Permit 1 1—
ky
.,.� - CITY OF TIGARD ELECTRICAL PERMIT
- COMMUNITY DEVELOPMENT Permit #: ELC2009 -00547
Date Issued: 10/15/2009
T1G.ARU 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S1046607900
Jurisdiction: Tigard
Site address: 14350 SW BARROWS RD 004
Subdivision: RUSSELL'S SCHOLLS FERRY SUB Lot: 2
Project: Barrows Dental
Project Description: (2) branch circuits to connect dental equipment. (Connection only)
Owner: FEES
NEW ALBERTSON'S INC Quantity Description Date Amount
ATTN: 70428 - CORPORATE TAX, PO BOX 20,
250 PARKCENTER BLVD 2 crt Branch Circuits 10/15/2009 $63.60
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 10/15/2009 $7.63
Electrical
Contractor:
JOHANSEN ELECTRIC INC
10984 SE VALLEY VIEW TERR
HAPPY VALLEY, OR 97086
PHONE: 503 - 698 -3417
FAX: 503- 698 -2486
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $71.23
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. ATTEN . • -.•1 law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952 - 001 -00 r through OAR 95 401 -0100. p ma obtain a copy of the rules or direct questions to OUNC by calling I .. • 6.6699 or 1.800.332.2344.
Issue. By: �cl� 1 �_���' Permittee Signature. ` 0.:2!- '!IPS/
•
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: ��
i
LICENSE NO. 3 S
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
? ti
•
RECEIVE-1
Electrical Permit Application volt (Sf I l( I: l :I - . ON I. \.
City of Ti and 0 C T 13 2009 Received
City g DareB /0 L 709 AS Permit No.: E ke, dQ , �54
13125 Sw Hall Blvd., Tigard, OR 97223
Plan Review
' Phone: 503 639.4171 Fax: 503.598.1960 CITY OF TIGAR 11 DateB ^ Other Permit:
'i 1, - , , t,., Inspection Line: 503.639.4175 BUILDI DIVISI N a te Ready ey: El See Page 2 for
Internet: www.tigard or.gov aled,Method. Supplemental Information
RR � _ ^�� +any ��1� t �,pf
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❑ New construction :4°7 ddition/alteraiion/replacement Please "hr Please ohonk all thatapply (submit1, setsofplansw /items checked below)!
❑ ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition Other:
where the available fault current ❑ Marinas and boatyards,
! 1 ' 1,071 ,i ��' 3 t s, 3,t exceeds 10 000 amps at 150 volts or Floating
VIM.,, nit., 1.4' Ci,e °.k): w E tiWaa ., - 1 , P %Li " s s ) P 0 ball dirge.
building less to ground,
other or exceeds 14,000 n. CI conrnercial•use agricultural l- and 2- family dwelling Commercial /industrial ❑ Accessory g amps for all other installations. buildings.
❑ Multi- family Master builder ❑ Other: ❑ Fire pump. ❑ Installation of75 KVA or
! F + __ i w i , 1 t . , 1 t... j 9 r 1 l ui 7..t E i O :tn c ! i . ` -'• : ❑ Emergoncy system. larger separately derived system.
,
2 1 riatnet i' ::01. a t"41, +fit!_ aai Ht ❑ Addition of new motor load of ❑ "A" "E","1-2", y "1-3", y
fob no.: Job site address: 15I '' I
. 1 I / 100HP or moro, wt occupancy.
❑
..0 0 ' ❑ Six or more residential units. Recreational vehicle parks.
City /State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ HarBdous locations 600 volts nominaL
Suite/bldg. /apt.no.: my I Project name: 09 'O S 1 7I I ❑ Sernce orfeeder600
t s. _ a ' 1 W z c
:h.LaRt*
Cross street/directions to job site: '� a: ' � €''�' t .: �~ a . � � � �'� `l � •�
Description Orr. Fee. Total •
New residential single- or multi -family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Tax ma / Ea. add'I 500 sq. ft. or portion 33.92 1
p parcel no :
Ilk i J�1° s�'na ° A x l*s� 1 I , ,I 11 ., ` filar Limited energy, residential 67.84 2
ice- :` o + . etal".a nla erh{ "Cr !95 °', L'' 1L. I I,.Wry with abo 4.
ti 4I1.C4 desk• -i;j e i' nAL41 -I y " y�
Limited residential ( th above s multi-family 67.84 2
%,� � � (Jinn 0 (V Lam/ I . residential (with above sq. t3.)
( Services or feeders installation, alteration, and/or relocation
t P ., a �ry�9 1,g r 200 amps or less 100.70 2
' ° in ; :, 4 , /f 1V,1 - $ al 6:; :3. ,: 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address:
601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
I relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits— new, alteration, or extension, per panel
T A aria° AIM u�u :• u,l „ n - , A. Fee for branch circuits with
. I °, ll ' ' sa } 1B as§9 t' I' `"` 1 l r above service or feeder fee,
each branch circuit 7'42 2
Business name: Johansen Electric Inc B. Fee for branch circuits
Contact name: Charlynn Leifsen without service or feeder fee, 56.18 2
first branch circuit r �fo lg
Address: l0948 SE Valley View Terrace Each add'I branch circuit I 7.42 "1,42. 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Happy Valley, OR 97086 Each manufactured or modular 67.84 2
dwelling. service and/or feeder
Phone: (503) 698 -3417 Fax: : (503) 698 -2486 Reconnect only 67.84 2
E -mail: Pump or Irrigation circle 67.84 2
re° �,.r r
I , ..0 N / F ,+s r�"$ r e,' ; ,, . 1 : ; 1tl1ircr + IL!"-; Sign or outline lighting 67.84 2
Business name: Johansen Electric Inc Signal circuits) or limited -
energy panel, alteration, or
Address: 10948 SE Valley View Terrace extension. Describe: Page 2 2
City /State/ZIP: Happy Valley, OR 97086 Each additional inspection over allowable in an of the above
Phone: (503) 698 -3417 Per inspection 66 25
( ) I Fax: (503) 698 -2486 Investigation per hour (1 hr min) 66.25
CCB Lic.: 51539 I Electrical Lie.: 3 -243C Suprv. Lie.: 2053S Industrial plant per hour 78.18
Suprv. Electrician signature, require ti b Subtotal: (, 4,p
Print name: Carl Johansen Date: L0,112,109 1 � Plan review (25% of permit fee):
l 1 State surcharge (12% of permit fee): 7�'7 4,3
Authorized signature: TOTAL PERMIT FEE: "1 i , 23
nc1 This permit application expires if a permit is not obtained within 180
Print name: Charlynn Leifsen Date:
S �I�r J 1 days after it has been accepted as complete.
" Number of inspections allowed per permit.
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