Permit ,, CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00320
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/26/2009
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 430
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: Reference Capitol Management
Project Description: (1) one 200 amps or less service feeder and 8 branch circuits
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY
#300 1 ea Services or Feeders - 200 06/26/2009 $80.30
amps or less
PHONE: 8 Crt Branch Circuits w /Purchase 06/26/2009 $53.20
Service or Feeder
1 ea 12% State Surcharge - 06/26/2009 $16.02
Contractor: 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 $149.52
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 5 - -p h1 -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: l 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.
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.
Jt7n 25 2009 2:50PM HP LASERJET FAX p. 2
RECEIVED
Electrical Permit Application JUN 2 5 2009 I'.It'Irll(l 1 .`l. ttl.,
City of Tigard fl :
Pwmit No.:
13125 SW Hall Blvd., Tigard, OR 972 ( TIGARD Ilan Review ' 0 " Phone: 503.639.4171 Fax: 503.598.1 Dato/B : Other Permit
_ ' w Inspection Line: 503.639.4175 g I DING DIVISION D an g� Jaen: See Page 2 for
Internet: ww.tigard NotiSed.'Method: Sappleaseatallnforoadon
S P4 j '! +er p!t .bail Nile i, 4' y Isalt 7 . .i y � LL 'Ii. , ' � 3j j1Gli _ i . 1; l. d4 Y'c• { , 5 .,
■ - Please check all that apply (submit j seta of plane wfitema checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stones.
0 Demolition i♦ ♦ r, where the available fault current ❑ Marina and boatyards.
i ,,, y . ?, u• Ntl✓ "iKa "cep' i <4 i y, l �„ r , is t exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
i +!fl( " jE• {,�.4.1 " u'; 7Yli:; . • io ed t'!c r a . ?iltiiN ' ' tl :dktlC'il 4rc
, : , ' .t' %.+� ✓ra,::'::: r �.'. r�;I �, less to ground. or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other inatallaions beddings.
❑ Multi family ❑ Master builder ❑ Other ❑ Fire pump. ❑ Installation of 75 KVAor •
a t i , 1 ' ; :i fl El Emergency system. larger separately derived system
4 1 ,t 1 ettr '% • . I fi i . ..r ., I 4 ,` u r i R L.! ii ❑ Additim of new motor load of ❑ A "E »l_2 ' 1 -3
alµ.. I � .i4�t � t r � , . -.t JAL m 1} li 1 1 1.
Job no.: I Job site address: 12909 SW 68th Pkwy 10011P or more. occupancy.
❑ Six or more residential amts. ❑ Recreaticaud vehicle per.
City /State,21P: ❑ Healthcare faciliticr. ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal.
SuitelbldgJapt.no.: 430 I Project name; Reference Capital ❑ Service or feeder 600 amps ormore.
�°`v' '!. tl§.t ii4 1:.,' . • •.Kitt', e ..i %1 .. ,i74a.
Cross street/directions to job site: Description 14ty. I Fee. I Tend
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or leas 145.15 4
-
Ea. add'I 500 sq. ft. or portion 33.40 .. 1
Tax map/parcel no.. Limited energy, residential
i 1 , i .
. J , , ' 1 !"a,aw. a - . ; 'r • 131 '1�•77� I, e4 ft) 75.00 2
?�'•:' , - ; � ,,.. ,; � .rsSit�'n.- " ".'.���..;..,, ,
. ._ .001C. f r:,.. r.4j,y3 ?lrll.� ',1 r. %: ii�NB %,. (with above
Limited energy. multi - family 75.00 2
Tenant Improvement residential (with abOVe sy. R•)
Services or feeders inatallation,alteratioa, and/or relocation
�yl� q 4; ? {{}� � }��® 200 amps or less 1 80.30 8 0 . 3 0 2
'i' Lu3 • - ' ad' x tail „i . ' . ±: $113ggifi I �' i t 1 ° �li i .. , 'fLi d�R "� a, 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation ,
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 _
1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch elrcults - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
„ I"" t q • : rr @ o tr . u _ „ al ;` . R 1, above service or feeder fee, 8 6.65 53.2 2
_ each branch circuit
Business name: Johansen Electric Inc. B. Fee for branch circuits
without service or feeder fee, 46 85 2
Contact name: Charlynn first branch circuit
10948 SE Valley View Terrace Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not Included)
City/State/ZIP: Happy Valley, OR 1 : , Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Reconnect only 66.85 2
E-mail: johansenelect@man.com Purnp or irrigation circle 53.40 2
, ;ic :;:•Sr;,I „•lLit. ,• itji.blf.i . i" % -Ji r o • 1_: 1 4 '. ;i 4 ;t3f'iJ :. ; +'4,ii r'..,:i3' G N,I•Fd• #i I Sign or outline lighting 53.40 2
Signal circuit(s) or limited-
Business name: Johansen Electric Inc.
energy panel, alteration, or
Address: 10948 SE Valley View Terrace extension. Describe: Page 2 2
City/State /ZIP: Happy Valley, OR 97086 Each additional inspecdon over allowable in aax of the above
Per inspection 62.50 _
Phone: (503) 698 - 3417 Fax: (503) 698-2486 Investigation per hour (1 he mini 62.50
CCB Lic.: 51539 Electrical Lic.: 3 -243C 4 / 1 Suprv. Lic.: 20535 Industrial plant rhour 73.75
x , , ,„ ,Lil�4 grpc, ••'•:•" . ».»:...- ,...�.., t li . `, „: „. , : "; :r^ !' . it t
q y �jJ
Suprv. Electrician eiti ttlrr, required: �'�t , /'o Subtotal: 133.50
Print name: Carl K. Johansen Date: 6/25/09 Plan review (25% of permit fee):
State surcharge (12% of permit fee): lb • 0
Authorized signature: CA./A../ TOTAL PERMIT FEE: 149.52
Print name: Charlynn J. Leifsen Date: 6/25/09 mi
Tbia pert application expires Ira permit is sot obtained within 180
y days after it has hem accepted as complete.
• Number of inspections allowed per permit.
Il$ uild,ng'PerinitstELC- PenenApp.doe 05/23,06 440- 4615T(11 /05.COM/WEB