Permit CITY OF TIGARD ELECTRICAL PERMIT
1111 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00080
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/03/2011
Parcel: 2S113AC00101
Jurisdiction: Tigard
Site address: 16655 SW 72ND AVE 300
Project: Food Sales West Subdivision: PACTRUST BUSINESS CENTER Lot: 0
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 - 624 -6300
HONE: 503 - 698 -3417
FAX: 503 - 698 -2486
FEES
Quantity Description Date Amount
40 crt Branch Circuits w /Purchase 02/03/2011 $296.80
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/03/2011 $59.78
Type of Use: COM Electrical
Class of Work: ALT 2 ea Services or Feeders - 200 02/03/2011 $201.40
amps or less
Type of Const:
Occupancy Grp:
Total $557.98
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 952 - 001 -0090. You ma o p . the = or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
•
Issued By _ Permittee 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 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 Applica CEIVED I 'it OI I I( I I tit (0,1 \
RI
City of Tigard 4 "ad _ _ i� u _�tti
13125 SW Hall Blvd., Tigard, OR 97223 0 1 2 Q ! Plan Review ,
Phone: 503.639.4171 Fax 503.598.1960 Date/B : Other Permit. ` it
Internet: , ti a� g 7S CITY OFTIGARD Noti Ready/B: ethvo: �/ Supple Pane l for
�i SkmeatalLionisation
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Please check all that apply (submit 3 sets of pima w /items checked below):
El New construction ® Addition /alteration/replacement
❑ DCIDO►Itlon ❑(?tiler; 0 Service or feeder 400 amps or more ❑ Building over throe stories.
where the available fault current ❑ Marinas and boatyards.
tr : 10 , t- c r !P1mu fwft t,I '44 1 i,:,' e E
e , , � d ,�" ; �,°'"s; �' � k�y I l , � p � exceeds 10.000 amps at 150 volts or El Floating buildings.
1
Pe .. . s.; t a r a'lot .. ; • v _ aim ..., . ,.n. ( Ile thk h R
less to ground, or exceeds 14,000 ❑ Commercial-use agicultucal
❑ 1 - and 2- family dwelling ® Cotnmercial/industrial ❑ Accessory building amps for all other instillations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: Q Fire pump ❑ Installation of 75 KVA or
�i�(1 �tti,'7 ® - -- I` z r ;fir•'r c - 5 �� j '. p ( fir , ce . ❑ Emergency system. largerseparatelyderivedsystem
-
.. ... ,. �.t,G ,1 h. :ir.... s ... . . #ltr a.) 3E2. -. . „ 1� . t_ ❑ Addition of new rooter load of ❑ "A" "E "1.2" "1 -3"
100HP or more, occupancy. Job no.: Job site address:
16 6 5 5 SW 72nd, 3 0 0 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal
Suite/bldgJapt no.: 300 I Project name: Food Sales West ❑ Service or feeder 600 amps or more
Cross street/directions to job site: Description o x l t� t ' l t, t ,
J Orr Fee. Total " ' p
New residential single- or multi - famiy dwelling unit
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Tax rilap /parcel no.: Ea. add'! 500 sq. fl. or portion 33.92 1
ttuwp 1� ,,, l a II n r , v , _ Limited energy, residential 75.00 2
' i ,€ ' a . , ! " s 5. " `*, (with above se• ft.)
..., W .. , 4 .:,. , ..:..:....sx:aec r ,...:.. a al.Jacus i.lt#3a f. v{ as . r
l .- S .
Limited energy, multi- family 75 00 2
Tenant Improvement residential (with above sq. R) _ _
-- Services or feeders installation, alteration, and /or relocation
200 amps or less 2._ 100.70 24/, l/ �2
i4 " , p Via`' r ``` 7*°°`r * 1 . ` t ' c1 " t { , z: 201 amps to 400 amps 133.56 2
. f ,":1- a G • ai , ; , :iiidbcdn 016 C ,1 W d ith I . 111. i i ll e,11 . ":' 4 . 1 ' ti,,,I :. =� ' fill 14 , \( r f
401 amps to 600 amps 200.34 2
- Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State./ZIP: Temporary services or feeders installation, alteration, sad/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1 1
201 amps to 400 snipe 125.08 2
Owner installation: This installation is being made on property that I own which is not
401 amps to 599 amps I 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with feeder fe
above service p
r N a or. l it , ! f01 r 1 ito. w, k -'l ix 7.42 ���0 2
.hhW1 ,,, n, al , , each branch circuit
Business name: Johansen Electric B. Fee for branch circuits without
service or feeder fee, first
56.18 2
Contactttame: Charlynn Leifsen branch circuit
Each add'! branch circuit 7.42 2
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
City/State/ZIP: Happy Valley, OR 9 7 0 8 6 d
Each dwelling, service or modular 67.84 2
p py Y r dwelling, service and /or feeder
Phone: (503)698-3417 I Fax::(503) 6 9 8 - 2 4 8 6 Reconnect only 67.84 2
E-mail: Pumporirrigationcircle 67.84 2
i Sign or outline lighting 67.84 2
' / I.,s : gip :W 141N _.V..� LiL,41:Dz r .. __ .. . �u .r. 1 , i S " ,y 1`:1r..4' 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 Additional inspection (lhrmin) 66.25/hr
City/State/ZIP: Happy Valley, OR 97086 Investigation (lhrrein) 66.25/br
Industrial plant (1 hr min) 78.18 / hr
Phone: (503) 698 Fax: (5 0 3) 698 Inspections for which no &c is 4000/ hr
s.ecifical listed h hr min
CCBLic.: 51539 Electrical Lie. :3 -243C Suprv.Lie. :20535 +iii, ,,,' " "i ':`,;; i(.,)71;' ,. ) :1 "" l" ,"
P B k a Subtotal: r9� 44 Su tv. Electrician signature. required:
tlxt`/ Plan review (25 /o of permit fee):
Print name: Carl Jo risen ate: 2/1/11 State surcharge (12a% of permit fee): S9dig
Authorized signature: TOTAL PERMIT FEE: x 5 1 7, 0 96
Mb permit app6caties expires if a permit is not obtained within IBS
daps after it
allow d been permi as complete
Print name: Charlynn Leif s en Date: 2 /1/11
* Number of inspections allowed per permit
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