no.: Job site address: (Cj"i q ( 5 Vf c'i ' eau' Six or occupancy.
a W " ❑ Six or more rcaidential units. ❑ Recreational vehicle parks.
City /State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for 'wroth=
❑ Hazardous locations m 600 volts no nal
Suite/bldg./apt. no.: I Project name: i �1 e ❑ Service a feeder 600 amps or more
alit i ;t" r,'d1lfrit r di11 :1:1 i, i fl!1 { i1 4 tr a a•
Cross sireet/directions to job site: Description . I Fee. 1 Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'/ 500 sq. ft. or portion 33.92 1
{ Limited energy, residential
i 1 4* i � ry 1 r4 i _1L11r ] tr q a i�.111 w , fi 0 ; .1i.; s r {U: ±flfTtrt ;s • ': tF (with above sq. ft.) 67.84 2
r Limited energy, multi- family
eirOn Q� residential (with above sq. ft.) l 67 2
( Services or feeders installation, alteration, and/or relocation
200 amps or less I 100.70 2
! t K al ., al s . .' , ns s a - r, itr I r 5r . a it ■ ;, Ii I1 ji ; » . . :..1.,'.4,,.," . ,_'.s
:rt # .i. .: .; ri . t tia I: t '' iiiiid `;i , � Ir ,. 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amp 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City / State/Z[P: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I 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 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: d A. Fee for branch circuits with
' I i `rl! , ' ' " f i i , „ ' r '�`- ' l At j<i tli, l k !S ;' u t,7 l > Al , -i , .ri 4 r above service or feeder fee,
each branch circuit 7A2 2
Business name: Johansen Electric Inc B. Fee for branch circuits
Contact name: Charlynn Leifsen without service or feeder tee, 56.18 2
first branch circuit . �
Address: 10948 SE Valley View Terrace Each add'I branch circuit 7.42 .z..4 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: (503) 698 - 3417 Fax: : (503) 698 - 2486 Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
aatgt si �zc r S�1ttap `1 dai"t. o I r : .^ " 11'i ti, .Ia - Y' sign lighting 4e .,, -19P5 ki.1'li „ttit '1., ,. ..,t.,r, a _ 0-'11111P-4 : �pq , �'11t'i s?Lt3X1f`lit "I'etifi g gM g 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
Phone: (503) 698 -3417 Fax: (503) 698 -2486 inspection 66.25
per hour (1 hr ruin) 6615
CCB Lic.: 51539 t i',�/t 1 b 1 Electrical Lic.: 3 -243C 1 I 1\ It Suprv. Lic 2053S - '' 1 i 1 1 Industrial plant per hour 78.18
r, c t ,�, t :4
� � � f Eb1�U s r ; , r ''� 7`;p ' -sl# if r 3•� t � ,
Suprv. Electrician signature, required: � ..1 X Subtotal: 7 $ -
en Date: c/74
�� Plan review (25% of permit fee):
Print name: Carl Johansen State surcharge (12%ofpermit fee): q, 9'/ !
Authorized signature.
TOTAL PERMIT FEE: . es
This erm b pit application expires if permit not obtained within 180
Print name: Charlynn Leifsen Date: V/,20 / days after it has been accepted as complete.
• Number of inspections allowed per permit.
I: ltu;ldingPenma)ELC- PemitApp.doc I0/01/09 440-4615T( 11 /05/COM/WEB
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