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Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2011 -00280 1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/25/2011 TIGARD Parcel: 2S 113AA00500 Jurisdiction: Tigard Site address: 16112 SW 72ND AVE B18 Project: Encore Subdivision: OREGON BUSINESS PARK 1 Lot: Project Description: (4) branch circuits for TI Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES 10948 SE VALLEY VIEW TERR ATTN: N PIVEN HAPPY VALLEY, OR 97086 15350 SE SEQUOIA PKWY #300 PORTLAND, OR 97224 PHONE: 503 - 698 -3417 PHONE: FAX: 503 - 698 -2486 FEES Quantity Description Date Amount 4 crt Branch Circuits wo /Purchase 05/25/2011 $78.44 Specifics: Service or Feeder 1 ea 12% State Surcharge - 05/25/2011 $9.41 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $87.85 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 Or - •5 4 090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: IL Aw/-tom ` Permittee Signature: D%✓ // / l 6r-77e 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 Applic ilon Ile ` � ki 1,;()R I)FI'lt L 1 s6 O'.i. City of Tigard 2 4 2011 Received Date /B : // %_ _ Pennit No. &-2.tn2 —era ,gF / 13125 SW Hall Blvd., Tigard, OR W., Plan Review R . Phone: 503.639A171 Fax: 503 5 19 0 Date : Other Permit. T I i A R f Inspection Line: 503.639 4175 Cl Y O B F TIIGA iD Date Ready /By: See Page 2 for Internet: www.tigard or.gov BUILDING DIVISION Notified _Method: Supplemental Information v+I'WII!3 •„- , l' 'rli II14, •,, I i1 V4 `"1110 ii i- trtil•',• _ , IOi i I li . - 31, �s._u r7 t' it , .I6 d k . ,450i#3r7�, ,,:mz- . i III •i - t � h:r '.,....,.,,v/1-4,.; 3- n - W . � � t New i c onstluction 11 +1 �� Addition/alteration/replacement �� �,��Illllalbi+��?� ,;.I � ] tt�tN ,,. �; ,! <"r• ' '� �;►1t . �,,'.t ❑ ® 4 p cement Please check all that apply (submit a sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stones. [I ! Demolition .sp. pp r ,;,.d 0 Other: where the available fault current ❑ Marinas and boatyards. t[ ti }Ill Pt lri € - Ii if ,I�. i r ' ,e 111 R 9 t. r t a i 1f r. h '�.. t II exceeds 10,000 amps at 15 volts or ❑ Floating buildings. . Il�llly. ' ti� less to ground, or exceeds 14,000 ❑ Commercial•use tagnculttval ❑ 1- and 2- family dwelling © Commercial industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: El Fire pump ❑ Installation of 75 KVA or Fl.'s,""'fll,. ti;-: _ - �v ;µ�;., a „xaiaW: • _.., t„ .•'s itw I ,4s;.:=,^��� y .: l'.su ❑Emergency system. largerseparaselyrived system. _, al,,tl Il3 " Ili rli ,. - `. ;;tau it I I _r';: I a Er = ,. +, ,.,, . ' I r� It II :� ' l i�;,; �,, it�a • ,�„'�I It itzu >na ❑ Addition of new motor load of ❑ "A" "E” "1•Z" " -3" 100HP or more. occupancy. Job no.: Job site address: 16112 SW 72nd ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: ❑ Health facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Strite/bldg. /apt.no.: I Project name: Encore ServiC or feeder 600 amps or more ptii 3., r s, nt i si ii : -. I t ODPp �� ?: �. d't f : ,. - ...� r -�s�P �•'s 1x a +F�r:r�s Cross street/directions to job site: Description Qty. Fee. Total • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: 1 Lot no.: 1,000 sq. it or less 166.54 4 • Ea add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential i vs r l l 3 .r- r f -rt gr±**a 1 f pi 119 -till.' 75.00 2 `'. i It . t �_ r >w'. o1 , t ,l a it a a , 'Ii- a s (with above act ft) Limited 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 100,70 2 a r ItiPr t � r � pr 1 it I 'fr , of , -- '• / c 2 01 amps to 4 00 a mps 133.56 2 •I" : ti1A a'57 , 4 ∎,' It lii1Dl W a , , ,.. ,1 t a . a.. . 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 Temporary services or feeders installation, alteration, and /or City/State /ZIP: relocation Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1 20l 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 'N ''' fl . 1 1 `� l , '`_ above service or feeder fee, 4. ex3 e"i. - 4 .0 aim � ii � I : ., 7.42 2 each branch circuit Business name: Johansen Electric B, Fee for branch circuits without - service or feeder fee, first 1 56 18 6.18 2 Contaallame: Charlynn Leifsen branch circuit Each add'l branch circuit . 3 7.42 2.26 2 Address: 1 0948 SE Valley View Terr Miscellaneous (service or feeder not included) City /State/ZIP: Happy Valley, OR 9 7 0 8 6 Each m g, service or modular 67.84 2 ppy y r d welling , service and/or feeder Phone: ( 503) 698 -3417 Fax: : ( 5 0 3) 698 -2486 Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 Email Signor outline lighting 67.84 2 lit I, , . 5 • idlit t tied. 4// i; , - c2 a _ q " t ' ;, i st a (l.�- �� t� , i.'g'n�ffil., ._ ' ,- ,, �, -., � ;It1ti0 .. � I +�tl,, :. , ����>�� - Iii��' ., Signal eirouit(s)or limited - energy Business name: Johansen Electric panel, alteration, or extension. Page 2 I 2 Each additional inspection over allowable in any of the above Address: 10948 SE Valley View Terr Additional inspection (1 hr min) 66.25/ City/State.i"ZIP• Happy Valley, OR 97086 Investigation (I l mm) 66.25/ hr • PPY Y r Industrial plant (1 hr t hin) 78.118 / hr Phone: (503) 698-3417 Fax: ( 503) 698-2486 Inspections for which no fee is 90.00 / hr s.ecificall listed Vs hr min fr CCB L ic.: 515 3 9 Electrical Lie.: 3 - 2 4 3 C Suprv. Lie.: 2 0 5 3 S Suprv. Electrician signature, required: ,c� / / �,. e Subtotal 7 44 ' ,, ta,-/ Plan review (25 /c of permit fee). Print name: Carl Johansen 1'fte: 5/24/11 State surcharge (12% of permit fee): 9•.41 / TOTAL PERMIT FEE: 87.85 ✓ • Authorized signature: This permit application expires if a permit is not obtained within 180 Print name: Char 1 nn Leifsen Date: 5 / 2 4 / 11 dope after it l ow d p accepted as complete. y Number of inspections allowed per pent it. 1: 1Bwld .ng■errrnts■Et.C- PermitApp.doc 07/01 /It 440 - S7(1 I,'05ICOM/WEB 8 ' d XUJ 13C2I3SIa1 dH WFJ00 : 0 I I I OZ -0a ReW