Permit CITY OF TIGARD ELECTRICAL PERMIT
IIII ' COMMUNITY DEVELOPMENT Permit #: ELC2011 -00690
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/07/2011
• Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 6650 SW REDWOOD LN 333
Project: Anchor Subdivision: 1996 -048 PARTITION PLAT Lot: 2
Project Description: (3) branch circuits 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
P
PHONE: 503 - 625 -6300
PHONE: 503 - 698 -3417
FAX: 503 - 698 -2486
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 12/07/2011 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/07/2011 $8.52
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 accord - . - - • 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. ATTENTI►- : Oregon =w re•uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 route OAR 952-0i1 %190. • may obtain a cop of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800. 32.2344,
/ // , &
Issued By: 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'
� � • __,r " ,i ! �a- - / <r�� 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.
Electrical Permit Application ���� IOR (11 I it •I; I Sl: ()'I.V
City of Tigard =' 6 1 Eriy' wg wemill No.: eGCADI /-' V .90
1111 .„--.. 13125 SW 11al1 Blvd,, Tigard, Ott 97223 ` ;,. - t --e°,15'
■ Phone; 503.6394171 Fog: 503,598.1960 w -.t. ► � .#1
1 i , ..\ i, t , Inspeetion Line; 503.639.4175 `�' e : ;1r .. Twin: to Sac Pip Mr
Internet: www,tigard- or.gov CO ' - Supplemental Information
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Please check all that apply (submit 2 sets of plans w/itdr is Checked below):
C] New oonsiruction ® Addition /alterationheplace' e l
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition 0 Other: where the available fault currant ❑ Marinas and hontynrda.
. ",'' ";` ,"`' '* %, 4 � g a y' , y ,, � at '�� ' ;'t . , exceeds i0000 amps N 150volts DFloatingbuildin s.
? " ��•. `r"S,o'T�; a ^° ° i Y 1 ' f;
lass to ground, or exceeds 14,000 ❑ Commercial-use agricultural
Q 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations, buildings.
❑ Multi- family ❑ Master builder ❑ Other' 0 Piro pump. ❑ installation of 75 KVA or
,17,n V-,,y ;i y' v , . y ., ” � M , I , ; , r ; z,,, ,. � . ,:, « ; 1 3 ,, C3 Eumegency ayatcm. larger aeparaiely derived system.
„ "' da. ; ; * k,_,
, t ";: , .,,,n, ., . , l D Addition of new motor load of 0 "4"
Job 610.: Job site address: 100HPor ntore, occupancy,
66 5 0 SS W Redwood ❑ Six or mere residential units, D Recreational vehicle parks.
City /State /ZIP: 0 Health - care facilities, 0 Supply voltage for more than
❑ Hazardous locations, 600 volts nominal.
Suite/bldg. /apt. no.: 333 I Project name: Anchor QEA ❑!:ervico keder600 amps or more. �y
Cross street /directions to job site: nve4ripuen f sty . Foe, Mimi
New residential single- or multi - family dwelling unit.
Includes attached garage. _
Subdivision: I Lot no.: 1,000 eq. tt, or lose 168.54 4
Ea. a 500 sq, ft. or portion 33.92 1
Tax map /parcel no.: Limitedeourgy, residential
. t r
%, r - at : 0,. " '
". °1 ', ( above eq. ft.) - 75.00 2
1..i mired energy, multi- family 75.00 2
Tenant Improvement residential (with slfove sy.ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or loss 100.70 2
l:. � ;i ' / ^,•,. ,.,,�.. .,,� �,�, , fin •,o'., .wr ,,.'y , .,
S•,:• 5 `;t .i'` , . #4*: _ 'r,,;', i'„ .,[. ,1i r;k4t '''r N•i',', , ,.i: 20l ampsto400amgs 133.56 2
Name; 401 amps to 600 amps 200.34 2
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/o
City/State/ZIP: r •
Phone: ( ) 1 Fax: ( )
200 amps or loss 5936 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 I68.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits— new, alteration, or extension, er panel
Owner signature: Date: A. Pee for branch circuita with
` r • dt �il Ik 1' s " z f, above service or fee fox, 7.42 2
•.t ' tech branch circuit
Business name: Johansen Electric B. Pao for branch circuits without
. service or feeder fad, first 1 56.18 6. 2
Contact name; Cha r l ynn Tae i f s en branch circuit
Each add') branch ciruust 2 7.42 14 • 8 2
Address; 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City /State/ZIP: Happy Vail ey , OR 97086 dwelling, service wed /or feeder ,
Phone: ( 503) 698 -3417 Fax: : (503) 698 -2486 Reconnect only 67.54 _ 2
Pump or irrigation circle 67.84 2
E-mail; n 6 114 2
....... ...:. ,
a \ ,, �� �' *"'7� • ; 5igsi +i lighting 7
• . ,.. i:i„ ,' • 1 ., . • ,. k.'•,' =" + .• .;61 r 4' 1 l , ., .vim: Si eircuit(s) or limited - energy
Business Warne: �70haris exa Electric panel, alteration, or extension. , Pane 2 2
Each additional inspection over allowable in any of the abov
Address: 10948 SE Valley View Terr Additional inspection (I hr min) 66.25/ hr
investigation (I hr min) 66,25/ hr
City/State /ZIP: Happy Valley, OR 97086 Indurtri4l plant (I hr inn) 78.18 / hr
Phone: (503) 698-3417 Fax: (5 0 3) 6 9 8 - 2 4 8 6 lnspeottons for which no feels III 90 00/ hr lin
a ecificall listed 'S he min
CCB Lie.: 51539 Electrical Lic.; 3-243 C Suprv. Lic.: 2 0 53 8 ',',•epti °;aaw_"?[;'1°_"y"'1' ,,;;
Suprv. Electrician signature, required: ` Subtotal; 7
1 .", i 0 �L� � 1 Plan review (25% of permit fee):
ttu
Prin name' Carl J n [ � haneen late: 12/6/11 State surcharge(12% permit fee), 8 , 52
/ // TOTAL PERMIT FEE: 7 9. 5 4 1
Authorized sigttatunl: ' //�
ff SS Tfila parmll apphcaflan expires if a permit Is not obtained within 150
name: Char 1 nn Le i f s en Date: 12/6/11 dap after it lras Wen accepted as complete. Print name:
N umber of inspections allowed per pnmlit.
Pt iuuildingl Pcrmits\ELC- PormilApp.dna 07101/10 440.4615T(11/05 /COMAVRA
9 /E 'aDVd 98VZ869E05 98tZ869C09 ZOH'Ia NHSNVHOL'INId Z':EO TTOZ'90'e90