Permit CITY OF TIGARD ELECTRICAL PERMIT
• - COMMUNITY DEVELOPMENT Permit #: ELC2011 -00371
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/06/2011
Parcel: 2S112DA00800
Jurisdiction: Tigard
Site address: 15115 SW SEQUOIA PKWY 170
Project: Spec Space Subdivision: Lot:
Project Description: TI
Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES
10948 SE VALLEY VIEW TERR ATTN: N PIVEN
HAPPY VALLEY, OR 97086 15350 SW 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 07/06/2011 $100.70
Specifics: amps or less
8 crt Branch Circuits w /Purchase 07/06/2011 $59.36
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 07/06/2011 $19.21
Electrical
Type of Const:
Occupancy Grp:
Total $179.27
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 O • r 2- 001 -0090. You may o. • - - • , of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
EIP 11P
Issued By: / /�L. _ a 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 Application 05 ) r•OR Or i si.: ON 1,1
Cit of Ti and Received ,
Y (d.) �-. Datc/13. ,(/
13125 SW Hall Blvd., Tigard, OR 97 l
a ' Those: 503.639.4171 1ux: 503.598. 1. t Z� ,• s Other permit
1 I (,.', r 1 , ltmpcction i.inc: 503,639.4175 v a :, .. , .urn: 0 See Peg! 2 for
Internet: www.tigard or.gov ,v .%G t • •'' • air , Supplemental information
' .('':' , 'I''.' . - . , .. .' �tv . �'i n�/. • ��1, '1
❑ i. New C0118truCtiOn ®Addition /Alteration /reptgC Please cheek all Ch apply (atrbmit a sets of pens ,v/items checked below)T
❑ Service or leader 400 leaps or more 0 ilai Wing over three stories.
❑ Demolition ❑ Other: # where the available (huh current ❑ Marinas and boalyarde.
'!::� w.:',:;:. a: -s ✓c "a;:;a y :i , .n : amps Hooting -.; , .' , ;' ;';i` : '. ' exceeds 10.000 n at 150 volts or }' li ngbuildings.
1# >�1" iQ ;4" 11w ' `'' S . .: . . ' .:::.i... use agricultural
•- °• < :, ' - ' ' ' '` ' :: ' s
loss to ground, oroxooeda14,000 ❑Cmnmca�ciel• Commercial-use It
:
❑ 1- and 2- family dwelling El Commercial /industrial ❑ Accessory building amps for all other installations, buildings.
❑ Multi -fam ily El Master builder ❑ Other: 0 Fire pump, ❑ Installation of 73 KVA or
j , r�r:� .[ 0 Emergency system. larger separately derived system.
,. , JOB"'> B l A$ 1i1ATfo Al Jii it0 r `. ., , 0 Addition ofnew motor load of C7 "A "1:" ' .. I.3•',
Job no.: Job site address: Si o morn. occupancy.
� .J S IC) u ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardone loonti aa>t. 600 volts nominal,
Suite/bldg. /apt,no,: , Project name: U Service or ibeder 600 stops <it more.
Cross street/directions to job site: * Drsrclptton
Y.r 1 Qty. )" Pee. I Total ,I ,
New residential single- or multi - family dwelling unit.
includes attached garage,
Subdivision: I Lot no, ; 1,000 sq. 0. or loss 168,54 4
Eat. udd'l $00 sq. rt. or portion 33.92 I
Tax map /parcel no.:
Limited energy. residential 75,00 2
''i DESC',` 'Kbif : ;: COXl.: :72: (with ubuvu 1141.111) S J ace Improvement Limited energy, multifamily 75 00 2
p p merit residential (with above sq, ft.)
Services or feeders Inatalletton and /or relocation
yyam..,r 200 amps or less � ; 100.70 ( 10 2
" SWJ= 1!1etk!11iC'Y':''0.1Fh' :. 0:'T „ 201 amps m400amps 133.36 2
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 3 2
Cify/SlalclZlP: Temporary services or feeders installation, alteration, and/o
relocation
Phone: ( ) I Fax: ( ) 200 amps or Ices _ 59.36 1
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 168s4 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 brunch circuits with
above service or feeder fee, 42 2
*o , .. .,..1.,:..;,::i
J'!'1r each hrwtch eirouil <6 7 "1
Business nan10; 1), Foe for branch circuits without
Johansen Electric .. service or feeder fee, frst
Contact name: brunch oircuit 50'18 2
Charlynn Leifsen
- -- Each ndd'l branch circuit 7.42 2
Address: 10948 SE Valley View 're rr Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City/State/ZIP: Happy Valley , OR 97086 dwelling, service and /or feeder
Phone: (5 0 3) 698-3417 Fax:: (5 0 3) 698-2486 Reconinect only 67,84 2
- - Pumper irrigation circle 67.84 2
E Si oroutlineli lighting 67.84 2
or..r ��pp Sign 8 8 -
r'a � ..'., ,. „ _ ..:... !1�14�"Y'b. Y • .. ..�''� ,. .. , . Sigaal circttit(s)or limited-energy
panel, alteration, or extension. _ Page 2 2
Business name: Johansen E lectric
— _ ____ .. Each additional Inspection over allowable In any of the above
Address: 10948 SE Valley View Terr Additional inspection (1 hr min) 66,25/ hr
lnvesligeliun (I hr min) 66.25/ hr
City /State/ZIP: Happy Valley, OR 97086 ' Industrial plant (1 hr min) _ 7$.t10 hr
Phone: (503) 698-3417 I Fax: ( 503) 698-2486 Inspections for which no fee is 90.00/ hr
speciliwll , listed ('n hr min)
,�.i r
CCB Lic.: 51539 Electrical �Liiee �3 Suprv, Lie,: 2 0 5 3 S .. . . ":K::': , �; '&,G'ttiCA PERI F E$ _ 5 t = r . (' : :
•:f: , " ':<
Suprv. Electrician signature, required:C.C,�/4,G X ✓ e Subtotal: ] (p6. U�
Plan review (25 /c of permit fee):
Print name: Carl Johansen Date: 7/5/11 State surcharge (12% of permit fee): /q . a/
TOTAL PERMrr FHE: ! "1":24r 11 -1. 2 -77
Authorized signature. This penrdt application aspires if a penult is not obliged widths 180
Print name: Charlynn Le i f sen Dec 7/5/11 days after ites has been accepted as complete.
+ Number of inspections allowed Per permit.
0,
I : \Ruildina'Permns1.7.0 PermitApp.doe 07 /0l /l0 440.4615T(11 its/cum/min
b /E • HDVd 98I7Z869E09 986Z869E09 SOaria NHSNVHOf rya 8Z:E0 TTOZ•5O•Tnr