Permit 1 , 1 ,'
; CITY OF TIGARD ELECTRICAL PERMIT
_ . COMMUNITY DEVELOPMENT Permit #: ELC2009 -00307
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/23/2009
Parcel: 2S112DC00500
Jurisdiction: TIGARD
Site address: 15895 SW 72ND AVE 190
Subdivision: OREGON BUSINESS PARK III Lot: 40
Project: Truman Capitol Advisors
Project Description: 200 amp service 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 06/23/2009 $80.30
amps or less
PHONE: 8 crt Branch Circuits w /Purchase 06/23/2009 $53.20
Service or Feeder
1 ea 12% State Surcharge - 06/23/2009 $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 $149.52
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 95 0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: -
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
CaII 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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Electrical Permit Applictlji n ' l i ilt t,, F I (t:: 1 Sh: t i,\ t.l: ,
City of Tigard N 1 1 20 Received
13125 SW Hell Blvd., Tigard, OR 9 23 DatcB : • ”'
4 P hone: 503.639.4171 Fax: 503,59.8.19,60 , J Pert Review Other Permit:
Ins ction Line: 503.639.4175 4r • "
i t r 1 , l� ,.. P.1Fr�P Date Ready/By: Avis:
.,�I y Internet: www.tigard- or.gov - ,. , ,.� .,, NodfiedrMethod:
:d jl E tl 11'1 • 31 i [ t t c , ,y� .t ,2f l , I .Ai. . 41� Yw, g� i, n
Il ;Lt 1 : tillilt 4f .BS it; ,t 1$ . ! I',. -2, , 00.1: t =, ,( V y ; t ? 1."1.4..:::;:i' w t(: 1111 i i 1 • :`f j+ N ffit {;
�! ; � �, � u 4 u +'�i ++t'i't A rt ,v:;.'�,kxe t��fu�xESr;?1E'w' 4�
❑ New construction * Addition/alteration/replacement Please check all that apply (submit facts ofptm,a w/iterna chucked below):
❑ Demolition ❑Other; ❑ Service or feeder 400 amps or more ❑ Building over three aeries.
ories.
where the available fault current ❑ Marinas and boar/link
t
*. ? w1u:. �K {te<ar t�areri
F . , : ' yd Fill =EM a N : u krvr s a, s !beau +'!}I : , 11 ..�-I� ?� 1 .11' t :� exceeds 10.000 amps at ISO volts or ❑ Floating buildings.
fl �`� " `° `� 11 less to ground, 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 ['Fire pump. ❑ Installation of 75 KVA or
(1{ z• , >P�Ir!�(�. tj; ?; Iin e�,: a +�r4!p' 1 , ❑ Emergency system. larger separately derived system.
..,-6 +• . ' sui➢,1i+ l lj�e'LUllydmoEiirt�t. t4.tBs" iL is i .:.'il lit 1 , ), ,I: ' II ❑ Addition of new motor load of ❑ °A E' '1 -2 t -3
Job no.: Job site address: 15895 SW 72nd lOOHPornare. occupancy.
❑ Six a more residential units. ❑ Recreational vehicle parts.
City /State/ZIP: ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts no minal.
Suite/bldg/apt no.: 190 1 Project name: Truman Capital ❑Service or Reader 600 amps or more.
.
Cross street/directions to job site: "• "'1"" `i 41 �t;a q'; °i:x :201ME r :-
Description OR% Fm Totel •
New residential single- or multi- family dwelling melt.
Includes attached garage.
Subdivision: I Lot no.: 1.000 sq. ft or less 145.15 4
Tax ma Ea. add'I 500 sq. ft. or portion 33.40 1
p/parcel no.: Limited energy, residential
u ��iJ� S�[�!�u x uYe:NC, ?� gwtsn , 1 , x 41 75.00
1,1 ; 1 . . ! tigaI cg �' �, .:ali +`if.E 2NEM t. ?",,i u i."...£4'!: 1 1`:r it.)
2
oohs nna ix•�r �'.rau '�`1 i ', (with abovesq.
Limited energy, multi - family 75.00 2
Tenant Improvement residential (with above 34. R.)
g Services or feeders installation, alteration, and /or relocation
, faarr Lb IStoltn 111 ; sn �
I r ' 200 amps or less 1 80.30 li() 2
iJ ,a ilfr l a 4,ilau ,4,lkllii , .,. : x fi r, J: # , 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 1 1 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. , 401 amps to 599 amps 133.75 i f 2
1 I
Owner signature Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
W yrrr� y rs;: 1�t�J r q T above service or feeder fee,
. i , , .. t , n''I. II e,: 4"� yl. t 1 i�t( gee t ;:: 4 IneilSia.�trra.a l 1'• 'Lint ''Cl. 1h each branch circuit 6.65 53,20 2
Business name: Johansen Electric Inc. B. Fee for branch circuits
Contact name: Cbarlynn Lteifsen
without service or feeder fee, 46.85 2
first branch circuit
Address: 10948 SE Valley View Terrace Each add'I branch circuit 6.65 _ 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Happy Valley, OR 97086 Each manufactured or modular
90.90 2
Phone: (503) 698 -3417 I Fax: : (503) 698 -2486 dwelling, service and/or feeder
Recorlrtect only 66 85 2
E -mail: joilansenelect @msn.com Pump or irrigation circle 53.40 2
116 si . r r I IT +, f !!I " E I,. ' 1 I; 1 k) ;3 : v '''- Sign or outline lighting 53.40 2
Business none: 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 an ' of the above
Per inspection 62.50
Phone: (503) 698-3417 I Fax: (503) 698 -2486 Investi per
Investigation hour (1 hr thin) 62.50
CCB Lic.: 51539 I Electrical Lic�✓33-- 2443CC� I Suprv. Lk.: 2053S Industrial plant per hour 73.75 �
Suprv. Electrician signature, required: �� 'L.e `j
Su
x ri , I h '; I:?!: ::. I Y i Subtotal: r 1�t ;}�i'E
/t btotal: -
Print name: Carl K. Johansen Date: 6 19 09 Plan review (25% of permit fee):
�" State surcharge (12% of permit fee): It, . 0Z-
Authorized signature: 1 / 1 TOTAL PERMIT FEE: i j or -5,2_
Print name: is cot obtained Churl nn J. L.eifsen This permit application aspic ifs permla i within 180
Y Dat e: 6 / 19 / 0 9 T days after it has be accepted as complete
• Number of inspections allowed per permit.
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