Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit g: ELC2009 -00264
I GA RD D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/04/2009
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Parcel: 2S 113AA01100
Jurisdiction: Tigard
Site address: 16596 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. ATTE N: Ore! •n law -quires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0 0 through OAR 9 2 -' *1-0 0*. You may obtain a copy of the rules or direct questions to OUNC by calling . 46.6699 or 1.800.332.2344.
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Issue y: ' ■ - ■- 4 = . , Permittee Signatur
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' 10...,, 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.
1
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Electrical Permit Applieatio r I - __ � = :1' , , ! !
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City of Tigard Received / _
N.,..
U Dates Le 1 O 9 ', v Permit No.: flee ',420?-4,0,24
13125 SW Hall Blvd., Tigard, OR 97223 ll 2009 Plan Review
Phone: 503.639.4171 Fax: 503.598.I96Q)U11 Date/B .: Other Permit:
- I , Inspection Line: 503.639.4175 Date Ready/By: WJ1111 ® See Paget for
Internet www,tigard-or.gov Y � / > f J Notifed/Mehod:
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li y ff,ili i t ( 'a �:dl ti n +pttjl'',m . t¢+ yi }i1tlt i, "• I .1:""1"g• c n
I 1 1 , 11,,1. {+.1r Ii& it • 3 (I 1 .0 lifts i 117 1Yr .,15.7e f'-tl y'J I + j 1 (L`t_' t•" ee , , ' 41 , .,m,: :4 2-
❑ New construction ® Add ition/alteratiOn/replacement Please check all that apply (submit d seta of plane wlitems checked below):
❑ Demolition El Other ❑ Service or feeder 400 amps or more ❑ Building over three stories.
.., , where the available fault current ❑ Marinas and boatyards.
i•,l: -• ,'.� 'i� i 'F7t�� d ( s:w � -. i si l I ,LJr, y�k _ -' , R . exceeds 10,000
f' { !ii;liti }?Ib.l.,;;: : Jir1=+y!'}y? r O iii, . . amsat150moltsm Floating buildings.
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building leas so r all o , a exceeds II 14,000 . ❑ Commercial-use apiculture! � amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: ['Fire pump. ❑ Installation of 75 KVA or
JJ i t , lr , f ,Y, • r ' t *t , `� . � , � i' rll Mt w , 1 I l i' . � i t fti ❑Emeency system. larger separately derived stem.
:. , -- t'reV . t r dl , : t'R F!s!t .,, , :t e 4n.., t� � �E .I ,,,11. ll ll. l! ; . �I .. r
❑ Addition of new motor load of ❑ A ,. ,. -2 . 3_ ti
Job no.: I Job site address: i�r/9 10 4} 9 _,.... 0 Ave. 100 ore. occ mpaney.
❑ or Six or moror e re
Six Recreational vehicle puke.
City / State/ZIP: ❑ Health -care facilities_ ❑ Supply voltage for more than
`` ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 0, 1 Project name: /3 S'i ot(^_al2e • c . ❑ Service or feeder 600 amps or more.
• Air: I ti t : rp. r „ maw a:F { •rr
.11; PI I.I; " ll lty' :11 f ,t ;; ii, 'ifltta''41
Cross street/directions to job site: ' Dercd°dea F. 1 Total 1 •
' New residential single- or multi - family dwelling unit
Includes attached garage.
Subdivision: I Lot no 1,000 sq. ft or less 145.15 4
fax map /parcel no.: Ea. add] 500 sq. ft. or portion 33.40 1
'I #Hl t l r. .•I U 1t itttri"1 II u' ; 1' t iyt Jt�l I Limited energy, residential
: ,: i •t ' 1lli!I . il t*P a ill Ir
l tllo- l('1:Ilti 'Ili " (with above sq. ft.) 75.00 2
77 /1- . , `y CC Limited energy, multi- family 75.00 2
- Ot residential (with above sq. fl.) _
Services or feeders installation. alteration, and /or relocation
t':'` :'Iil'" ' ` p� "..�Il,i' ' - 'r+ °` ' '•tl ;''('h 200 amps or less 80.30 2
1'.: ^(G} , 1 1 P F� . x^ 1 1 i cy "4t',j, (r. 11'1r�.i•.,'{• l a 'i' l
' � � i � ; li i{`,r:IIE Ilia.' i i ��l ., s • Iiit�s'� j,`...il';I' "� ~14 201 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: ( 1 I Fax: ( ) 200 amps or less 66.85 l
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
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date:
_ A. Fee for branch circuits with
' l °!l;' lI►'1 =i' >`�'I J l "1 x � t
1 •,.. { o' i ;S , 7 ..41..3., :., 1 Ili__tJ . 1 r, t t ; 1 .,, , t
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, � $ 46.85 7 2
fast branch circuit r
Address: 10948 SE Valley View Terrace Each add'l branch circuit _ 9' 6.65 9, 2
Miscellaneous (service or feeder not Included)
City / State/ZIP: Happy Valley, OR 97086 Each manufactured or modular
90.90 2
dwelling, service and/or feeder
Phone: (503) 698 - 3417 J Fax: : (503) 698 -2486 Reconnect only 66.85 2
E -mail: johansenelect®msn.com Pump or irrigation circle 53.40 2
fiii1if. :, ',', '' {itlkl:I:T-1µ i ':.ul1t ^,1•,:i11'4ij1';' ijt1 •-l1:1.. ;11 a11 1 ' "`I. l; i , ' 7ir Sign or 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 addldonal inspection over allowable In any of the above
Phone: (503) 698-3417 Per inspection 62.50
[Fax: (503) 698-2486 Investigation per hour (1 hr min) 62.50
CCB Lic.: 51539 Electrical Lic.: 3-243C Suprv. Lic.: 2053S Industrial plant • -r hour 73.75
Se "'s. . ,,514103 y i' ' a"'; ubt •1:'."'"
Suprv. Electrician signature, requir
Subtotal:
Print name: Carl K. Johansen I Date: (D///6y Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: C• ""s----______. TOTAL PERMIT FEE:
6///09 Tbis permit application expires ira permit is riot obtained within 180
Print name: Charlynn J. Leifsen Date: days after It has been accepted as complete
ber
ttguitding Permits \ELC- PsrmitApp.dac 05/23/06 440 -4615T(I l/0521:6511.IB • Num of inspections allowed per permit.
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