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Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2012 -00007 Date Issued: 01/06/2012 TIiGAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 2S112DD01601 Jurisdiction: Tigard Site address: 15755 SW SEQUOIA PKWY 200 Project: Orthopedics NW Subdivision: PACIFIC CORPORATE CENTER Lot: 4 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: FAX: 503 - 698 -2486 FEES Quantity Description Date Amount 6 crt Branch Circuits wo /Purchase 01/06/2012 $93.28 Specifics: Service or Feeder 1 ea 12% State Surcharge - 01/06/2012 $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 OAR • - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ,1 Issued By: PefmitteeSignature: 'ire I, 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. RECE JAN 0 52012 Electrical PermitA °nlicatio ►:oIr!I is i sr o' i.r I TY OF TIGAB li City of Tigard BUILDING "C © ; N Dat • 13125 SW Kali Blvd., Tigard, OR 97223 I�✓ ISIO Other Pormii; 71....-- a Phone: 503.639.4171 Fax: 503.598.1960 ENINI I I , . A I I , Inspection Lille; 503,639.4175 El tw ,� &I See Page 2 for Internet: www.tigard.or.gov .ylY `upplementalIntormation vo- , , v, , F 1 �,S' c V;'. A << 4 S,r� r 'r 1 ;,�> "i� 'Ir I ^cam, , ,, ❑ New construction (EI Addition /alteration /teplaeentent Please check all that apply (submit 2 sets of plans w /hterns checked below) ❑ service or fbeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. 7.7. 1,V,'- , ^r ,. )..;,0 , .r + ,1r' ,6 r,; !: c a.,�'� mends l0,000 volts or ❑ Floating buildings, i 7 ,, '^r, tV a i,�� q g " � :fob! �! ' M , n •.. I . M w, ''r4 'a C t '• ` � . yt•,• - a ` loss to staund, or exceeds 14,000 [] Commercial-use agricultural 0 1- and 2- family dwelling rgl commercial /industrial ❑ Accessory building props far all other inatallations, buildings. 0 Multi - family © Master builder ❑ Other: LI ire pump. C1 Installation of 75 KVA or i ,' ; ' 9 m,, ; „ sq u �., ,,,,,. n ,:.u', ; , ?`. .,t,° 0Emergency larger separately derived system. r y r, a � �we� , . 1 2itil 'O ' 14., i i4 :: ' ; "� u4 J ` ❑Additirntofnowmutor toad of 0•, - 2 „1 - 3„ 1001.1P or morn. occupancy. Job no., Job site address: 1 W Sequoia p Six or more residential units, ❑ Reermiormi vehicle parks. • City /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage fbr morn than 0 Hazardous locations. 600 volts nominal. Suite/bldg. /apt, no.: Project name: Orthopedics NW ©service or feeder 600 amps or more, Cross street/directions to job site: Ilreattallea Qtr. Irec Total " ' New residential single- or multi-family dwelling unit.. Includes attached garage. Subdivision: I Lot no.: y 1,000 sq. ft. or leas _ 168.54 4 Ea. add'I 500 sq. ft. or portion 33.92 1 Tax leap /parcel n0 Limited energy, residential 75.00 2 i g ", << IV' iy. 7 l' ", DF '1 A { 'i 1 �•• (with above sq. ft Limited energy, multi- family 75,1/1/ 2 Lighting upgrade residential (with above sq,ft), Services or feeders Installation, alteration, and /or relocation 200 amps or less 100.70 2 . r `' '.6; a 1 :: . a , - �' ' •: .1 �' 0 1333.54 ,.,,,, a , ....,.:, • , �• 40l amps to �� amp: n ; � \' a. .�:Lr.:,.t 2 S yr e�/o wr' ., •• , r � , ?'. 401 amps u 600 amps 2 0.3 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 City /State/ZIP: relocation _ Phone; ( ) ] Fax: ( ) 200 amps or legs 59.36 I 1 Owner installation: This installation is being made on property that I own which is not tot amps to 400 amp( 125,08 2 401 amps to 599 amps 168.54 IT intended for sale, lease, relit, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits new alteration or extension , er anal Owner signature: Date: A, Fee for branch circuits w //h 77,77 m.,,,rp ,ripW{al,,i... T above service or feeder fee, 742 2 �,'•i, .1. ,,a ��'a eu�h branch circuit Business name; Johansen Electric B, I've for branch circuit( wUlmu! service or feeder free, Grsl 1 56,18 5 6.18 2 Contact name: Char 1 ynn Le i f i9 en branch circuit Each add'I branch circuit 5 7.42 37.10 2 Address: 10948 SE Valley View Terr _ Miscellaneous (serviceor feedernotincluded) _ Each manufactured or modular 67,84 1 2 City /State/ZIP: Happy Valley, OR 97086 dwelling, service and/or feeder feeder . II Phone; (5 0 3) 698-3417 , Fax:: (5 0 3) 698-2486 Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E-mail: i or outlum lighting ting 67.84 2 ggn li t ,.,,,,., . t' . ", , „_a o : t%1 , r 0. , !' , , r ',i . $ippal circuit(s)orlimilnJ • anert3Y Business name, Johansen Electric panel, alteration, ddit i o nal or l econ extension. Page In an 2 ^ — E ar additional d diti o na l inmti over all owable In any of the above , Address: 10948 SE Valle View Terr Additional ins. tion(l 66.25/hr Investigation (1 hr min) 66.25/ hr City / State/ZIP: Happy Valley, OR 97086 Industrial plant (1 hr min) 78,18/ hr • Phone: (503) 698-3417 Fax: (503) 698-2486 1n spections for which n n far is — 90.00 / hr a.eorfioall listed r'4 hr min CCB Lie.: 51539 1 Electrical Lic.: 3-243C i Suprv. Lie,: 2053 S i'" , ", , , ` ., ! iMIE� °I, L l r , Subtotal: ' 3 . 8 Suprv. Electrician signature, required: , /��, / roviv (25 Ya of permit fee): Print name: Carl Jo any n Date; 1/5/12 `hate surcharge (12% of pcnnit fee): 11 , 19 7 ..- - . TOTAL PI+RMI'1' FEE: 104,47 Authorized signature( r- ,,,_� f .�' R This permit application expire,, if a permit h net obtained within 180 nn L Ben Date: 1/5/12 days aao sallo dporpe td Print name: Chart y ' Number of Inspections allowed per permit. 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