Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00288
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/26/2011
Parcel: 2S112DD00200
Jurisdiction: Tigard
Site address: 15862 SW 72ND AVE 100
Project: Spec Space Subdivision: PACIFIC CORPORATE CENTER Lot:
Project Description: TI
Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES LP
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
1 ea Services or Feeders - 200 05/26/2011 $100.70
Specifics: amps or less
4 crt Branch Circuits w /Purchase 05/26/2011 $29.68
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 05/26/2011 $15.65
Electrical
Type of Const:
Occupancy Grp:
Total $146.03
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 o. -,.y of - rules or direct questions to OUNC by calling 503.232.1987 or 1.800 332.2344.
dir
Issued By: _ Permittee Signature:
joy
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 Applicati _ - t(al t.,l,, lc l l S1 : t,.. , — — — —
City of Tigard Received
�
M AY 5 2 011 DateB •: I / —in Permit No
/J • 13125 SW Hall Blvd., Tigard, OR 9722 Plan Review /
Phone: 503.639.4171 Fax: 503.598. 19.60 Other Permit:
Oate
Inspection Line: 503.639.4175 C OF D TIGAR
I ! ' : A 1. 1'r I, Data Ready/By: Duns !a See Page 2 for
Internet: www.ngard- or.gov B [LING DIVISION Notified/Method: Z6 Supplenental information
EV ' : v d l t r i ifii ti9; ar t 4 1151 ;1 'i ttb y g r- �x I _ Isar mn,m
d - t' l 2 fi .,. �- a J r. H , ` e A�''fu1' i i 1( ., t a
� qi. ?u .� }rP,r .: Ei : ,i, llil , 'n� . i�i'. �liq tis�! �ri�. ��. ��1d11+ o�mu��` V�c, Luu, a�d3ra ..`.�k�i'�;Sl����'�u�.s�
❑ New construction ® Addition/ alteration /replacement Please check all that apply (submit j sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building ove - three stories.
❑ Demolition ❑ Other:
- exceeds 10,000 amps at
l�4l� ; IIOlk 111111illlil I nl B
IIORII!1I .« � fir# �ir�itusgiet �A OEM �, where the available fault current ❑Marinas and boatyards.
i 1 ; E 1 a t t D, n oL z- t 4, NE _ 150 volts or ❑ Floating buhlings.
ili,srt;- . t-i, i 1l:�h.,xlvi., x..as aR irl �litrintwlsri� 'r • 3 0' ' ,. i t -.. a ti
dwelling ® Commercial/industrial less to grow all of e installations. ons. ❑ C buildings.
cial•use agrioulturat
❑ I- and 2- family dwell
❑ Accessory building amps for all other insrallatiom. buildings.
❑ Multi - family ❑ Master builder 0 Other: ❑ Fire pump. ❑ Installation of 75 KVA or
al m �u we t :r' E imr ;r .�: ruaRex - t Sri • ° rt Y system. larger derived em.
t
ti s �J k} Er r H Hme nc s stem. er �3�'�� h l , r r ' i hip..
:tier, uu rr�€ rt' r alim ' b, ¢i..i s. htxrur3�u,:ca'tsis o1 - Whin �rrmm� �ri � ❑ Addition of new motor load of ❑ "A" "E" "1-2", "1 -3"
Job no.: Job site address: 158 6 2 SW 72nd ❑ 100 HP or more. occupancy.
Six or more residential units. ❑ Recreational vehicle parks.
City /State,2 ❑Health -care facilities. ❑ Supplyvohage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 10 0 I Project name : ❑ Senice or feeder 600 amps or more
. ��G C t� N q . r: .x Vi a,
Cross street /directions to job site: ti i " " t�� `r � , } ( i
oear
-1 A+ tion Q Pee. total •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax snap /parcel no Ea. add'l 500 sq. ft. or portion 33.92 1
Limited energy, residential
t' ]r r r �I @ �^s" "r`>+ i s n.� v �'• 75.00 2
1 + : ' � rt i � .. iif ii 1 ' B i (with above sq. R. )
`� '{ A ` I _-- .. ,. 4 ' : :: Limited energy, multi - family
with above ft. 75.00 2
r esidential
Install separate panel to vacancy ( �� )
Services or feeders installation alteration, and/or relocation
� ?� � q � 200 amps or less 1 100.70 100.7C 2
ai d/ i' i .,r ,ie . i krt"'ll � 6 wi i t r c iu 1 bu o a , .;, ` ll rJ 201 amps to 400 amps 133.56 2
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
Clty /StateiZ Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 1 59.36 1
Owner installation: This installation is being made on property 201 amps to 400 amps 125.08 2
g p perry that I own which is not 401 amps to 599
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. p amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
rrptt'bNI t „ r Y-, alf n ttg f it kµ €.; . s q t‚° t, above service or feeder fee,
each branch c i rcu it 4 742 29.68 2
Business name: Johansen Electric B. Fee for branch circuits without
service or Contact name: branch circuit
eder fee, first
56.18 2
Charlynn Leifsen
Each add' I branch circuit 7.42 2
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
City/State/ZIP: Happy Val 11 a OR 9 7 0 8 6 Each manufactured or modular 67,84 2
PPY Y t dwelling, service and/or feeder
Phone: (503)698-3417 I Fax:: (5 0 3) 698-2486 omaect only 67.84 2
E -mail:
Pump or irrigation circle 67.84 2
i s i , ! , , , , ,�„k N j Sign outline lighting _ 67.84 2
,Ilw3itili t :1 A ?t .4.0i r`k. .idrz *.e'Lw gr u"r,.» 1t �E71 #`Z11 :I1 Mr l ill:7: i
11 ) ignal Sc ireuit(s) or limited- energy
Business name: Johansen Electric panel, alteration, or extension. Paget _ 2
Each additional inspection over allowable in any of the abov
Address: 10948 SE Valley View Terr Additions] inspection (1 hr min) 66.25/hr
City /State,Z]P: Happy Valley, OR 97086 Investigation (]hrmin) 66.25/hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 698 Fax: (5 0 3) 698 8 6 Inspections for which no fee is
90.00/ hr
•ecificall listed '/: hr min
CCB Lie.: 51539 I Electrical Lie.: 3 — 243C Suprv. Lie.: 2053 S 4 k, ; '1R ""i ' x 7'; "n �`" "'y`, rif1, li
ta
Suprv. Electrician signature, required: Plan review (259'0 of permit Sub fto>ete)l: : 130.38
Print name: Carl an s e n ate: 5 / 2 5 / 11 State surcharge (12% of permit fee): 15. 5
TOTAL PERMIT FEE: 146 • 03
Authorized sign This permit application expires if a permit is not obtained within 180
Print name: Charlynn Leifsen Date: 5 / 2 5 / 11 days after it has been accepted as complete.
• Number of inspections allowed per permit.
l:1' Building \PcrmitslELC- PermitApp.doc 07 /01/10 440.4615T(11/05/COM/WEB
T'd Xd3 13CH3Sd1 dH Wd6i7:T T102 92 FeW