Permit CITY OF TIGARD ELECTRICAL PERMIT
a COMMUNITY DEVELOPMENT Permit #: ELC2010 -00488
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/10/2010
Parcel: 2S113AC00102
Jurisdiction: TIGARD
Site address: 7250 SW DURHAM RD, BLDG# J
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: Stash Tea
Project Description: (2) branch circuits for electrical alterations.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 2 crt Branch Circuits 09/10/2010 $63.60
wo /Purchase Service or
PHONE: 503 - 624 -6300 Feeder
1 ea 12% State Surcharge - 09/10/2010 $7.63
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 $71.23
Required Items and Reports (Conditions)
This permit issued subj- ,. to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done ' accordance with a• •roved 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. A ENTION: Oregon law equir •u • follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001- 010 thro .• h OAR 952 -001 -0 • •. You btain tain a copy of the rules or direct questions to OUNC by calling 503.246.669..2344.
Iss 1 ./ G ��' 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' -�( �j ') ;' / L . Date: 9/ /,,
2 , 0 5 - 3 5
LICENSE NO.
CaII 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 FoR UFFICI: USF a:mi
City of Tigard Received permit No.:
Y g Date/13 : 1� io /0 1;420Ao/0 —00 0
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 Date/ : Other Permit:
T I G A R t7 Inspection Line: 503.639.4175 Date Ready/By: tuns: El See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction Q[ 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 .14 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 ",
1001V or more. occupancy.
Job no.: Job site address: 1 : ?...5 - 0 S W Q ((1 a a¢-'`�, ❑ 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.: Project name: ..,7}!� i f - ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1 •
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
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
RRle�coL�-fail cYi o T 1 � c Limited energy, h ab ov e sq. 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
A APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
• Business name: To 11 1 G B Fee for branch circuits without
Gt, 5 �n service or feeder fee, first
Contact name: l._ /7 R branch circuit I 56.18 5(,1' 2
E ach add'l branch circuit 1 7.42 '- 4Z 2
Address: ! t' a 5 E Ll j 1 l J L) Le j Tor rue e_. Miscellaneous (service or feeder not included)
City/State/ZIP: f �,� -"" C V i Each manufactured or modular
Ci
ty 1 - "I p \i Ua 1 It tj O R g 1 0 S G dwelling, service and/or feeder 67.84 2
Phone: (503) ( 34 0 '7 I Fax:: (60 - — t `�, 4g ( Reconnect only 67.84 2
o • a Dll e.1 e— 1 LG @ m s fl . co Sump r irrigation l L 67.84 2
E -mail:
Sign or outline lighting 67.84 2
. CONTRACTOR Signal circuit(s) or limited- energy
Business name: h � �/Yl t�/1? a panel, alteration, or extension. Page 2 2
6C� �� Each additional inspection over allowable in any of the above
Address: Additional inspection (1 In min) 66.25/ br
City/State/ZIP: Sct Y V Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18 / hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically list ('/2 hr min)
CCB Lic.: 5 ( y3t9 Electrical Lic.: Suprv. Lic.: A0 _5 ELECTRICAL PERMIT FEES '
Suprv. Electrician signature, required: /7 / Subtotal: (p 3 . (PO
I_ (uz /� Plan review (25% of permit fee):
Print name: CAR d"6 ►" IG 17 5 eYl Date: 6) State surcharge (12% of permit fee): 1 4,
TOTAL PERMIT FEE: 1 I . �3
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
1:\ Building \Pennite\E1.C- PennitApp.doe 07/01/10 440- 4615T(11 /05 /COM/WEB