Permit •
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00578
T [GAR O 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/20/2010
Parcel: 2S113AB01201
Jurisdiction: TIGARD
Site address: 16290 SW UPPER BOONES FERRY RD
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: Dow Aerosciences
Project Description: Electrical for TI.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 1 ea Services or Feeders - 200 10/20/2010 $100.70
amps or less
PHONE: 503 -624 -6300 80 crt Branch Circuits w /Purchase 10/20/2010 $593.60
Service or Feeder
1 ea 12% State Surcharge - 10/20/2010 $83.32
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 $777.62
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 0 • •52- 001 -0100. You may obtain a copy - i e - or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: 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.
Jctrical Permit A liar catoE CEIVED 1 ( 1 1 : 1 1 1 ' 1 1 ( 1 . 1 ' . ( ) \ I l
City o and Received Permit No.: ^LL
1 - _,,e--- tY f Tigard Date:. i0 � 1- 9.010 - / ,
1 3125 SW Hail Blvd., Tigard, OR 9722 T y n Plan Review
Phone: 503.639.4171 Fax: 503.598.1 I 1 9 2 Q Q DueB : Other Permit:
- Inspection Line: 503.639.4175 Data Ready/By:
uiW .. Internet: www.tigard- or.gov 11111 , y • , Notified/Merhod: •,., _
AIt�!�,��• -�) y . 1 . t' rrec�n�s ?`rf'.� )?t1 uF1 t i�t �:; .'•r ��� � � � n t w. ,q. r-v� , to � y
k ink F 1 lit. d P :2 4 ".1, . a._. '. j
tb:eS,cli•:>�t;t.'L:3i�w1.!!.. .:;a.i3:. -.. . �3` is��'' �' is��lied H,.:����G� .�i�(¢Ata���JE.. . ",�:��o-{���'; ` .�i � `�' � 1` ��IIK.VP ?*`js
❑ New construction ® Addition /alteration/replacement Please check all that apply (submit 2, sets of plans w /items checked below):
❑ Service or feeder 400 snipe or more CI Building over duce stories.
❑ Demolition ❑ Other.
. 1!R"',i v igFrm7 • r . INbr where the available fault current ❑ Marinas and boatyards.
,i q � a i• :I iRf'; 7 ') u , o�, , ::: , ..: . • ' I t : iii i • ' ' .' exceeds 10.000 amps at 150 volts or ❑ Floating buildings. .
c ap l suns ,c am ') ' yi )lIP 1 loss to Foimd, 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: ❑ Fee pump. ❑ Installation of 75 KV A to
t 1 h l;rptl Ile; *7a7a 7� p�lN'6t aa^tnaenu� as ru w a �s11 p + " l e ❑ �ergencv aYawm largo- separately derived system.
1 'Y'�t� Imi 4 �'"! !$ , 1 •1: i, 1. s 11 ! 1 1.• N itY Y : i y�((
`�:.u rad. Y��;: o„ Ii�ei: szGue2 usrn; ni tr�iirrli .:wes.aljv:.�r�.�kw�n u F ss � : �' ..vs:+..A� � • ''ilNf a+ ❑ Add of new motor rust of ❑ • 'E "I.2" . •1 - 3' . ,
Job no.: Job site aridness: 16290 S Upper Boones looHP « occupancy.
❑ six or more residential units. ❑ Recreational vehicle parka
City/State/ZIP: ❑ Health -cars facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg, /apt. no.: I Project name: Dow; T ' ra ❑serviccar VeraPe ormore'
Cross street/directions to job site:
t '', `. `....j,.. "F' `frr!,•4 .M1,'_„1�)„ i� 4�. , �' rt
.) maMotias oft. PM. Total
New residential single- or mull- family dwelling unit
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. A or less 168.54 . 4
Tax map/parcel no.: Ea add'I 500 sq. R or portion 33.92 1
Ta
a . m �{ f� Limited energy, residential
t r" m- un.:.y^)'�??reaN ' p " SO,�y"' I �I ie!N ,Ti T ' r F • A - (with shave se. R) 75.00 2
R i
1:" �' "-`� Limited energy, multifamily 75.00 2
Tenant improvements residential (with above soft.)
Services or feeders installation alteratlost, and/or relocation
200 amps or less 1 100.70 10 0. 7 0 2
• ,= ! J �"�i , . rq'; e; � .1' �u ��L'L�, ;c� F° + � l -�''f,"1r, i `' tr '74 ,.. 201 amps to 400 amps 133.56 2
ill" , tf a -- a%a.�isliiatata>�rl IhC�::O;tii, � Nit4 �HH�'ro0iian'�n •. ; Ir- k`� - . - �. ,
Name: 401 amps 10 600 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 feeden 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 I 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, zer panel
Owner signature: Date: A. Fee for branch circuits with
,�,{�, }� ,.y,t..,q,.n � wfw• g1 ' 7 a• ��i'd+'" au.,^nn5c :, above service feeder fee,
each branch circuit 8 0 7
» , + � � .�,;lt e n l lh �I �wcnli ='un �: ! >. ;5 �i' .42 59 )2
:. S. iz ter:; kF,:.
Business name: Johansen Electric B. Fee for branch circuits w Arad
service or feeder fee, first 56.18 2
Contact name: Charlynn Leifsen branch circuit
Each add'l branch circuit 7.42 2
Addess: 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
City /State/ZIP: Happy Valle OR 9 7 0 8 6
Each manufactured d r r feeder 67.84 2
PPY Y • dwelling, service and/or feeder
Phone: (5 0 3) 698-3417 I Fax:: (5 03) 698-2486 Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
•iN11II�i61( pt:al:.���!s 1 j Sign or outline lighting 67.84 2
( Ii1riR !>tKiRIO}txfP3,l!.ii4 J F' Mille 0 kM.:� .ili. `1li. :1�.f Ti.._=4-g� ii,1
•;t'Sr.:. t S�tsYto��+� • • +r.:�:. ':iS9r. 'i. •�t• Signal circuits) orlimited- energy .
Business name: Johansen Electric panel, alteration, or extension. Paget 2
Each additional inspection over allowable in env of the abov
Address: 10948 SE Valley View Terr Additional inspection (1 hr min) 66.25/hr
City/State/ZIP: Happy Valley, OR 97086 Investigation (1 hr min) 66.25/ to
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 698 -3417 I Fax:(503) 698 -2486 Inspections for which no fee is 9000/h
i6call listed '/: hr min
CCB Lie.: 51539 I Electrical Lic.: 3 C I Su rv. Lic.: 2 0 5 3 S . . • "`r ,. 1 " i
it h"� "` ;w 'i`P c 1 f1 •
� �,, � � P �'�}�Gr�xr> �_�.'lr.�. y cis#:
Suprv. Electrician signature, required: a
subtotal: 694.3 0
Plan review (25 /o of permit fee):
. P r i " t name: Carl Johansen I Date: 10 / 18 /Ill state surcharge (12% of pemut fee): 83.32
TOTAL PERMIT FEE: 777.62
Authorized signature:
(,,,
This permit application expires if a permit is not obtained within 180
' -Pthtt name: 18 10 s after it allowed been rC�t°t"COmplete
me: Char lynn L sen Date: 10
I I • Number of inspections allowed per permit.
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