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Permit CITY OF TIGARD ELECTRICAL PERMIT `F - 11 1 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00700 Date Issued: 12/14/2011 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S113AC00103 Jurisdiction: Tigard Site address: 7204 SW DURHAM RD 300 Project: Consumer Cellular Subdivision: COUNCIL VIEW ACRES (LOTS 21 -44) Lot: 25 -27,2: Project Description: Remodel of restrooms. 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 6 crt Branch Circuits wo /Purchase 12/14/2011 $93.28 Specifics: Service or Feeder 1 ea 12% State Surcharge - 12/14/2011 $11.19 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $104.47 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 OA -001-0090. You may obtain a copy of the - • • ect questions to OUNC by calling 503.232.1987 or 1.800.332.2344. _ 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' 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. leet� river al Pmit .Application . E . � �� l t1R r)1 1 I F 1 St: lr�,l.� City of Tigard qq Received ✓ ' r1 Q�` / Pmmil Nn.: 1 '-ez 7 w 13125 sw Hell Blvd., Tigard, OR 9 223 l a P hone: 503,639.4171 Fax: 503.598.1960 \ � PR� s It f , , ,\ r i ) Inspection Line• 503.639.4175 �r �151� ® R l g m e . 2 1 nfurmMbn I I ntemet w ww ttgard or gov PP e,2t: g', . ,, ,,, l i •4 v` ' .. ,'dt,f ? ,i , (r� F {�r.�, I F, 'i a k,r v, r , � ., i�[�� , . '6 i t:,..�,F', `�,J �F „�2 t„ ,. .. ;i'v � ! y . 1. ,./.,',16 kit.* , 1,. { i;l. ` Please cheek all that apply (sub 2, s ets o pl ans Wheels °hac below). ❑ Now construction I Addition /alteratit 1 re accmcnt 0 Service or feeder 400 amps or mma ❑ Building over three stories. El Demolition ❑ Other: where the available knit current 0 Marinas and boatyards, ;.' : < .r „ g ta u,,' ,` ehi � . , ': ;r_ai ±.::, '`,`t! ; . " "' "=�* exceeds 10,000 amps at 150 volts or ❑ Floating buildings, "''z h t: ,• _ ] I x ' ,', t r ' k , i ,` a 7, ^ -lf'n ' ,e�h+ r,y,,; .•� ' n ' , ,- � ��•� • ,, . '^ '' ° '�" ` 1 ' � , loss to an)u »d, or exceeds 14,000 0 Commercial -use agricultural © 1- and 2- family dwelling ® Commercial /industrial El Accossory building amps fir all other installations. buildings. ❑ Multi family 0 Master builder ❑ Other ❑ Pita pump, d installation of 75 KVA or .'t,tt,; ? v ' ;: / 9', " iL 14 " $ ba , a :AA a ss 0. ; "t i' r ` ditl n of new load of 0 system. 1 A", "separately I „ 1r3 , um. ' 0 Ad system. 100HP or more, occupancy, Job no.. Job site address: 7 2 0 4 S W Durham Cl six or more residential units, ❑ Recreational vehicle parks. Oily / Stale/ZIP: ❑ Ilealth.carc facilitics. ❑ Supply voltage for more than 0 Hazardous locations. 600 volts nominal, Suite/bldg. /apt.no.; 300 I Project mane; Consumer Cellular 0 Sorvt00 0r feeder 600 amps ormore, '.?I. i 11 :,'�7 a "ri:':: m ::C ,'CC i,, yi"y , ti . :4,5! ,/. Cross street/directions to job site: Deer ' x , QC .I lke. j Total ) i.1 Now residential single- or multi - family dwelling unit. includes attached garage. W Subdivision: l Lot no.: 1.000 sq, it, or loss 16834 4 Ea. add'I 500 sq. ft. or portion 33.92 Tax map /parcel no.: limited energy, residential 5 '"y", : .4. :,!; , .r . i : :: ayi; ,:.4.,,.; ' .' '' wit above a4. it 7 2 Li mited energy, multi- family 75.00 2 Remodel of restrooms residential (with above sq, n,) services or feeders installation alteration, and /or relocation _ 200 amps or loss '1 100.70 2 • y a ,' 118 6* av "" } A 'n , ', "a j a b ' , . ' : t 1 i 1', '• „ ■' 1�, Iq , 201 amps to 400 snaps Lai,56 2 401 amps t0600 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 anatallation, alteration, and/or City /State/ZIP: relocation . Phone; ( ) Fax: ( ) 200 amps or lass F 59.3 I Owner installation: This installation is being made on property that I own which is not 20 amps ro 400 amps I 125,08 2 intended for sale, lease, tent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Branch circuits - new, alteration, or extension, per panel Owner signature: Date: A. pee for branch circuits with 41' 'l ;:r S' 1:08.0&I'1'. , :P „ c q !,, ; ., , m ' "' . r ',, _,; i :4 ,5 , above service or feeder fee, , . .'rl'- , " , ', , I. , t . ! U ` ' . c. . , each b ranch Circuit Z42 2 $usinesa name: Johansen Electric B Fee rviee brunch f s la r circuits tirm host aerv,Ce or feeder fee: tint 1 56.18 5 6.18 2 Contact name: Charlynn Le i f s en branch cirouil Each add'I branch circuit 1 5 7.42 3 7. 1 2 Address: 10 94 8 SE Valley View Terr Miscellaneous (service or feeder not Included) ach tnanu fact' rod or modular 67 84 2 City/Stew/ZIP! Happy valley l ey , OR 9 7 0 8 6 dwellintt ondfor feeder Phone; (5 0 3) 6 9 8 - 3 417 Pax; : (5 0 3) 698 -2 4 8 6 Reconnect only 67.84 2 m------ - Pump or irrigation oirolo 67.84 2 E -mail h Sign or outline lighting 67.84 2 . 4 0. r..,, t t r .g: e, r ' . ,S . I , ' , , „ '','.':, „ { : . 3igpal cireuit(s) or limited energy .anal alteration, or extension. Pa_o2 2 $usinessnume: Johansen Electric Each additional inspection over allowable in any tattle above Address: 10948 SE Valley View Terr Additional inspection (lhrmia) 66.25/lir Valley, a OR 9 7 0 8 6 investigation (1 hr min) 66.251 hr City /State /ZIP: Ha V y y' Industrial plant (l hr mitt) 78.18/ hr Phone: (5 0 3) 698 - 3 417 Fax: ( 503) 698-2486 Inspections for which no fee is 90,00 / hr a eciftcail listed 14 hr mm CCB Lie ; 515 3 9 Electrical Lie.: 3 - 2 4 3 C Suprv. Lie.: 2053 S ;Ic” ''.... ` >t ' i , iii iF"!'i l "` '`' ; , Subtotal: - . 2 8 Suprv. Electrician signature, requir �✓ .„,R „ef a? -4ti/ - Plan review (25% of permit fee): Print mine: Carl J hen e'en Date; 12/13 /11 State surcharge (12% of permit fee): 11 . 19 Authorized signature: - '" ^ TOTAL PERMIT h'h lt: 104 . 4 ' This permit application expires Ira width, not °bighted within 180 rin Le sen Date: 12/13/11 days pions It has been emoted as complete. Print name; Char 1 if y ` Numbarcl 'inapwtiottsallowedlwt•pannit I: 1Butl diegwrrmitsELC- PerreitAppden m /elno 44t.46152(t1 /o5/COMAVBR r /C 'HOVd 98bZ869CO5 9817Z869C0g ZDH'IE MaSMVHOf Nv ZZ:OT TTOZ'CT'DeC