Permit r 1.,
CITY OF TIGARD ELECTRICAL PERMIT
II 1 .''-- COMMUNITY DEVELOPMENT Permit #: ELC2009 -00174
Date Issued: 04/21/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S112AD01000
Jurisdiction: Tigard
Site address: 7007 SW CARDINAL LN 135
Subdivision: Lot: 0
Project: North American
Project Description: Install (12) branch circuits.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY 12 crt Branch Circuits 04/21/2009 $120.00
#300 wo /Purchase Service or
• PHONE: Feeder
1 ea 12% State Surcharge - 04/21/2009 $14.40
Contractor: Electrical
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 $134.40
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 -0100. You may obtain n a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. C �j
Issued By: c �� Q v�� ^ /�. L Permittee Signature: l� ` U(
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'N Date:
LICENSE NO.
. 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.
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City o f Tigard APR 0 200 .:.
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I Permit No.: CI . I]
13 125 SW Hall Blvd., Tigard, OR 97223 ��!• L
a ,'-,` '' ; Phone: 503.639.4171 Fax: 503.598.19 TTY OF I IGARD Plan Rev,ew Dare B : Other Permit:
I , Inspection Line: 503.639.4175 BUILDING DIVISION DateReady/By INNII la See Page 2 for
Internet: www.tigard- or,gov Notified/Method: Supplemental Information
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y ' ,? r iyj7 ,�+ } t�l$7t F "f%t' i�ty ye 1 , ( LL" �� ON 7 +c,• ®;
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❑ New construction ® Addition/alteration/replacement Please check all that apply (submit /sets of plans w/items checked below):
❑ Demolition ❑Other: ❑ Service or feeder 400 amps or more ID Building over three stones.
II,�' � � � ' `�1� '� It � � � E � m ns ai i � +:- ;sr;OSR?+ !�' ,l 3 ire e
where the available fault current ❑ Marinas and boatyards.
y I t r g. t -. ` "' *' a tV'� "[ r p . I i ii lat t' 'I* : exceeds 10 000 amps at 150 volts or ❑ Floating buildings.
1.t {t r �: tin., -3 4 s . - -.. ..-ns �Y"t " , , f#. 1 , ? , .. l ka • 3l 1. «L 4.
building less togrond, other installations 1 r3 Commercial-use agricultural
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory g amps for all other inetallatias, buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
, - li" FOIP Y N • . i - r ` ;:. , , !. ti . _ -; S1Pt %j ❑ Emergency system. larger separately '� - `!'
r 'WW iniatUn!` t i13 7 s rg' _tr i -. e �{' �-+ :., t/ : tG ately derived system.
I nt c ,�. i 1 R
rureb� - t,�.�<, , 0 of new motor load of ❑ "A" "£.^ .'1.2 •y -3••
Job no.: Job site address: 7 0 0 7 SW Cardinal Ln 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: 0 Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal,
SuitelbldgJapt no.: 13 5 f Project name: North American ❑ Service or feeder 600 amps or more.
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Cross street/directions to job site: Description I o". I I' 1' F ` . TOW 1
. New residential single- or multi- family dwelling unit
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
it i4 tz..ktr,,g Y . F r r a i, �g Ott 7� � }.,tt�,�. I .' ' 3` 75.00 2
:00„.!;',',. . 4 t i4R . '' 's.. [ t't Id ' -; .- �7Y Its, ,. d'a' 13 4' d � . id 03' x!', . 1 i ilEtlsgli t (with above 94'
Tenant Improvement Ll residentia energy, above Sq . l ft.)
75.00 2
Services or feeders installation, alteration, and /or relocation_
p �� � y t � p sal 200 amps or less 80.30 2
/� ! 1 10AU U P ,t°.,r ri ' '1 .;'A . "s lii '. '' I him' It I f I it ;t t " i tr p_ ri l ;> 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 169.60 2
601 amps to 1,000 amps 24-0.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 i 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature Date: Branch circuits - new, alteration, or extension, per panel
tit _ !;u 111�16y IpI �r , .«.i1 6at€r n a`A A. Fee for branch circuits with
� : 4 " § ` ° a: d;rAGiSidrm a N s E Ili' :- ° alt i i scan.!:,: " .: t' u r:..:. a �:;ti 4t� f above service or Seeder fee, 6.65 2
each branch circuit
Business name: Johansen Electric Inc. B. Fee for branch circuits
Contact name: Charlyna Leifsen without service or feeder fee, I 4b.85 Lit t 2
first branch circuit
Address: 10948 SE Valley View Terrace Each add'l branch circuit , (l 6.65 (7 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Happy Valley, OR 97086 Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: (503) 698 -3417 I Fax: : (503) 698 - 2486 Reconnect only 66.85 2
E -mail: johansenelect@msn.eom Pump or irrigation circle 53.40 2
-4 ., n , , a i 'l "al ,t r
€�ytt, e �,� � , "`��' � � ;, �'t rNi xizt�'�. z I its Si or outline lighting 53.40 ?
Business name: Johansen Electric Inc. Signal circuit(s) 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 any of the above
Per inspection 62.50
Phone: (503) 698 -3417 Fax: (503) 698 -2486 Investigation per hour (1 hr min) 62.50
CCB Lie.: 51539 Electrical Lic.: 3 -243C Suprv. Lie- :- 2053S Industrial plant per hour 73.75
Suprv. Electrician signature, required: CygAl ' t` ' ' gr't. -r�r+���''.,s�:1, vin a •- ( 1 1 t5 Subtotal: 1 � .
Plan review (25% of permit fee):
Print name: Carl K. Johansen Date: 4/20/09
.. State surcharge (12% of permit fee): I If .
Authorized signature: TOTAL PERMIT FEE: )54, t LIQ
This permit application expires if a permit is not obtained within 150
Print name: Charly ifsen Date: 4 / 2 0 / 0 9 days after it has been accepted as complete.
1 1Building \Permits\ELC- PamitApp.doc 05/23/06 " Number of inspection allowed per permit.
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