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Permit CITY OF TIGARD ELECTRICAL PERMIT 11 ,Y - - - COMMUNITY DEVELOPMENT Permit #: ELC2011 -00629 TIGARD 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 350 Project: Cornett PC Subdivision: 1996 -048 PARTITION PLAT Lot: 2 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: 503 - 624 -6300 FAX: 503 - 698 -2486 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 11/08/2011 $100.70 Specifics: amps or less 1 ea 12% State Surcharge - 11/08/2011 $21.50 Type of Use: COM Electrical Class of Work: ALT 4 crt Branch Circuits w /Purchase 11/08/2011 $29.68 Service or Feeder Type of Const: 0 ea 12% State Surcharge - 11/08/2011 $ -5.85 Occupancy Grp: Electrical 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 ado•ted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through O' ' '52- 001 -0090. You may obtain a copy oft • es or dire t questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: OSP 1_ 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 .Electrical Permit Application NOV 0 7 2011 FoR (IPf ICt: t SI 0 \I.\ vs City of Tigard .ma=r — r , imir 13125 SW Hall Blvd., Tigard, OR 972ITY OF TIGARD © Phone: 503,639,4171 Fax: 503.5Stt1.t DINGDIVISIO f , I , 1 , Inspection Line: 503.639,4175 [� 11 Dale Ready /By: BM n See Page 2 for Internet: www.tiguni- ur.giw �y �.l ' .�'i• � 7,Q Notified/Method: yy�� air'/ I+ Supplemental !• .; .'', � �l.( d7 :, 1 . ;yf, ' ,;' *, v i , ' ` ,,:� } rt'`� a' + Ir '' ,., ia 5l „ ''.. H 4i '.d . :n'. r W '1 ❑ New construction E Addition /alteration /replacement Please check all that apply (submit 2 seta of plans w /items chocked below): 0 Scrvion or tender 400 amps or more Q Building over three stories. ❑ Demolition ❑ Other: whom the available fault current ❑ Marinas and boatyards, ;; n c j ;:. y:, yY :, , ;, , •!- r r, ,p , a: i J ds 10,0 m at ❑Feasting buildin ,> 'r r i :r (��� t ;. �. + t ' • leas excee to g roun 00 d, or a Ps exceeds 14150 ,009 veils or 0 C.ommoroial - use sg rioultural ❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings, 0 Multi family ❑ Master builder ❑ Other; ❑ Piro pump, G,] installation of 75 KVA or µ �y� .�moa�w+.� 0 I;iner s larger separately derived zYsusan. '� . ' � F W1* trs� � ' ' u � t ' [ M;wi ; �1� 'i ° ° " ! :, ❑ Additiat of new motor loud of ❑ "A", "E” "I -2" "1.3" • 100HP or morn, oncupaaey. Job no.: Job site address: 1 SW Se. o± a Pkw ❑ Six or more residential units. 0 Recreational vehicle parks. ❑ Health -sore fiteilitlee, 0 Supply voltage for more than ❑Hazardous locations, 600 volts nominal. Suite/bldg. /apt. no.; 350 Project name; Corne t ❑ Service or feeder 600 am •a or more. / A ' c ,' , i ' j �nw ..i° A"'l !' ti;, - Cross street/directions to job site: nncription Qty. Pea rata/ " New residential single- or multi - family dwelling unit. Includes attached g ara g e. Subdivision: Lot no.; 1,000 sq. n. „r less J 168.54 4 Ea, add'1500 aq, ft, or portion 33.92 1 Tax map /parcel no Li mited energy, res idential 75,00 2 :'. .:.'.'r.::%'''•!a; r (with above sq, ft) — . Limited energy,multi- family, 75.00 2 Tenant im • rov ement residential (w above aq. n.) __ Services or feeders lnstalatlon „alteration, and /or relocation 200 amps or less / 100.70 /00,7Q 2 rl, y >Pf :i e. ° e t, ii 1. N ,A 201 amps to 400 amps 133,56 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 552.26 2 Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) 200 am or lass T 59.36 1 201 amps to 400 amps 125.08 I 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended tot' sale, lease, rent, or exchange, according to OILS 447, 449, 670, and 701. Branch circuits — new, alteration, or extension, eorpanel Owner signature' Date: A. Fee for branch circuits with ' �p hn soro or f ader foe, [/ ;'. ' `w :' ,, i ' ' a , 1'` ',0 . ' : , ,'Ii' `,4 1 . u ^ . u each va branch vic circuit 7 7A2 /, 4, 2 Busincssname: Johansen Electric B. Pee for bratlohoirouitswtrlratu service or feeder foe, first 56,18 2 Contact name: Charlynn Leifsen branch circuit Each add'! branch circuit 7.42 2 Address: 10948 SE Valley View Terr Miaceilaneous (service or feeder not included) Ruch manufactured or modular 67.84 2 City /Slate/ZIP: Happy Valley, OR 97086 _ dwelling, service and /or feeder Phone: ( 5 0 3) 698 -3 417 'Fax:: (503) 698-2486 Reconnect only 67.84 . 2 Pump or irrigation circle 67.84 2 { Sign or outline lighting few 67.84 2 r Y',,!,,.., ,../y' '' .t`1,.: >':ffllt, : ? .. '. r ... Signal circuit(s) or ljmited.enory Business name: Johansen Electric panel, a ire cnaion, Pagan 2 Each addlttanal ►napeatien over allowable in any of the abov Address: 10948 SE Valle View Terr Additional inspection (1 66.25/ Investigation (1 hr min) 66.25/ hr City /State /ZIP: Ha .py Vall OR 97086 Industrial plant(i hr rein) ',Sill/ hr Phone: (503) 698 - 3 417 Fax: (5 0 3) 698-2486 In spactirme for which no fee is 90,00/ hr sic cifcally mated 1 hr min CCB Lie.; 51539 Electrical Lie,: 3 -243C Suprv. tic,; 2053 S ,' , . • 'r �•y're^t a Plan review Subtotal: Suprv. Electrician signature, required: . _ / n permit fcc): Subtotal: / 0 , � , ,, . / , Z , , � ,, i cw ( of pann Print name: Car 30_ en ; State surcharge (12% of permit fee): (S.4 ,„1” TOTAL PERMIT FLeEl / Yo 0.3 Authorized signature: ' 1'ids permit application expires If a permit la not obtained within 150 days tier It has been Print name: Charlynn Leifsen Date: 11/7/11 accepted as complete. "Number of itlspooti0tls allowed per r permit. 1.1Duildit0WOrnutokcLC- PormitApp doe 07 /01!10 440- 4615T(11/OS/COM/W0f 9 /9 - aDVa 98t7Z869609 98bZ869C09 LOHZE NaSNVHO2 Nd 8Z:170 TTOZ'LO'noN