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Permit �t CITY OF TIGARD ELECTRICAL PERMIT 1111 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00001 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/04/2012 Parcel: 2S113AA00700 Jurisdiction: Tigard Site address: 16436 SW 72ND AVE B5 Project: Spec Space Subdivision: ROSEWOOD ACRE TRACTS Lot: D Project Description: (2) branch circuits to change lights Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY TRUST 10948 SE VALLEY VIEW TERR ATTN: N PIVEN HAPPY VALLEY, OR 97086 15350 SE SEQUOIA PKWY #300 PORTLAND, OR 97224 P PHONE: 503 - 624 -6300 PHONE: 503 - 698 -3417 FAX: 503 - 698 -2486 FEES Quantity Description Date Amount 2 crt Branch Circuits wo /Purchase 01/04/2012 $63.60 Specifics: Service or Feeder 1 ea 12% State Surcharge - 01/04/2012 $7.63 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $71.23 Required Items and Reports (Conditions) This p it is issued subje• to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be d ne in accordance with - .proved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 day . ATTENTION: Oregon la -q it you to follow the rules adopted by the Oregon Utility Notif - '•. Center. Those rules are set forth in OAR 95 001 -0010 through OAR 952- You may obtain a cop •f the rules or direct questions to OU • ^,- 2.1987 or 1.800.332. 44. Is ued By: ■ - Permittee Sign. !t 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' 4,110 • �`� /� ` 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. * nMid 1. 0 665)4(.e.4 7 E lectrical Permit Aeplication l'OR OFFI(( F. t .SI: (►\1.V City of Tigard � < :ew i3i25 3Blain Trd, 22 A '�`l Ptah R ' �� WIMP/ �/�/it/ Phone: 503.639.4171 Fax: Si t.59!•.1 A 1•:0 A. l 0 Date/B: Other Permit: o . 1, . A is I t Inspection Line: 503.639.4175 PN Dato Ready /By; ® :� !Memel to U www ltgurd gov .) \ ` Nouhed/Mathud , w" y r , nit �r i +it 'n. c ` t t 'W IP ly ,. i� ��(. ' ' t �'� ,,?, �, f� , , i � �,� �.�,.,.. 1 '., .,( ,,, •,�, ly, �i��J �Ial IY (" �� ",r 1, ,. f � „ .v ,.:. f f, '. , . �'�.ifii� r,,, o . , i © New construction ® ,Addition /alteratr tki u eennt Please chock all that apply (submit I salt ()COAT w /items chocked below): tl "*. ❑ Service or fonder 400 amps or more ❑ nt ilding ov er three str ies. ❑ Darnolition Otliar: V where the available fault currant 0 Marinas and boatyards. �'; , , F . i' y; ,i / 4 " s ' " " y{ ,, y "; 3 P e cceeda 10,000 amps at 150 volts or o Floating buildings. '� -- "" less to gratmd, or exceeds 14,000 Q Commercial -use aaricuihanl ❑ I - and 2- family dwelling M Commercial /industrial © Accessory building amps fbr all other installations, buildings. Q Multi - family 0 Master builder ❑ Other: ❑Fire pump, 0 Installation of 75 KVA or 1 n ".• w (' n " w,r v 1.;. © Emergency system. larger anparutnlyderivoxl ryaLtlnt, / + ' ,j. ' ;vf g r,' N a, - ,' g , I ' a : , r a jl, ,,,. Ir l�a9 : rti+ J, ; :n . + " : , .: ,i,,'.,, • ` ❑ Addition oYncw motor load of ❑ "A" "E" "1.2" "1•7" Job no.; Job silx address; 100HP of mom. occupancy. 16 4 3 6 SW 7 2 nth, ❑ Prix or morn rosidenlial uni Is, Q Recreational vehicle parks. City /State /ZIP: ❑ Health-earn facilities, 0 Supply voltage for more than ❑ Hazardous locations, 600 volts nominal. Suite/bldg. /apt. no.: I Project name: Vacancy ❑ Service or ibudor 600 amps or more. Cross street/directions to job site: , . cls7111111:110i111111WIZENIIly New residential single or multi family dwelling unit. Includes attached gar' :e. Subdivision: I Lot no.: 1,000 sq. ft or less - 168.54 MN 4 Ea add'I 500 sq, ft or portion IIM 33.92 - 0 Tax map/parcel no.: I,imiletl energy, rtsideapal '' ` t Y rtg r s : err r I 75.00 _© III , / , r r ' .f r , :, ll� �, �' . , ' ', °, c with above s.. ft. Limited energy, multi - family ■ 75.00 _ Change lights residential with above s..ft. Services or feeders installation, alteration and /or relocation 200 amps or lass II. 1 00.70 11111111113 v't ! ;'?141 '''0 a ft ..,' 'Y10 rvl/ ? ,t 201 amps to 400 amps = 133, Q 401 amps to 600 amps _ 200.34 - Name: sot amps to 1,000 amps mil 301,04 - Address: Over 1,000 amps or volts MI 552.26 City /State/ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) f F ax: ( ) 200 amps or less 59.36 -II Owner Installation: This installation le being made on property that I own which is not 201 amps to 400 amps I25.ORM intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 1614.54 - Branch circuits - new alteration or extension . cr . and Owner signature, D ate A. l•eo for branch cirouits with i 11 t r : iN ! + . about h b service rnnah or oituu feeder it ice, y�.� ., , (71','1, ouc Business name: Johansen Electric B. Fos for branch circuits service or fader fao, tirst 56.28 Contact name: Charlynn Le i f s en branch circuit Each add'I branch cirouit P.• 7,42 Address: 10948 SE Valley View Terr Miscellaneous service or feeder not included City/State /ZIP: Happy Valley, Valle OR 97086 " Each munufuclurod or modular 11111 67 84 © dwellin : service and/or feeder Phone: ( 503) 698 -3417 I Fax : (503) 698 R000nnactonly 6784 1111.11113 Pum■ or irri_ation circle ME 67.84 -© E-mail: Sign or outline lighting IMI 67.84 - : s 'i , `` ", 3:,, " ..' 1g ,,' .s , im.''A,r,', ,;y Signal circuit(s) or limi1ad.orery ■�_© Business name; Johansen Electric el alteration, or extension. Each additional Ins action over allowable in an of the above Address: 10948 SE Valley View Terr Additional inspection (1 hr min) MINI 66.25/hr MM. Investigation (I hr min) - 66,25/ hr -. City/State /ZIP: Happy Valley, OR 970 Industrial plant (Ihrmin) =I 78, /hr _■ Phone: (503) 698 -3417 Fax:( 698 -2486 In apauliona for whichno fee ls 90,00 /hi . sveciftcall listed h hr min CCB Lic.: 51539 Electrical Lic.: 3 Suprv. Lic.: 20535 a " at: it r I' Suprv. Electrician signature, required: Subtotal; mum 1 . / / Plan review 25% of permit foe): ..! Print name: Carl ans en / Date: 1 / 4 /12 State sureharge (12% of permit fee): 7.63 TOTAL PERMIT FEE: INIMI Aulhorir..ed signature ' 'Hilt permit application expires if a permit is nod °homed within VW days after II ltaw been aceepte4 as complete. Print name: Char lynn Le i f s en Date: 1/4/12 ► Number ..f inspections ellnsvad per p e r m i t , It Building \PrmutetBLC.PaamitApp.doc 07/01/10 440 T(1 l /05h'OM/WEB Z /T 'HEVd 9817Z869 €09 98t7 869005 ZOH''IE MHSNKHOr MI T9:Z0 ZTOZ'VO'uur