Permit I I _,,� CITY OF TIGARD ELECTRICAL PERMIT
. COMMUNITY DEVELOPMENT Permit #: ELC2011 -00165
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/30/2011
Parcel: 2S 112 DD00200
Jurisdiction: Tigard
Site address: 15862 SW 72ND AVE 150
Project: Immunology Subdivision: PACIFIC CORPORATE CENTER Lot: 0
Project Description: Electrical modifications 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
2 ea Services or Feeders - 200 03/30/2011 $201.40
Specifics: amps or less
40 crt Branch Circuits w /Purchase 03/30/2011 $296.80
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 03/30/2011 $59.78
Electrical
Type of Const:
Occupancy Grp:
Total $557.98
Required Items and Reports (Conditions)
This permit is ' . =- b'ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don - ' accordance wit proved 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 la . req you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 001 -0010 th ugh OAR 95 00 0' ou may obtain a copy of the rules or direct questions to OUNC • , • or 1.80
`� .332.234• '
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ssued By: P ermittee Sig � t �. /5 �:. i
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. t 9'5 S
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 • 1 t 1K t 11 L 1( 1 1 NI (t.I \
City of Tigard Received Deters // . Permit No.: 6.e ii -4.41/6, 5-
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone; 503.639 4171 Fax: 503.598.1960 D : Other Permit,
Inspection Line: 503.639.4175' Date Ready/By: furls: to See Page 2 for
Internet: www.tigard or.gbv Notified/Method: Supplemental Information
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❑ New construction ® Addition/alteration/replacement Please check all that apply (submit a sets of plans w /items checked below):
❑ Demolition ❑ Service or feeder 400 amps or more ❑ Building ova three stories.
❑ Other: where the available fault current ❑ Marinas and boatyards.
i +nt s !! v a sari €!l 9 e � 4 li exceeds 10,000 s at 150 volts or ❑ fl buildings.
rt 'ix r kr • i :a.:'! „ ,. 3 .`• , .€ . ( �- A; - ...J 4 1 :.rn tai"" � " '''''' ' { amp Floating ding a.
w
. ' lees to ground, or exceeds 14,000 ❑ Commercial-use agricultural
❑ 1- and 2- family dwelling IN Commercial/industrial ❑ Accessory building amp* for all other installations buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVAor
largo separately derived syste
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k p er p , „ er g , r F } t ' ❑ F_ntergency syatesn. m.
ia' : i ? t fit t''.t ', a te. '. ; , 4� : ° ❑
.... r � i 4e *It ' tn 4 ' uF Se nS ( ❑ Addition of new motor load of `A ", "6•', "1.2 ", "1-3'
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Job no.: Job site address: 15862 SW 72nd or more. occupancy.
❑ Six o or r more residential atria, ❑ Recreational vehicle parka.
City /State /ZIP: ❑ Health - care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal
Suite/bldgJapt. no.: 15 0 I Project name: I mmuno 1 ogy ❑ Service or feeder 600 amps or more
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Cross street/directions to job site: Deseriptlo. Q. Fe d To
New residential single- or multi- family dwelling unit
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. R. or less 168.54 4
Ea add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
'` �� t 4�lai Ilia i'.'- d *'3e ' .E� , =t41/%:7•:; : ',;'',;::::; i . " A ! !4�44 a 75.00 2
# t (with above sq R )
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Limited energy, multi - family 75.00 2
Tenant Improvement residential (with above so. ft.)
Services or feeders installatio alteration, and/or relocation
200 amps or less 2 100.70 2 01 . 4 C 2
,l-77 • i i r `. Fyn r � cr x ` -1 t I , l a l y "
' , 201 amps to 400 amps - 133.56 2
li
Name: 401 amps to 600 amps 200.34 2
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, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or Less 59.36 1 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 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
above service or feeder fee,
4 Q 7 42 2 9 6 . 8 2
t i 1 .., -,,.: ° e
-c •k '` -: 4 ; ,, I �` ' . 'r 'el.,.
- k :0
:;'fit, ' I each branch circuit
Business name• Johansen Electric B without
service or fader fee, first
56.18 2
Contactntune: Charlynn Leifsen branch circuit
_
Each Mel branch circuit 7.42 2
A dfleSS: 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
City /State/ZIP: Happy Valley, OR 9 7 0 8 6
Each manufactured serv a or modular 2
PPY Y r dwelling, service and/or feeder 67.84
Phone: (5 0 3) 6 9 8 34 1 7 I Fax:: (5 0 3) 698-2486 Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
a , ! a !'r is tier IM t 717 ! .1 ,l -
t • Sign or outline lighting 67.84 2
I ,l .�";if $,�„ i6!itl lii�� h. ,- �'' ', 4 . r% a , _ l 4 1ttl' of t' , • ' Si oircuit(s) or limited- energy
Business name: Johansen Electric panel, alteration, or extension. Page 2 , 2_
Each additional inspection over allowable in any of the above
Address: 109413 SE Valley View Terr Additional inspection (1 hr thin) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: Happy Valley, OR 97086 Industrial plant (11n min) 78.18/ hr
Phone: (503) 698-3417 Fax: (5 0 3) 698-2486 Inspections for which no fee is 90.00/ hr
s ecificall listed 'h hr mm
CCB Lic.: 51539 I Electrical Lic. ,2'43C Suprv. Lie.: 20535 , t'� , r ��� . �`��`�';"
,a'C_ ,,.„ : � ,
Suprv. Electrician signature, required: �. ! A e Subtotal 498. 0
Plan review (25% of permit fee): 7 8
Print name: Carl 1I! AnT hans en Date: 3 / 3 0 / 11 State surcharge (12°fo of permit fee). 9 4" J• • y •
Authorized signa tiu1 `Y l TOTAL PERMIT FEE: 5..9.-7-:-.84
This p ermit a expires if • permit is not obtained within r80 qg
nn Leif f s en I Date: 3 3 0 / 11 y days after it has been aecepted ma complete. 5516
Print name: Churl
Y Number of inspectioam allowed per permit. Q,
r Platuldingl Pemuts'.ELC- PernveApp.doc 07/01/10 440- 4615T111/05/COM/A'EB /�_ I'lb
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