Permit 74 CITY OF TIGARD ELECTRICAL PERMIT
g COMMUNITY DEVELOPMENT P ermit #: ELC2010 00709
TIGARD, 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/22/2010
Parcel: 2S112DC00701
Jurisdiction: Tigard
Site address: 15951 SW 72ND AVE
Project: Miller Paint Subdivision: OREGON BUSINESS PARK III Lot: 38
Project Description: Electrical for TI.
Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES
10948 SE VALLEY VIEW TERR 15350 SW SEQUOIA PKWY #300
HAPPY VALLEY, OR 97086 PORTLAND, OR 97224
PHONE: 503 - 698 -3417
PHONE: 503 - 624 -6300
FAX: 503 - 698 -2486
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 12/22/2010 $100.70
Specifics: amps or less
20 crt Branch Circuits w /Purchase 12/22/2010 $148.40
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 12/22/2010 $29.89
Electrical
Type of Const:
Occupancy Grp:
Total $278.99
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 -0090. You may ob a copy o orSJirect questions to OUNC by calling 503.232.1987 or 1.800.332.2344. \
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Issued By: /�..�_ r __ P ermittee Signature: —' - .Ar / .. .0
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NER 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 the next available inspection date.
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 RECEIVED i'01, (i i It l: l wl: <)
City of Tigard Received
DateB : 3 , 310 all Permit No.: I N Ig 13125 SW Hall Blvd,, Tigard, OR 97223 P lan Review
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Phone: 503.639.4171 Fax: 503.598.1960J L. � 1 L. 2 4 1 2010 �� ; Other Permit: i t � _ -� • `, -�
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Inspection Line: 503.639.4175 ady y: � Page tar
Internet: www.tigard-or.gov Or gov CITY OF TIGARD fi d/M �� Supple mental 2 llnfarmatlon
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❑ New Construction ® Addition/alteration /replacement Please check all that apply (submit a sets of plans w /items checked below):
CI Service or feeder 400 amps or more ❑ Building over three stories -
❑ Demolition ❑Other:
where the available fault current ❑ Marinas and boatyards.
rr t t li p ; r1 t t�34�.nr ,
_ y C' 1, 22 ('i u - 1 x - `i ' t , /1,4 t w' acceds at 15 vo ❑ uildin
. ... s atl n. 1 tx ro :th r... a x n = hi S]ig, I�,.�i 1' Ieo_sto e pound orex aeds 14,000 0 lts or ❑ Flo Cotirmere -use aagricultural
❑ 1- and 2- family dwelling Q Commercial /industrial ❑ Accessory building g amps for all other installations. buildings.
❑ Multi-family , ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
EN a m lt= t'aS l r
_ ', -, _ m, �. ; r t
El Emergency system. larger separately derived system.
EfdSlc VI zi E it s i 1 �, . t» i i-i _
1 {r - .�.. : ❑ Addition of new motor load of ❑ „ A
Job no.: Job site address: 15 9 51 SW 72nd ❑ 10011P m more. occupancy.
Six or more residential units. ❑ Recreational vehicle parka.
City/State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 1 Project name: Miller Paint ❑ Service or feeder 600 amps or mote.
t 11i E- t M a,r , y
Cross street/directions to job site:
neaeri , � 8 4
ption Qty. Fee. Total
New residential single or multi family dwelling snit
Includes attached garage.
Subdivision: ' Lot no.: 1.000 sq. ft or less 168.54 4
Tax map/pane Ea add'1500 sq. ft. or portion 33.92 1
Limited energy, residential
�9 ����ar T O. giant a tmemmrr It 4 t n t i - a ioi l 75.00 2
e.. l Wild - z l� ,- ,< us: '� t (with above sq. R)
Li mited energy, multi - family 75,00 2
Tenant Improvement residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less i 100.70 Ic)t) 7s. 2
fa l i t l �tix� € �, ic'+7S , 'i /.ry lldi 1 _ t 201 amps to 400 am
• �i3 #F � ( it ; a:` � 1 �+� amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
A�c dress: Over 1,000 amps or volts 552.26 2
City/Slate /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 am f 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
„r
� °” rlp`]� i o z 3 :� 1. Iq eeu n r sr ' 4 m i € above service or feeder fee,
E orim� c c :.., I E'er ,', Il&, aI u< ¢ a w t! as each b circuit 7.42 `ipl , r 4/O 2
Business name: Johansen Electric B. Fee for branch circuits without pip l5
service or feeder fee, first Sb.18 2
Contact name: Charlynn Leifsen branch circuit
Each add') branch circuit 7.42 2
Address: 10 94 8 SE Valley View Terr Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
ty Happy Valley, OR 9 7 0 8 6 dwelling, service and/or feeder 67'84 2
Ci
Phone: (5 0 3) 698-3417 I Fax:: (5 03) 698-2486 Reconnect only 67.84 2
E-mail:
Pump or irrigation circle 67.84 �2
r + #, Sign or outline lighting 67.84 2
P { �` R ' iW o yl oti t nin d t # . . a u ," t; Signal circuit(s) or limited- energy '
Business name: Johansen Electric panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the abov
Address: 10948 SE Valley View Terr Additiomal inspection (lhrmin) 66.25/hr
city /State/ZIP: Happy Val OR 97086 Investigation (1 hr min) 66.25/h
Industrial plan (l hr min) 78.18/ hr
Phone: (503) 698-3417 I Fax: (5 0 3) 698-2486 Inspections for which no fee is 9004/ hr
s•ecificall • listed Vz hr min
CCB Lic.: 51539 I Electrical Lic.: 3 4 3 Suprv. ic.: 2 05 3 S 1 . f, l s' „ °W s it ref Al,
Suprv. Electrician signature, required: '-�� Subtotal ,g4,-./
Plan review (25% of permit fee):
Print name: Carl Jo a s e n Date: 12/21/10 State surcharge (12% of permit fee): 149. 79
Authorized signature: , TOTAL PERMIT FEE: '� a v�
/ ..� ,� This permit application expires if a permit is not obtained within 180
Print name: Charlynn Le ' ' s en Date: 12/21 / 10 • days
e c Lions a has
ow e d p accepted s.8 eomplecomplete. .
' Number of inspections allowed par pemvt.
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use 07,'01 /E6 440- 46]5T(]1 /05 /COMIWEB
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