Permit •
• • i a CITY OF TIGARD ELECTRICAL PERMIT
I Is COMMUNITY DEVELOPMENT Permit#: ELC2009 -00263
T I G A R p 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/04/2009
Parcel: 2S 113AA01100
Jurisdiction: Tigard
Site address: 16592 SW 72ND AVE, BLDG# B11
Subdivision: OREGON BUSINESS PARK I Lot: 0
Project: Spec Space
Project Description: TI - (10) branch circuits.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY
#300 10 crt Branch Circuits 06/04/2009 $106.70
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 06/04/2009 $12.80
Electrical
Contractor:
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 $119.50
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 ugh 2344
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952 -0 -0100. You may obtain a copy of the rules or direct questions to OUNC by cang 03.2. or .0.33..,
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Issued B Pe rmittee 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 pemiit 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 Applica .51!-- ' ��` 1 t,lr (ttr1(,: 1 ,1 1,,,)
City of Tigard 200 CCBy: IA, Ca?cv9 ekna
- LLIIII __ Da te/fiy: ' / 09
x t No.:
13125 SW Hall Blvd., Tigard, OR 977 N ® Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 D 3 . : Other Permit:
J I,.• •, i . :.1_:. Inspection Line: 503.639.4175 ��ss� f. :I'.(.'' , !,) Date Ready/By: J Ti R5 See Paget for
Internet www tigard - gov a.. ,, '`r t a t , , Nott od/Method: I Supple/swami Information
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❑ New construction ® Addition /alteration/replacement Pkasc check all that apply (submit 1 sets of p lans wrtema checked below):
❑ Service or feeder 400 tunas or more ❑ Building over three stories.
❑ Demolition ❑Other.
where the available fault current ❑ Marinas and
� �� ( �fl yc boatyards.
•s'ILI:vili''1 I S`ilptJl�l'irii• :,. �. :�,{ �1 7; :if l...tt`ft. _ '_n�,,,: :_;dl'
4lii,' buildings.
t.1 rnt' exceeds 10,000 amps at 130 volts or ❑ Floatingbu
I less to
❑ 1 - and 2 - family dwelling ® Commercial/industrial ID Accesso Y ta building or all o , or exceeds 14,000 ❑ Commercial - ux agricultural g amps for ell Omer installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Firepwnp• ❑ Installation of 75 KVA or
li,r�...
' {: :,'' .' ' I!s+ 'T.-
' G�: stqun 3 r s ,: r,Mi, : ; :d1' ' � ; . , p; Emergency system. larger separately derived system.
r . " ' s;.. t �' ' � I: it li' ; ��i.w� N • ❑ Addition oCncw motor load of ❑ "A" "E ", "1 -2" - 1 3 ^.
Job no.: Job site address: I L iq L r / , t l or or a rest Recrez occupancy. o
Q Six or more rcaidential traits. ❑ ]tecrcatianal vehicle parks.
City/State7ZIP: ❑ Healthcare facilities. ❑ Supply voltage f� more than
n ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: bl` I Project name: /3 g /J c vacancy e) DService feeder 600 amps ormore.
V // �- "J L 'j'".'t` .'' ;1i1(t1pt.; .•`: €,:u "T a ' " f .
Cross streeddirections to job site:
Desolation On. Fee. Teed •
New residential single- or multi - family dwelling unit.
- Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax reap /parcel no.:
Ea. add'l 500 sq. ft. or portion 33.40 1
a _ Ilr ; r Limited energy residential
11N a il" { '9 r i •„ u r tt vr,
t �'tlrl. , } ircJj:i.•., I� fit `r'n 1 „ 75.00 2
.x�•: 1 �. a .L �Ail., ''•17iFt�iif::i..._ f'!a' °.`,tif,•!4� , "s't;i '! (with above e-9. Q.) _
/ I Per . 't) Can c Li residential ntial (w th above so. 75.00 2
I f'7/)' Y residential (with abmro se-. 11.)
Services or feeders installatioo,alteration, and/or relocation
1 i:t�+s�I . w e 1 t 200 amps or less 80.30 2
;tY Jg : 1 l ' i1:Z fg :,5 ti alt jj:. tU it ;i n !, .. ,.
�uL.rt ' fl , •,�' -' ,,,�,t11 �tlil. :.' i�t:;tu =; °i,. �,t;<;"2*g%l'f' 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 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
Owner si store: Branch circuits - new, alteration, or extension, r panel
! Date:
s '' f ; pp��'W r't "�!"F rr' ;r r , G�T'aN i!p:. apps; :a A- . Fee for branch circuits with
L::,t6i;=,R, l:G.:ii I; iI, f LI Ord, ht rt lrl .ice ... • ),
, above service or feeder fee, 6.65 2
each branch circuit
Business name: Johansen Electric Inc. B. Fee for branch circuits
Contact name: Charlynn Leifsen without service or feeder fee,
fast branch circuit I 46.85 ( .. 8t" 2
Address: 10948 SE Valley View Terrace Each add'] branch circuit 4 _ 6.65 59 •SS' 2
Miscellaneous (service or feeder not included)
City/State/ZLP: Happy Valley, OR 97086 Each manufactured or modular 2
Phone: (503) 698 -3417 I Fax: : (503) 698_2486
dwelling, service and/or feeder -
-
E -mail: ohansenele Reconnect only 66.85 2
ct@msn.com Pura o irrigation it
, , .r �,,,,, , , P circle _ 53.40 2
...,,t��.1,l1.LML721. VI -h ,.la I I •s,', I,' Signor outline lighting 53.40 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 inspeceton over allowable in any of the above
Phone: (503) 698 -3417 Per inspection 62.50
Fax: (503) 698 -2486 Investigation per hour(i hr rein) 62.50
CCB Lic.: 51539 Electrical Lic.: 3 -24 C S pry. Lic.: 2053S Industrial .]ant per hour 73.75
Suprv. Electrician signature, required: Subtotal: i 0 , . TO
Print name: Carl K. Johansen I Date: 6109 Plan review (25% of permit fee):
State surcharge (12% of pennit fee): fZ • gin
Authorized signature: / "----'■ -----
TOTAL PERMIT FEE: /jig . 6
Print name: Charlynn J. Leifsen I Date: OA 9 This permit application ex piresifapermitisnotobMinedwith in180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
1 BuiIOinaTemuts tELC- Pemd,App,doc 03/23/06 4 0.4615T(t 1ro5/COM'WEB
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