Permit CITY OF TIGARD ELECTRICAL PERMIT
1111 • COMMUNITY DEVELOPMENT Permit #: ELC2011 -00188
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/12/2011
Parcel: 2S113AB01201
Jurisdiction: TIGARD
Site address: 16280 SW UPPER BOONES FERRY RD
Project: Spec Space Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project Description: 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
16 crt Branch Circuits wo /Purchase 04/12/2011 $167.48
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/12/2011 $20.10
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $187.58
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 • s r -2 -001 -0090. You may obtain a copy of th= . act questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: i _ _ — �� 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.
RECEIVED
Electrical Permit Application 'Ilk' (III 11 l I 'NI ()NI 1
City Tigard APR 1 2011 Received
g Date/13 : 7 I / a
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review I � �, ,t,
B Phone: 503.639.4171 Fax: 503.590P401 V IGI' W names Other Perini':
Inspection Line. 303.639.4175 H See Page 2 for
Internet: www.tigard- or.gov B UILDING D N
N a : Supplemental information
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❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 2 sots of plans w /items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition Other; where the available fault current t 0 Marinas and boatyards.
d!1 ' - „ t t 4 i� 5 P r 7 • r [ F 1 , ' ,. r exceeds 10,000 snips at 150 volts or 0 Floating buildings.
p't{�r.(y��j al' (�� - Z :st 9� y� 9 i� {� p ,,t S, � ,
1C"'J • • . �al. A ? 9�rv.� :' .i1flSl71: :1 n 'fa . . .J it ta1 -lAi .r ad I - ; t > fi +
l to,.
d, or exceeds 14,000 0 Cattlme -use agricultural
❑ 1- and 2- family dwelling ® Commercial,/industrial ❑ Accessory building amps for all other installations buildings.
❑ Multi - family ❑ Master builder ❑ Other: 0 Fire pump. 0 Installation of 75 KVA m
t °t"i k , . i c^•Ir • t '�'','? x a �? r 0 Emergency system. larger separately derived system.
t< : - tai . - • a .r..ra+ r 4 7 1 . fi t tt 8 r i t a l 1 i
'� .. , , i1�l+,t.{�: ,. j 0 Addition of new motor load of 0 "A" "E" "1 -2" "1 -3'
Job site address: ,p IOOIiP or mac. occupancy,
Job no.:
16 2 8 0 S aIIl Li ftk) ! S 0 six or more residtmtial units. 0 Recreational vehicle parks.
City /State/ZIP: 0 Health -care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal
Suite /bldg. /apt. no.: I Project name: s ❑ Service b0
,ce or feeder 0 amps or more. r
✓ 'c.c� ; 0114. 5' +r 11'11 b °
t'i y ,s3 , . , 4 . 'Y
Cross street/directions to job site: 1 oesenpnon i Qty. pee, I Total I
New residential single or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax Inn r
' ap1p ii�l '
....., _ :... , .. it? i
o ri.lt�Wl(e';"u° zaK 3
. ' i 3r a '1.la w# 4
. 1 (with above s ft)
75.00 2
Limited energy, residential
"'t"' }, ' Limited energy, multi - family
75.00 2
Clean up space for lease residential (with above sq. ft)
Services or feeders installation, alteration, and/or rebcatiOn
200 amps or less 100.70 2
1ki4'r''n' r) I i,t1 1(( a g('r�11t11 €, ?i'JI F'lil ., 201 amps to 400 amps 133.56 2
t ,ii' 4l( 1 I 3 , e a'i II II. i.
{ - 1 _ f � 401 amps to 6 00 am
Name: ps 200.34 2
��} e)' V Y� 601 amps to 1,000 amps 301.04 2
Address: f l ��' ‘)- Over 1,000 amps or volts 552.26 2
LP �(0f \‘L41 Temporary services or feeders installation, alteration, and/or
1
City/State/ZIP: I vr� 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, tamer panel
Owner signature: Date: A. Fee for branch circuits wide
t+ss Y tir k` `rs I cr }szdr r ► above service or feeder fee,
1tlt't11 itt f r .. ,, I / FX , .�r+z . .. . , . 1, - s ' ; ! t • each branch c 7.42 2
' Business name: Johansen Electric B. Fee for branch circuits without
service or feeder fee, first
Contact name: Charlynn Lei f sen branch circuit , 1 S6 56 . 1 2
- Each add'I branch circuit 15 7.42 111. a
Address: 10 94 8 SE Valley View Terr Miscellaneous (service or feeder not included)
Valley, OR 97086 ► manufactured or modular
City /State /ZIP: Happy 67.84 2
ppy y . dwelling, service and/or feeder -
Phone: (5 0 3) 698-3417 Fax:: (5 0 3) 698-2486 Reconnect only 67.84 2
Pump or irrigation circle 67,84 2
E-mail: Sign or outline lighting 67.84 2
t i o a x vii i .
I _ .. ie •' 'tr a ., .p r t ;,r ,,, = wr. 0 s+,�ascaii�£oii? i 2'.l lit% signal circuits) or limited- energy -
Business name: Johansen Electric panel, altention, Page 2 2
. Each additional inspection over allowable in any of the abov
Address: 10948 SE Valley View Terr Additional inspection (1 hr min) 66.25/ Iv
Investigation (I hr min) 66.25/
City /State/ZIP: Happy Valley, OR 97086 Industrial plant (I hr min) 78.111/ hr
Phone: (5 0 3) 698-3417 Fax: (5 0 3) 698 - 2 4 86 Inspections for which no fee is 90 00/ In
CCB Lie.: 51539 Electrical Lie.: 3 Suprv. Lic.: 2 0 53 S , ' `fically d(i min 4. t {
Suprv. Electrician signature, required: / .&t- f` a Subtotal: 167.48
+ Plan review (25 /o of permit fee):
Print name: Carl Johns en at . �ie ate: 4/11/11 State surcharge (12% of permit fee): 20.10
f TOTAL PERMIT FEE: 18 7 . 58
Authorized signature: L
This permit application expires if a permit is not obtained witbia 180
Print name: Char lynn Leif f s en Date: 4 � 1 1 � 11 days after it has been accepted as complete.
,� • Number of inspections allowed per permit
51Buadisg\Pe ntibiELC- PermitApp.doc 07/01i to 440- 46151'(11/05/COM/WEB
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