Permit CITY OF TIGARD ELECTRICAL PERMIT
° PERMIT #: ELC2009 -00010
COMMUNITY DEVELOPMENT DATE ISSUED: 1/8/2009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 112DC -00100
SITE ADDRESS: 15675 SW 72ND AVE ZONING: I -
SUBDIVISION: OREGON BUSINESS PARK III LOT : 002 JURISDICTION: TIG
PROJECT: BRIDGEPORT DISTRIBUTING
Project Description: (2) branch circuits. Rerpair from roof collapse.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
PACIFIC REALTY ASSOCIATES JOHANSEN ELECTRIC INC
15350 SW SEQUOIA PKWY #300 -WMI 10948 SE VALLEY VIEW TERR
PORTLAND, OR 97224 HAPPY VALLEY, OR 97086
Phone: Contact #: PRI 503 - 698 - 3417
FAX 503 - 698 -2486
FEES
Description Date Amount Reg #: ELE 3 -243C
[ELPRMT] ELC Permit 1/8/2009 $53.50 LIC 51539
[TAX] 12% State Surchar 1/8/2009 $6.42 SUP 2053S
Total $59.92 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: O l 1 R 1 A.X AA Permittee Signature: � A9p 1 ` 6 n A-60-, {.
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
.. _. ,
RECEIV r D
Electrical Permit Annlication 1.01z. (11:1:1( 1•: , .`1, u01.1
City of Tigard JAN 0 8 2069 Received
III Date f U r Permit No E 1
13125 S W HaII Blvd., Fax: 503.598 Tigard, OR 97 ` �� �` coo I
Phone: 503.639.417
CITY O F T • ! "
] te/gv: Other Permit.
Inspection Line: 503.639.4175 age
! sP Ready I See P 1 for
1 l c , .
Internet: www.tigard- or.gov 3UILDING DIV'S d4ie � Se.
( r � ,�., ^I1 � 1 %ri tJ� �, - t Ia •r nr r t. r , r�lll ,, I t {: Ali - yji {� y � „�•l i%:. n��; Supplemental Information
ri a r
�11f �f ( . 4IV (� 1 1 1, 1 4 ): ��11� �, . } 1 �( 1 ,; ;:it, r h 1i 1 ','1,4 .'tl RI 1.1 4 J/ t'Y �1
•s � �,, �1F t :�.��`�. t> 'll�l�$�;t 4 ..?,:1; l :f:- ..,,. II _._, i�k'� L '• ir•:i'�:. r..,{ 1 ,J�' .r
❑ New construction ® Addition /alteration/replacement Please check all that apply (sum 1 sets ofpl®s w /items checked below
❑ Service or feeder 400 amps or mare ❑ Building over three stories.
❑ Demolition ❑ Other:
i where the available fault current ❑ Marinas and boatyards.
I �IRI Ate k 1,j `Lr!i 7,1?, i; !2 + '.. 'C0* I ` ,:..r`. .LA I� : fi; ?„ ! tq exceeds 10.000 amps at 150 volts of ❑ Floating buildings.
1 ...1. r, �•" ,.,: �• 1.4;:r ,�. less to
❑ I- and 2- family dwelling ® Cotnmercial/industrial ❑ Accessory building arnpe ground, or exceeds 14,000 ❑ Com lvx agricultural
far all other installations. holdings.
0 Multi-family . ❑ Master 7 builder ❑Other` ❑ Fire pump. ❑ Installation of75KVAor
firltf,.!I i ?t'.; C r ! {'`:l, ,i,Iitl�+f'. g' I a IF t s 1 2 "4"'"111S. k i ' " {('';� '• �., .. : , , ❑ Emergency system. larger separately derived system.
ft�.. ,•,7.M� t wlwidai�ab c 1 e en r• ... . !•.1 ,.. ❑ Addition of new motor load of ❑ A 'E l -2 °1_3^
Job no.: Job site address: 15675 SW 72nd 1001IP or more. occupancy.
❑ Six or more residential unit . ❑ Recreational vehicle parks.
City / State/ZIP: ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt no.: 1 Project name: Bl dg 219 D Service or feeder 600 am.s or more.
Cross streeVdirections to job site:
.!:1;.• : fir �" : :, :.1� a = 'N ' ' `
jo mimeo= Qtr. Fee. twit •
New residential single- or molts- family dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq ft. or less 145.15 4
Tax map /parcel no
Ea. add'I 500 sq. R. or portion 33.40 1
(( r'� ;� � +[Ii '1i,� 1�{ ',({ I Ii t y 1'4 c i `trtiAr %1 1:? ' , rti Limited energy, residential
c .,. ll .. 1 1N1a', "kl;,1,.� ..r. I j•1'; pk . " ltil}•.ii;,ir,f4;.., !i t di t l.l.,,. (with above se. R) 75.00 2
Limited energy, multi - family 75.00 2
Remove electrical where roof collapsed residential (with above sq. It)
Services or feeders imtallation, alteration, and/or relocation
I 1 r t +fr•..'aF..' I ,M! �; :jl{{��{{ i , n' i �;, °`. I'.7j'I,}�1�- (1!luit 200 amps or less 80.30 2
ki rt:�'C>!P!r��!a 1 kII`! .1° �� �• �d ( 20 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 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 1 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 circuits - new, alteration, or extension, r panel
Owner signature: Date:
. , b ;# �j +:',�„�,� �' �:+ , _ A. Fee for branch circuits with
i
c
j i • •- ?. w D Ii a '�. :,._ ,.`;.1,N, , ., above service or feeder fee,
each branch circuit 6.65 2
Business name: Johansen Electric Inc. B. Fee for branch circuits
Contact name: Charlynn Leifsen without service or feeder fee, 1 46.85 6 • 85 2
first branch circuit
Address: 10948 SE VaIey View Terrace Each add'I branch circuit 1 6.65 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Happy Valley, OR 97086 Each manufactured or modular
dwelling, service and/or feeder 90-90 2
Phone: (503) 698 -3417 1 Fax: : (503) 698 -2486 Reconnect only 66.85 2
E -mail: johanseneleet®msn.com Pump or irrigation circle 53.40 2
c
;• tl I 1e•9�+Cnw�.lyr , , r
'' iiu i I�tiltE.1.:MIT1IMIS 1 1 ; ` _'l `ir3`' ), : ... �1 ..r,', Sign or outline lighting 53.40 1 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 use above
Per inspection 62.50
Phone: (503) 698-3417 I Fax: (503) 698 -2486 Investigation per hour (1 hr min) 62.50
CCB Lic.: 51539 I Electrical Lic.: 3 -243C Suprv. Lic.: 2053S Industrial .Iant r hour 73.75
Suprv. Electrician COW l/ Jn�,h A�, t.;�rr : ' > 7 1 � �� r� °I t °I t o . lam- � R+ � .., 1t.ii=s.., i.e.. ir' ;� !. e p ig nat ure, required:
Subtotal: •
Print name: Carl K. Johansen Date: 1 / 0 8 / 0 9 Plan review (25e/s of permit fee):
State surcharge (12% of permit fee): 6.42
Authorized signature: TOTAL PERMIT FEE: 59.92
Print name: Charlytm I. Leifsen ei...l f A, /,0.9 This permit application expires if a permit Is not obtained within 180
days after it has bees accepted as complete.
• Number of inspections allowed per permit.
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