Permit n CITY OF TIGARD ELECTRICAL PERMIT
1111 is COMMUNITY DEVELOPMENT Permit #: ELC2009 -00418
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/13/2009
Parcel: 2S113AC00101
Jurisdiction: Tigard
Site address: 16655 SW 72ND AVE 200
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: Spec Space
Protect Description: (15) branch circuits for TI.
Owner. FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 15 crt Branch Circuits 08/13/2009 $139.95
wo /Purchase Service or
PHONE: 503 -624 -6300 Feeder
1 ea 12% State Surcharge - 08/13/2009 $16.79
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:
. r
Total $156.74
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 0 R 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.66999 oor 1.800.332.2344.
Issued By: Permittee Signature: A/ /� / "P L /t?f91 /vA/
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 603.639.4176 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 Applic4;k ,,,: \):I r U) 1.4 )1:. in..i..if . 1.: 1
City of Tigard
13125 SW Hall Blvd, Tigard, OR 9//c4 1 1 2009
• Phone: 503.639.4171 Fax: 503.5 8.1960
.
Internet www.tigard-or gov CITY OF TLEA.P Date Ready
ID Received c . . ,p, permit No. . , -
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Plan Revie
!By: Soe Page 2 for
NotifiecVMethod: Other Pamitthi/ 009 --pi. /5
Inspection Line: 503.639.4175
lignil El
Supplemental Information
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' 7 teREZZIN ... 1.1 . ', - Y. ''':. AIINIV.7 "•I . :' ; •- ' '! MLIH 4'4717'• "Mgr" '''' :1 '
0 New construction El Additionlaheration/replacement Please check all that apply (submit 2 acts of plats w/items checked below):
0 Service or feeder 400 amps or more ID Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Maims and boatyards.
s - . . .. .
104,1) :_t' ., ,l.: : 1 : 1 4 ,47. !r. - 'I S P; i ''".". ; I. exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground. or exceeds 14.000 0 Commercial-use agricultural
ID 1 - and 2 dwelling El Commerciabindustrial 0 Accessory building amps for all othei installations. buildings.
0 Multi-family 0 Master builder 0 Other. 0 Fire pump. 0 histallati'm of 75 KVA or
ij It - A 4''' . POLIPM:WI MIN 0 Emergency system. lager separately derived aystem.
1 1 .'Ir'.'.. `;iil. I 'S 44,11 0 Addition of new motor load of . 0 "A", - E", "1-2", '1-3",
Job no.: Job site address: 16655 SW 72nd 100HP or more. occupancy.
0 Six or more residential] units. 0 Recreational vehicle parks.
City/State/ZIP: 1:IHealds-care facilities 1:1Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldgjapt. no.: 200 1 Project name: pbc 168-200 spec 0 SaltiCe OT feeder 600 amps OS MOM.
1111=r7r./EDITEN ` '
Cross street/directions to job site: Isaniation Oar. Fee. Total •
New residential single- or maht-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or Icss 145.15 4
Ea addl 500 sq. ft. orportion 33.40 1
Tax map/parcel no.: Limited energy, residential 75.00 2
iminithimmoi rrmiss (with above sq. fl.)
Millarit7
Limited energy, multi-family •
75.00 2
Tenant Improvement residential (vrith above eq. 11.)
Services or feeders installs don,alteration, and/or relocation
200 amps or less 80.30 2
1 201
.' , WW,IF';11',..i.1. 1 .1 .. - it stii 7 :1 •.. 1,'• T A amps to 400 amps
'0-.4.11" i• • '.`• '•': .'•:.• ,,, . 4 '.---•-•.:: c'... ,.. -1, ..,...4•40'.:••=-. ,- I . ' • '..... r. •••. ' 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 Fax: ( ) 200 amps or less 66.85 I 1
Owner installation: This installation is being made on property that 1 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 _401 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
Mil . 2, :4 Witt.17,Mar i'l 'Ai ,, i'''l 'Li: :, iiiiiiiiWiril=1311111711 above service or feeder fee, 6.65 2
each branch circuit
Business name: Johansen Electric Inc. B. Fee for branch circuits
without service or feeder fee, 3
Contact name: Charlynn Leiften first bran . ch circuit 46.85 46.85 2
Address: 10948 SE Valley View Terrace Each addi branch circuit 14 6.65 , 93 . 1 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 I Fax: : (503) 698-2486 Reconnect only 66.85 2
E-mail: jobansenelect@msn.com Pump or irrigation circle 53.40 2
itignESZEU,SUMME0,77,0,;23221111191MallffraMintili Sign or outline lighting 53.40 2
Signal circuit(s) or limited-
Business name: Johansen Electric Inc. energy panel. alteration, or
Address: 10948 SE Valley View Terrace extension. Desenbe: 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 Fax: (503) 6, Investigation per hour (1 hr min) 62.50
1/. •
CCB Lic.: 51539 V I Electrical Lic.: 3 Suprv. Lic.: 2053S Industrial .lant per hour 73.75
',_),
Suprv. Electrician signature, required: .... Ae , e /4. 0444.8244. "
Subtasl: 139.95
Plan review
Print name: Carl K. Johansen Date: 8/11/09 (25% of permit fee):
State surcharge (12% of permit foe): 1 b. 19
r yN.....
Authorized signature: TOTAL PERMIT FEE: 1 56 .74 ar
This permit application empires if a permit b not obtained within 180
Print name: Charlynn J. Leifsen Date: 8/11/09 d after it has been accepted as complata
' Number of inspections allowed pa permit.
1:1BuildingTermitslELC-PeimitAppAgc 0S/2346 440.461 5T(11/03CAMAVP33
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