Permit CITY OF TIGARD ELECTRICAL PERMIT
11 11 II COMMUNITY DEVELOPMENT Permit# ELC2011 -00603
Date Issued 10/28/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 2S113AA00400
Jurisdiction Tigard
Site address 16240 SW 72ND AVE B2
Project Production Tools Subdivision ROSEWOOD ACRE TRACTS Lot C
Project Description (1) branch circuit for grinder
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
1 crt Branch Circuits wo /Purchase 10/28/2011 $56 18
Specifics. Service or Feeder
1 ea 12% State Surcharge - 10/28/2011 $6 74
Type of Use COM Electrical
Class of Work ALT
Type of Const
Occupancy Grp
Total $62 92
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 obtain a co• of the or hest questions to OUNC by calling 503 232 1987 or 1 800 332 2344
Issued B• Perm ittee Signature
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
RECEIVED
Electrical Permit Application ° 2 6 2011 UM OH f b I NEAI'I.V
City of Tigard "s,
13125 SW Nan Blvd ga
Ili
d , t ird, OR y OF TIGARD
i II
Phone. 503.639,4171 Fax 50130 G DIVISION Other
' 1 t l 4 s it I 1 Inspection L. 503 639 4175 B v IN Mtn Ready My r" iv 91 See Page 2 for
- Internet wwss gnn,n'
Irl- goy Notified/Method p ,Supplemental Information
,i rPP:,Q
nab; check all that apply (aubmui 2 sets of plans w /Gems checked below),
❑ Nev, construction ®A ddmm�lalteraftott/roplaecmatf 0 Service or theder 400 amps or more ❑ Building over throe atones.
❑ Demolition 0 Other. whore Ma mumble WE eirren't ❑ Marinas and boatyards
r eAriexari Or, CON9'C9'UC17QN: . i „ ” exceeds 10,000 ampa at 150 volts or ❑ Floanng buildings
le.s to ground, or mead, 14,1(x1 ❑ Lommerelal.we agricultural
❑ 1- and 2-fancily dwelling iii Conuuercial /industrial ❑ Accessory budding mapi for all omur msiallarinn buildings
❑ Multi- Family ❑ Master budder fl Other. 0 lora pump ❑ amtallanoaet 7510,A or
,`�ob'6XT�' Il'>YiFAI{hMAPI(1N ANTL ;'L'ITCA`I'ION ' . ❑ Fmerannc larger E 1-2 derived system
r r „
�:'''�' ;, ''• „'^ ❑nddinnnnfndw mahu loednf ❑ °Ae 1 g °'1- 2 „ "1 -3•
16011P or more oeeupnmy
Six or
Job no' Job site address' 16240 SW 72nd atom reerdenlral units Q Recreational vehicle perk.
City /State /TIP Q lloalth.cvo ihcdltica ❑ Supply voltage for more than
0 Hazardous locations 600 volts nominal
Suite/bide /apt no J Pioject name' Production Tool 0 Service or loader ens amts or mere
NEC sc#/ TIC' , '' , s., ',
Cross street/directions to Job site � ° I en: I +'K I raw L'
New roudcntfal single- or multi-family dwelling malt.
Includer attached garage
Subdivision Lot nail 1.000 sq tt or less 16854 4
Tax neap /parcel Ito,.
Ca add'I 500 aq ft or portion y 33 92 1
Limited energy, rtmdentlal 75 00 2
,,, 'oHSCAgTYON,00 WoRic ` ' (with shove aq R)
Limited energy, multi- family 75 CO 2
Grinder residential (with above aS fl,)
Services or feeders Installation, alteration, and /nr ieloratlon
200 amps orlasb 10070 2
C,1.iROCiai *mutt I �'' ,'1. CI tENAtrr'' 201aimpamaoaamps uvd 2
e 401 amps to 600 amps 20034 2
Name
601 amps to 1,000 amps 901 04 2
Address Over 1 000 amps or volts 55226 2
Clly /$tateJZIP' Temporary services or feeders Installation, alteration, and/or
relocation
Phone' ( ) Fax ( ) 206 amp, or la.s 59 36 1
Owner installation: This installation is being made on property that I own winch is not 201 amps to 400 amps Izs 65 1 2
intended for sale, lease, rent, or exchange according to ORS 447, 449, 670, and 701
401 amps to 599 amps 1614,54 2
Breach tlreuib new, alteration, or extension, p er panel ,
Owner signature _ Date' _ A. 1 co for breach cirumte with
' N 4F1+Y ICANT , ' `' I [rl' coNTA - � • •bove'newer or feeder too 7 42 2
each brunch omit
Bnautcss nflntc' JO)'1ans en Electric 13 Poo for hnmch circuits without
servtu or feeder fat, first 1 5415 6 , 18 2
Con10e1 name. Charlynn Leif sen bnmohomoil
Lach add'I branch mrvuil 7 42 2
Address 10948 SE Valley View Tarr Miscellaneous (service or feeder not Winded)
City /Statc/ZIP Happy Valley, OR 97086 P-ach s erv nncd ofmfeder 5784 2
PPY Yr dwelPnx.s a., aodnrrn.,der
Phone (503) 698 -3417 Fax (503) 698 -2486 Reconnect only 67.134 2
Pump or irrigation circle 67 R4 2
E -mail'
Sign or outline lighting 67 84 2
.r y _ °'C0N�'*.d.yt..u. • Signal wmvn(.)orlimilal.nnergy
panel, alteration, or extension Page 2 2
Busuress Ban +c Johansen Electric
Each additional tmpechon over allowable in any of the above
Address 10948 SE Valley View Terr Additional inspection ( l he min) 66.25 /hr
City /State/ZIP Happy Valley, OR 97086 investigation (t hr hi m) 7515 /hr
industrial pinni(1 hr nun) 75 18/ hr
Phone. (503) 698 -3417 Ft.( 503) 698 -2486 (nspecbnns for which no fen it 0000 /hr
specifically listed ('A hr min)
CCB Lie . 5153 9 Electrical Lie 3-243C Suprv. Lc 2053S " '' , tLtCt*ICAL,,PCR ! F$ ',.'
Supry Electrician signature, required
Suhbrwl 56.18
,, �7 Plan review (25% of person tee).
Print name' Carl r7 h /��{MAFagP6rd.II.&(,1'1 timte +waharga(12v of penult feet) 6.7
Authorized StEitturc / �_,J�"�JJ�4 TOTAL PiRMITFI?l;. 62 92
l./ fats penult tope/Mon expires If a penult b not obtained within 180
do} afterlt Print nape Charlynn Leifsen Date 10/26/11 • mycelium Men a innit. as complete.
• Number of mepecimns allowed per permit.
I WntdatzWennitaW 0 I'rrmOrr doe 07101116 4411 4615701 /05/COMMBLI
Z /T - 3DVd 986Z869£05 986Z869£05 SDE'fl N'3SNVHOP Kd 83 :T0 TTO3'93'700