Permit 9 CITY OF TIGARD ELECTRICAL PERMIT
1111111 2 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00631
T[GA.R.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/08/2011
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 320
Project: Professional Eye Subdivision: 1996 -048 PARTITION PLAT Lot: 2
Project Description: Electrical for 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 - 624 -6300
HONE: 503 - 698 -3417
FAX: 503 - 698 -2486
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 11/08/2011 $100.70
Specifics: amps or less
4 crt Branch Circuits w /Purchase 11/08/2011 $29.68
Type of Use: Service or Feeder
Class of Work: 1 ea 12% State Surcharge - 11/08/2011 $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 obtain a copy o the rules •r direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: - e-P 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.
RECEIVED
NOV 072011
Electrical Permit Application 1 -(1((H II( 1•: us (►'\
City of Tigard CITY OF T IGARD it Bad 9! �� Permit No,; j _1 ,, .
13125 SW f 9 ,4171 Blvd., Tip :50 �fG DIVISION
Phone; 503 OdxrPcrmik 2
. ,63,4171 Fax: 503.59R,19G0 /.G •
, , , , .\ i; f I Inspection Lute: 503,639.4175 Date Reedy/Hy ® See Nip 2 fir
Intsmet: www,tigard- or.gov Nettflcd/Mehod; Mil Supplemental Information
.=.,!.., e Y ; � \ ' S i .,( x... > ' a bv a;t'.°`0 r t •T{. * 'h i, r " ) : . e , ! •'•p
0 New construction ® Addition /alteration/replacement
Amami check all that apply (submit a iota of plains w /item) olleckod below):
0 �l ❑ Service or feeder 400 amps or more Q Building over three stories.
0
0 Demolition Other; where the available fault current CI Marinas and boatyards, • :; + r ;; l ? t, i 1,��x; :: ,..4,' Is :W i{ii ..;,., J t ° r rascals moon amps at 150 volts or ❑ Floating buildings. •
�'I , , ?'. �J 1 ,Wi' / J .IJ��W?>R t. M
:.,M�. ; . °'0 '.ri•J t >,
' .1,:1F Inns to gmuud, or exceeds 14,000 ❑ Ctlmweroial -use agrioulNrel
13 1- and 2- family dwelling tgi Commercial /industrial 0 Accessory building amps fur all ether lastsllationa, buildings.
❑ Multi - family 0 Master builder Other: 0 Fire pump. ['Installation of 75 KVA or
^,un','" i >'•sv + " ° ' {,y; ^ „> _ - ; ,.
' +',... nal^ � , „ lr. Y : ,.:err; ..` ❑ Emergencysystem. larger separately derived system.
r''S f, , ','•h b ,'► `1,,i,,' .iIpltu'a6m�t, * % f� I:,., ;i r ,
❑ Additionofttawmotorloadof ❑ - „ "1 -2„ "1 -3',
S 10011P or more. occupancy,
Job no.: Job site address:
1,154-0 S e true i a Pkwy ❑ Six or mom residential units. ❑ Recreational vehicle parks.
City /Stete/ZIP: ID Health.cere facilities. 0 Supply voltage for more than
❑ Hazardoes locations. 600 volts nominal.
Suite/bldg. /apt. 320 Project name: Prof essiona1 Eye ❑Service or feeder 600 amps �ormon�. ,
', l
i �;..�.,, yy ' d'�i' Cyr''
Cross street/directions to job site: Dn.r peoa 1 QV. 1,. ri., I 'rout I '
New residential single- or multi - family dwelling un
Includes attached gargle.
Subdivision: r Lot no.: 1,000 sq. ft. or less 108.54 4
La, tidd'I 500 sq. ft. or portion 33,92 - I
Tax map /parcel no Limited energy, residential
lit W a�n i , rc , :. , wq.8.) 75.00 2
„ s . 1 ° ; '' r . r 't�'VW ;>'� Via , 1 ., : .p (with above s _ -,
Llmiled energy, atilt/- family 75,00 2
Tenant improvement residential (with above eq. ft.)
Services or feeders installation, alteration, and/or relocation
' 200 amps or leas / 100.70 /0O, T!) 2
i ca ''''''''; ,' .,, a t, �' .. y r > . :', 201 amp) to 400 amp0 133.56 2
401 amps to 600 amps 200,34 2
Name:
601 amps to 1,0 nrilpa 301 04 2
Address: Over 1,000 amps or volts 552.26 w 2
City /Statc/Zlp:
Temporary s ervices or feeders installation, alteration, and/or
relocation
Phone; ( ) Fax: ( )
200 urt,ps or less 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 1611.54 - 168.s4 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per 11n cl
Owner signature: Date: A. Ilea for branch circuits with
14%:', • t , above aervion or £oodnr fee, 7 / 29
n ! .e a.. 1. tt � . f.?,au "•'• ••• circuit T 7.42 �2
v : i y ' '. each brunch
Business name: Johansen Electric B.see forbr feed einuits wtrhoar
.... service or fonder foe, first 56.I11 2
Contact name: Charlynn Le i f s en branch circuit .
- -- Each add'1 branch circuit 7.42 2
Addresg: 10948 SE Valley View Terr Miscellaneous u or feeder not included)
Each manufgetured or modular 67.84 2
City/State /ZIP: Happy Val l ey, OR 97086 dwelling, service and/or feeder
Phone: ( 503) 698-3417 I Fax; ; (503) 698-2486 Reconnect only 67.84 2
Pump or irrigation circle 67,84 2
E Sign or outline l ghting 67.84 2
^,p a, 1 1 , li e i' 'V , , I i
.; �, :, !„> , (�� w , ,, +;W' ' , .e'p� :0 � " ak;', � �,i. ' ?' . , Y , y ; si aircuit(s) or limited- energy
pan cl Nan 2
Business name: Johansen Electric 2
Each additional inspection in an over allowable in any of the abeve
Address: 10948 SE Valley View Terr Additional inspeotion(1hrmin) 66,25/hr
Valley, lnvnaiigaftou (1 hi' min) 66.25/ hr
City /State /ZIP: Happy y OR 9 7 0 8 6 Industrial plant (1 hr min) 78,18/ hr . -
Phone: (503) 698-3417 Fax: (5 0 3) 698-2486 Inspections for which no fcc is 90.00 / hr
a ecificall listed 'F, hr min
CCB Lie.: 51539 Electrical Lic.: 3-243 C Suprv. Lie: 2 0 53 S , , 0 5't"i a a >, i'
Suprv. Electrician signature, required: 944-444 '' Q 4 ! 4 .✓ 1 Su it fe e): / 3(j. 3 P1nn review (25% of perm// fat );
_
Print name: Cdr 1 J hansen 11 / 7 / 11 State surcharge (12% of permit fee); /6 . (,a
fo AL PERMIT F E E : I V 4 f , , Z e —
A u t h o r i z e d signature: 'fhb permit application tapir's If a permit is not obtained within I80
Print name: Char 1 nn Le i f sen Pate: 11/7/11 a dope L It has been accepted as complete
Number of inspections allured I parinit.
I:i Bultellaa1 'trmitANt.C-PemutApp.doc 07f01 /10 444)-w $1 (t l /09K10b!/WL'Il
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