Permit CITY OF TIGARD ELECTRICAL PERMIT
.
2 COMMUNITY DEVELOPMENT Permit #: ELC2010 00390
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/29/2010
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 200
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: CNA Insurance
Project Description: TI - (3) panels and (60) branch circuits. 9/15/10 added (2) additional inspections B.T.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 3 ea Services or Feeders - 200 07/29/2010 $302.10
amps or less
PHONE: 503 - 624 -6300 60 crt Branch Circuits w /Purchase 07/29/2010 $445.20
Service or Feeder
1 ea 12% State Surcharge - 07/29/2010 $89.68
Contractor: Electrical
JOHANSEN ELECTRIC INC 133 da Reinspection Electrical 09/15/2010 $132.50
10948 SE VALLEY VIEW TERR 16 da Reinspection Electrical 12% 09/15/2010 $15.90
HAPPY VALLEY, OR 97086 State Surcharge
PHONE: 503 - 698 -3417
FAX: 503 - 698 -2486
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $985.38
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 = r direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: ` -_ i 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' 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 rY CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00390
Date Issued: 07/29/2010
T TGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 200
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: CNA Insurance
Project Description: TI - (3) panels and (60) branch circuits.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 3 ea Services or Feeders - 200 07/29/2010 $302.10
amps or less
PHONE: 503 - 624 -6300 60 crt Branch Circuits w /Purchase 07/29/2010 $445.20
Service or Feeder
1 ea 12% State Surcharge - 07/29/2010 $89.68
Contractor: Electrical
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 $836.98
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. At 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
952-001-6. I through OA' • 2- 001 -010 ou ay obtain a copy of the rules or direct questions to OUNC by callin . .6699 or 1.800.332.2344. `
Issue. By: Permittee Signa ure:
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' ! ! f 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.
M1
** *ADD TO ELC2010 -00390
Electrical Permit Application , . / V t 1 1 . „; 0 I I I I I : i , l ,
City W Hell Blvd., 13125 S CNN `Ji Permit No.: -1 6 1 6 W d, Tigard, OR 972 s
Phone: 503.639 4171 Fax: 503.598.1 r1-\\) >'la"Aeview
SI
1 p Other Permit:
Inspection Line: 503.639.4175 n > D,, Reedy/By: tuns • Internet: www.tigard C S ee Page 2 for
1 •� ti �` . SuppltsnmtalInformation
:1V;:-.1.• l H: 1 (''" ` . � tt1 "1t1 99Y�y�� . '''' 7.. '' rs: a i r t ' • 1i ' et i` u" _} `ri ft i!i V�A I ,4 S ; i 2_ ^ -3 t { ..0. ry �1 alR. A r,
_ _ . . fi .iL . ili = '161L +v■ i .f. �..1V ill N.4 6 1 ?•i§1 : ii.diit8 t,� 60. i '�dg '' i! + '1;2':::LIi N • . i y 8 -4I N • ❑ New construction ® Addition/alteration/ .1j 1 ' Please check all that
apply (subvtit j aeb of plane w/items checked below):
❑ Demolition ❑ Other s Vl 0 Service or feeder 400 amps or more D Building over three uories_
where the available faah current 0 Marinas and boatyards.
i Vl� 4 111: 1 i „∎ , ,,,anti i ls`Ls u` err G' . .x $ 111 11 #iil t exceeds 10,000 amps at 150 volts or D Floating bw1diggx
❑ I - and 2- family dwelling ® ConunerciaJ ce
industrial ❑ Acssory building f all other installati D co la►
❑ Mukl- family ❑ Master builder ❑ Other re D Fi pump. ❑ w aloof 75 KVA or
. lye Ir"�arli . {Ih, t' �r -K� n nr ix csc t l 1�us u �l i ca u r DFJ syatom 1
�, ,,tt� f ++ m E" "1 - , derived system J:ll3.��sl ��i�l,zii, I!',:I 1 ;,..., i ; i�ilL _ .v }. { r Ilia . 1 � .
�iu �'iE�. =.b1 .�y , , N, k l , �,L'. ; i t,.F.ltt.r!71$ul�l �:H�a�.,:r: D Additiaa ot ttenu motor bed of D "A° " , E . •1 -2 •l -3"
lob no.: lob site address: 12 9 0 9 SW 6 8th , 2 0 0 D 100HP or more. o cy.
Six or more residential units. D Recreational vehicle padre.
City/State,ZlP: 0 Health - cane ilncilities. 0 Supply voltage for more than
0 Ha: rdous locations. 600 volts nominal.
'Suite/bldgJept. no.: + Project name: CNA 0 Service or feeder 600 amps orr more. ,
Cross street/directions to Ob site: ialtNil
De,eriptlep anNI 'L iL d -...'. lk 'iiA'iyll r p . lif 1 ;"rg a
0!4. ..� rporl .
New residential single. or multi - i.nlly dwelling sail
Includes attached garage
Subdivision: I Lot no.: 1.000 sq. R or less 168.54 4
TeX map/parcel no.: Ea. add'I 500 sq. t o r portion 33.92 _ 1
Limited energy, residential W f!a`r�'�zl3 titi.!' r {59 )II>ti Nn..;:'.°; t „ , ._ "..:t :.,. , ,1 i{ �i 7 11 itiifll l l n-- (with above sv. R) 75.00 2
Limitedenergy,multi- family 75.00 2
ADD TO PERMIT #ELC2010 - 00390- residential(withabove .
Add inspection fee , as e r ins ere t o r Services or feeder installation alteration, and/or relocation
1 � 200 amps or less 100.70 2
ji�';;il;! '�'- }}+ a A •a it, ,. ) I t! i �' R 1 t l T
:!Ya.�:y_',1 �e:'4.�t ivd.._.,�i`uniu.} i}iW iJ'.4N!Ilt or ?f .'LYin i111i1�S�'.r![fF.a7 201 amps 10400 am
Ps 1 33.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1.000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City /StatefLIP: Temporary services or feeders Installation, alteration, and/or
reloeatbo
Phone: ( ) ( Fax: ( ) 200 amps or toss 59.36 I 1
Owner installation: This installation is being made on property that I own which is tot 2oi amps to 400 amps 123.08 I 2
l iptended for sale, lease, rent, or exchange, according to ORS 447, 419, 670 and 701. 401 snips to 599 amps 168.64 12
' Branch circalta - new, alteration, or extension. panel
Owner signature Date A. Fee for branch circuits with
°91�itt i iii r ; i ` il. :,j', olil .s2t. Ilfa - 1 : 'n'niFhl{'' r - y�s ,•Form•..., abovesenticeeedertbe.
ll,t x,u,rt#,_,.ic _.. , ax.S, _.r��.',r! l_.4n,.vl.i.tt�+ = ': n ;,'ti: h,l
�^-; 1
� ,..a ,1..... �..a -; aYw;nutllb each b ranch c i rc u orf it 7.42 2
Business name: Johansen Electric B•Feo forbranchcircuits
service or feeder fee. first
Contactname: Charlynn Leifsen _ bsanchcircuit 56.18 2
Address: Each add'I branch circuit 7.42 2
10948 SE Valley View Terr Miscellaneous (serviceorfeedernotinemded) _
Each City/State/ZIP: Happy Valley, OR 970 n 11faC41redOr 67.84 2
dwellitut servicservice and,or feeder
Phone: (5 0 3) 6 9 8 - 3 417 ! Fax:: (5 0 3) 6 9 8 - 24 8 6 Reconnect only 67.84 2
E -mail: Pump or irrigttlimr circle 67.84 2
v� f " r s S'E ro' "' T i •tylly9 f r 9,iL� i , Signor outline lighting 67.84 2
ti , ��n"r`{?x "d.�;.. �Ll_T� tdr.� i l Ell? et nt-,I..d _9,r c....t..,t�a• iI: .,. ?; 5 11..r l3ritlitf � rg.3:11 Signal circuit(s) or limited energy
Business name: Johansen Electric alteratioaorextmaion. Pago2 2
Each additional inspection over allowable in any of We above
Address: 10948 SE Valley View Terr . Additionalinspection(1 hr min) 2 66.25/ht ' 132 . SO
�y /S L Happy Valley , OR 9 7 0 8 6 Investigation (1 hr tam) 6625/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (5 0 3) 6 9 8 - 3 417 I Fax: (5 0 3) 6 9 8 - 2 4 8 6 Inspections for which no fee is 9u
CCB Lic.: 5153 9 I E ifeall listed %hr min • lectrical Lic.: 3 - 2 4 3 C I Suprv. Lic.: 2 0 5 3 S ''. tiaa Nr... ?z. i. ..�. 1 ; 4.1.3 !,t i!.
Suprv. Electrician signature, required: A - subtotal: 13 2.5 0
Plan review (25% of permit fee):
Print name: Carl Jo s en Date: 9 / 14 / 10 State surcharge (12% of permit fee) 15.9 0 •
Authorized signature:�� TOTAL PERMIT FEE: 14 8 . 4 0
This permit application eydros If a permit is not obtained within 180
Print name: C ha r l yon Leif [Date: 9 / 14 / 1 Q o f days after it has been accepted m complete.
impee:ices allowed par permit.
ElasildinBlamrtAELC- PermitAppdoe 07/01/10 440.461Sr(1 I/OS/COM/WEB
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Electrical Permit Applica I� !. CEI�IE�J 1 t i� t tl 1 1 4x1 t �I
' C of Tigard 6� 7 D l ' 3 . 7 d7 /o ( k Rim= N ° -: ie.e..toto—er,390
• 13125 SW Hall PIvd., Tigard, OR 9' .. 2 e . Q t Plat Retina
a+ Phone: 503.639.4171 Fax: 503.598.1960 Date /B . Other Permit: 6,4.P,Ipla 0400 97
u_ 1 Inspection Line: 503.639.4175 �/ OF TIGt1 ` R1] Date Ready/By: See Page 2 for
>_; - ` Internet: www.tigard -or.gov
CITY E � d ho : SapplemeatalInfor % asafioe
• . #�S" i'8P l�iPftiUl lR�i``at l ' t $ n
y mm, r .ea 5 9 'a (w.: B 'EOM,. °r-r 1 1.. - t.atc., wtPmuuu� ran y � , u , li . .t � 9 t
;s, -7 18 Iki ll .,II.la,r at aria. G il ,14. -M�t' hr'.: illJi SL t �rt" 1�_d.€! . N�i,: , F ? � AS�` � is igiiiM +..: i ,X. dl ..,Ut 'Witif 1`si9(
❑ New construction ® Addition/alteration/replacement Please dick all that apply (submit 2 sets of plane w /items chocked below):
❑ Service or feeder 400 amps or more ❑ Building ova three stories.
❑ Demolition ❑Other.
where the available fault airman ❑ Marinas and boatyards,
r F e e •ha a } u L'fta�"}� y °y 7 nia ats; �r+mtr ; t a tc u tvpp t m,p a 122 .. a
IV! �n,�,�pp::rtt tt a n r • L�p �, i q ��,r s�,y t r,4 {� „ exceeds 10,000 mope a 150 voles or ❑ Floating buildings.
1µ.11:•,.!n' '. ....,..„ it ii ,'' liai....,..)u. {.S +Mai:* T • .. is S,a d�f t � ial 1 ,.e . _,
❑ 1 -and 2- family dwelling ® Commercial/industrial ❑ Accessory building less tograllo, other installations. QCommersialvaoagrioultaral
amps for all other instailationa iruitdinge.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ installation of 75 KVA or
Ic f ! ��� r . ItTi r Y t;rs ry•x. tr• 'r s ❑ Emergency system. larger separately derived system.
l `i^} ur �'}'i%.. t .:J �I `t u ia_ + 8+mw I 0 I t ' VY tt a ' ' v-t lit, ❑ Addition of new motor load of ❑ ••A ^, "E ", "1.2" "1.3",
i 00HP or mote. occupaxy.
Job no.: Job site address: 12 90 9 SW 68th Pkwy, 200 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for mere than
❑ Hazardous locations. 600 volts nominal
Suite/bldg. /apt. no.: 2 00 I Project name: CNA ❑ Service or feeder600 . or more.
Cross street/directions to job site: 4eer+oaoa otv. Pr. Total •
New residential single- or multi - family dwelling snit
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. It or less 168.54 4
Ea addi 500 sq. fl. or portion 33.92 1
flax map/parce1 110.:
1
I i7b s�T ) (tilr r 'SF
• l ep ;m�„ n reek _.- ! Limited energy, residential
Ari l a ll tu,.th,nl'i(w.`.! =;=1.I�.Yd c tom't� a 1 1 11:-' t 11" ( 95.00 2
�l: Limited abovesq.ftited energy, multi-family
r esidential with above sq . ft) 75.00 2
Tenant Improvement (
Services or feeders installation, alteration, and /or relocation
200 amps or less 3 100.70 302 .10 2
nF " lmusnxt w't l�� (li. ttNel at�a r urt P l;{t.
t. 41=Wallanahiasioaa �,4. t ss :.r.aio ` 11 1:4 tin va'� ' i `.' 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
CitylStene/LIP Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fa ( ) 200 amps or less I 59.36 I I 1
Owner installation: This installation is being made on property that I own which is not 201 amps m 400 ra 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps m 599 amps 168.5 112658.048 I I` 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
q "� �¢ nte I` q i�a rte' ' :r'i „
,lilt ' 3 • :try.:,.,rs.!.ti;a, TD at.V... M£S;k.7'> w � . iEt'Cd r".,c sr wr .M' .a �c�„attdll t above service or feeder fee. 6 0 7.42 445.2 J 2
ead6 branch circuit
Business name: Johansen Electric B Fee for branch circuits wither
service or feeder tee, first 56.18 2
Contact name: Charlynn Leif serf branch circuit
Each add' I branch circuit 7.42 2
Address: 10948 SE Valley View Terr Miscellaneous (serviceor feeder not included)
City / State/ZlP: Happy Valley, OR 9 7 0 8 6 Each manufactured or r modular 67.84 2
PPY Y t dwelling, service and/or feeder
Phone: (5 0 3) 6 9 8-3417 _ I Fax:: (5 0 3) 698-2486 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
t�ti, asrz 1i6� s ac rn.q}�ru +tt ) mat r , tie typ 1 Sign or outline lighting — 67.84 2
J)111i1 I�F.tinriffil i t.) I1114AV'IIIIIRfrriti ,?tta �.tiNBEEI A t Signal arcuit(s) or limited- energy
Business name: Johansen Electric
panel, alteration of extension. Page 2 2
Each additional inspection over allowable in any of the abov
Address: 10948 SE Val ley View Terr Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66251 br
City/State/ZIP: Happy Valley, OR 97086 industrial plant (Ihr 78.18/ In
Phone: (5 0 3) 698-3417 I Fax: (503)698-2486 Inspections for which no fee is
90.00/ hr
s . ificall listed %z hr min
CCB Lie.: 51539 I Electrical Lic.: 3 Suprv. 'c.: 2053 S 0—, It1 R 'l ' l T 11.3 "' �; i << s Ids ' i '+ c ; )''`
Subtotal 747 3 0
Suprv. Electrician signature, required: plan review (25% of permit fee):
Print name: Carl Johansen I ate: 7/26/10 State surcharge (12% of permit fee): 89.68
TOTAL PERMIT FEE: 836,98
Authorized signature: Thb permit application wires ifs permit 1, not obtained within 180
iT Pfint-na.mc: C ha rlynn L e i f s en Date: 7 / 2 6 / 1 0 • Number of ink after a a has d been accepted ere eompkta
apectioas llowed per permit.
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