Permit �� CITY OF TIGARD ELECTRICAL PERMIT
4 COMMUNITY DEVELOPMENT Permit #: ELC2010 -00594
Date Issued: 10/26/2010
T 1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S112A602300
Jurisdiction: Tigard
Site address: 14150 SW MILTON CT
Subdivision: Lot: 0
Project: NW Medical Teams
Project Description: (1) branch circuit (tenant downsizing)
Owner: FEES
NORTHWEST MEDICAL TEAMS INTERNAT Quantity Description Date Amount
14150 MILTON CT 1 crt Branch Circuits 10/26/2010 $56.18
TIGARD, OR 97224 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 10/26/2010 $6.74
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 $62.92
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 952 - 001 -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: Perrnittee Signature: a/1./ e9/ . L / ! 1 7OA
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 603.639.4175 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 E'I 1
PP I { 1 )1 1 1( 1 1 N I.4 ).1 1
City of Tigard OCT 2 2 2 u; . Rio Vi;� P t N° Cg• i -v - 4
I N
13125 SW Hall Blvd., Tigard, OR 97223 Rev'
j Phone: 503.639.4171 Fax: 503.598.1960 D Other Permit:
i t; f• i;, ii Inspection Line: 503.639.4175 CITY OF TIGA' . • , - MY' r gas Page for
Internet: www.tigard- or.gov BUILD!► a ti ■ . 'i;; _ . ethod: • ,..'mental Information
49r1 t iR °I•l. fi'Si .r >r .J3- H . ! 4 f J { r, r n: 1 w is , i .: •
�� rl r k llnci r�;Qtf'lr' - . .. tr 5 � ' i� s v:•,y� 1 t s .:', gf * i 1 , 1� 1i :.
tin. ,.• �i4'Y" +: j, ril. r +9 ii -..' .g ,�.,�uy tia:� . '1 •..a.V.nrri • i. i�91E�i) F `f i�'j' '.i ti ,.` r o-�} I cl' - c�j�':
El New construction ® Addition/alteration/replacement Please check all that apply (submit 1 sea of plans wtitema cbecked below):
❑ Service a feeder 400 amps or more ❑ Building ova time stories.
❑ Demolition ❑ Other: whore the available fault parent ❑ Marinas and bmtyarda
trr rs1.><r r s.1 4 d 4S{•' u®'�f' ASy �1' t z exceeds 10.000 at 150 vales or ❑ bw7
y e ?.I t t 'udlaa�6 .+tJ@s: s i,t • +' ;'a ?n y F
,.I.utJl ':tta6i .� � ,. .._ •r _.,� _ - -�. ' '• '�� = :t , less to ground, or exceeds 14.000 ❑ Commerclel -pee a(gieulturel
❑ 1 - and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other inatallatiana. bnildiogs.
❑ Multi - family ❑ Master builder ❑ Other ❑ Fin pump. ❑ Installation of 75 KVA or
�xm ti . :ter va s- .- .,, +� ; u;.: , y�v�r�� � t � y . -..-- ❑&norge^cysys largmeeperat1y
.'+Ste ; ' 3ut : e , : . 31 rl 1 r 7 d ` f . • 7 9 - `,: i " : I If Y i' N- 'BuCa' ..tt � ' L + � �tt ,., ❑ ❑ "A . " " 1.2".
rmd 1. i} r :1..e.. ai 4 W , i' ... L..rr: nil naraa I +is.+_ ,. - 1>x, Addition of ne motor loa of sap deriv
100
HP no.: Job site address: 14150 SW Milton Ct or or more. occupancy.
❑Six or more residential amts. ❑ Recreational vehicle parka.
City/State/ZIP: ❑ Health -care locations. ❑ Supply 'adage far more than
AIM/ ❑ Flazerdous locations 600 volts nominal.
Suite/bldg./apt. no.: l Project naive: Medical Teams ❑ Survive or feeder 600 amps or more.
Cross street/directions t/directitms to job site: 111,.1 ' .� r "may .! ` . Fse, 1f ~ "`°' ' :1. • .
nesaietke 01c F ee tau •
New residential single- or multi- family dwelling unit
Includes attached garage.
Subdivision: I Lot no.: 1.000 sq. ft. or less 168.54 4
L
Tax map /parcel no.: Limited te'ro energy, e t or portion 33.92 1
Y ll� '1 l r p mrewu
z+ :1s.: �quS. 'r s < ' / t ° x k -rr l ; ls 1 above aq residential 75.00 2
' �k u`7aiiga ne 1 eS1=1;711 'r �,4,:.: •Il'�n s '7r.,, z('i' .rH2 1x:11 ` r-, C+ 4 yT (with above sq. R)
Limited energy, multi - family 75.00 2
Tenant downs i Ze residential (with above so. ft)
Servkes or feeders inatallatiouoilteration, and/or relocation
200 amps or less 100.70 2
f J ;
"''f' ^• UI P: t tC r'1 'xt' el L'
,j `:ii L . '13rwa(` VVW1 ( t .. ' r � L • f t ere f -' ns ` !) ' ., s ' 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Ova 1,000 amps or volt 552.26 2
Temporary services or feeders installation, alteration, and/or
Phone:.( ) I Fax: ( ) 200 amps or less I 59.36 1
t Owner installation: This installation is being made on property that I own which is not 201 ramps to 400 amps 1 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps m 599 mops 168.3 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with r
` �� t (J: r 1 ,�',,, 1 - 4) .3 1 Lyr!P�,+..•y H above service Or feeder fee.
1 f r ;; ; i = 1 . 4 '1 ) 1 ' # {it I t IC ` iar k .:.1 n r Y 742 2
}tf .mot ' x s� r , , Yi z J :,y ,(btu' d �c each branch circuit
Business name Johansen Electric B Fee for branch circuits without
service or feeder fee, first 56.18 5(0 46 2
Contactname: Charlynn Lei f sera branch circuit
Each add' I branch circuit 7.42 2
Address: 10948 SE Valley View Terr Miscellaneous iservke or feeder not induded)
Each manufactured Ciry /StateIZTP: Happy Valley, OR 97086 dwelling. sserviiceaandd/iaf 67 .84 1 2
Phone: (503)698-3417 I : ( 5 0 3 ) 6 9 8 - 2 4 8 6 F a x : Reconnect only 67.84 2
Pump a irrigation circle 67.84 2
E-mail: . 2
I s. 5' wF n .. m „ • , sus r Sign or outline lighting 67.84
i'�tY• t.?iY! fr�.tol t.i �..� i°f, a ,a. {,.,.. }, ' . - 1 t . li ai`il : n ,. v 1 1Gt signal circuit(s) a limited - energy
Business name: Johansen Electric panel, alteration, or extension Purge 2 _ 2
Each additional inspection over allowable in any of die abov
Address: 10948 SE Valley View Terr Additional inspection (I hr min) 66.25/ hr
City/State/ZIP: Happy Valley, OR 97086
Investigation duipant l I hr a i 78.8/ hr
PPY Y • Industrial plant ( � �+) 78.118/ hr
Phone; (5 0 3) 698 17 Fax: (5 0 3) 98 lnspocuotrs for which no fa i9
90.00/ )r
• - ificall listed VS hr min
di,V ,/ CCB Lic.: Elec Lic.. 2 0 53 S ,y,t ��rpi;�`�;4� ' i _,,... . .r.:.!. I 'si 416Lit
515 3 9 I 3 - 2 4 3 C Suprv. Lic. • 'C i.Nltlt9i�te�.�' :•� :'9'",j_ '�' �,�.:il�' : .' ' 3 n ,�
Subtotal: i (o .IS
Suprv. Electrician signature, required: .4.gr/ Plan review (25% of permit fee):
Print name: Carl J a ns en T Date: 10/22/10 State surcharge (12% of permit fee): (p r ay
TOTAL PERMIT FEE: ( 2,42
Authorized signature:
permit application expo ifs permit is not obtained within 180
days after it has bees accepted as complete.
Print name: Charlynn Leifsen ate: 10/22/10 • Number of inspections shaved per perrmt
1 :\&dlding\Pcin4&S.•Pavd&App.doc 07/01/10 440 - 461 IT(I IeS/COat/WEa
2' d Xb3 13C213SH1 dH WdSO :2 0102 22 '400