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Permit CITY OF TIGARD ELECTRICAL PERMIT 111 COMMUNITY DEVELOPMENT Permit #: ELC2012 00037 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/25/2012 Parcel: 2S113AA00600 Jurisdiction: Tigard Site address: 16180 SW 72ND AVE B1 Project: Vacant Subdivision: ROSEWOOD ACRE TRACTS Lot: C Project Description: (4) branch circuits 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 4 crt Branch Circuits wo /Purchase 01/25/2012 $78.44 Specifics: Service or Feeder 1 ea 12% State Surcharge - 01/25/2012 $9.41 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $87.85 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 0 952 -00 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: -- Permittee Signature: e.v /57--. G / / re .4./ 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. R ECEIVE D Electrical Permit Application JAN 2 4 2012 1 fit I I 15h I /`I.' City of Tigard Received i t�7 Permit No,: 7 Y g 1)ate/11 . , Star �u c p -ma * 13125 SW Ral1 Blvd., t•igard, oR 9 €ff(GF T!GAD� 4® .._ A i Phone: 503,639,4171 Fax: 503. 0ilpt/+ IVi�iON FEEIIMIIIIIIIMI r t , j„ , Inspection Line: 503,639,4175 s Lv { mitt�� L! !' t ®Sle II 2 fir Internet: wtvw.tigard•or,gov Supplemental Inthrmation ( (. . ) k I r ' • 0, a l: I� r :: : (i I �' ;t t+ I f: a r.,' A r � Oo :,id ` I ,'� � ,. yf16., ! i, ,�`�.. ), „xa ., 1 i � .j �y,y r ' ., , „ � r � i ' 1 :;�,'� -, C 1r ., © New construction ® Addition /alteration /replacement Please check all that apply (submit ants of plans w /items checked below); l] Service or ibcdor 400 amps or more 0 Building over throe atones, 0 Demolition 0 Other: M em tire available fbult current 0 Marinas and boatyards. r y 7 Mr mi , ' I , al� t t , ' I ` ” e n ' 1 r , h '' ; F '7 a 7 < t p „ . lr pl , ° '„� � eXcoOda 10,009 amps at 150 volts or 0 Floating buildings, • less to ground, or exceeds 14,000 0 Commercial -use agricultural ❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all of er installations. buildings. ❑ Multi - fa/nil ❑ Master builder ❑ Other: 0 1 ire pump. 0 Installation of 75 KVA or t r / „ a .: " s bra Yy n ^ CI Hsmargaaey aysusm. larger separately derived system. ',I � j �6 :'' ��1+Rr ) i ` ' 0 Addition anew motor load of 0 "A", "E", "1.2 "1.3 ", 1001IP or more. occupancy. Job no.: Job site address: 16180 SW 72nd Rec reation al vehi ❑ Six or mole residential ''nits, �) parks. P 0liealth -care iltcililios. (J Supply voltage for more than (] liazardnus locadtma. 600 volts nominal. Suite/bldg. /apt. no.. CIMMZZMIMIIIIIIIIIIIMI 0 3evvim or theder 600 amps or more. Cross street/directions to job site: nipuon I� � r „or Foe. I 'rata' I New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or Ices 168.54 4 13a, add't 500 sq. ft. or portion '33,92 I Tax no map/parcel ma / P l 75.00 2 P Limited energy, residential ` ;-> ; I , , ; ;j) _.: e C a ; •,:r i, ,. , : (will, abovesq,R.) Limited energy, multifamily 75.00 2 Clean up space _ residential (with above sq, 11.) Services or feeders installatlon,alteration, and/or relocation 200 amps or l oan 100.70 2 i i :,, ,fit a • k , e, ay ' 1i9 .,'$! r : 201 amps to 400 amps 133.56 2 401 amps to 600 amps 20034 2 641 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 Te services or feeders Installation, alteration, and /or relocation Phone: ( ) Far 200 amps or lass 59.36 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 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits — new, alters'% or extension, ear panel Owner signature: Date: A. Fee for branch circuits with above service or feeder fcc, 7A2 2 : ',. , N; , ' , '::. ' 0'.!. ,7, 14.0100,01,11 . 01: .; !'4?; ' .. •. MI ”; OW' each branch circuit Business name: Johansen Electric B.Fcc for branch circuits wlrhr l service or feeder kr, first 1 56. t g 5 6.18 2 Contact name: Charlynn Leif elan branch circuit Each add'I branch circuit 7.42 22.26 2 Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not included) Each manufactured or modular 67.84 2 City/State/ZIP: Happy Valley, OR 9 7 086 dwalliog, aorvico and/or tocdor Phone: (503) 698 -3417 Fax::(503) 698 -2486 - Reconnectonly 67.84 2 Pump or irrigation circle 67,84 2 * ,.', Sign or outline lighting 67,84 2 , ti t ti,,, a Signal circuits) or limited - energy Business name: Johansen Electric panel, alteration, or extension, Page 2 Each additional inspection over allowable in any of the above Address: 10948 SE Valle View Terr Additional inspection (1 hr min) 66.25/ hr Investigation (1 hr min) 66.25/ hr City /State/ZIP; Happy Valley, OR 97086 — Industrial plant (I he min) 78.18/ hr Phone: (503) 698-3417 Fax: ( 503) 698-2486 Inspections for which no fee is 00.00/ hr B.:cifieall listed 14 hr min CCB Lio.: 515 3 9 Electrical Lie.; 3-243C Suprv, Lie.: 2053 S }: ,,; °,•Si ", i )tp °e7E . Yri >, ,. : Suprv. Electrician signature, required: subtotal: 78.44 .. _ I I Plait review (25% of permit fee): Print name: Carl Johansen. / Date: 1 / 2 4 /12 , - State surcharge (12 of permit fcc): 9 . TOTAL PERMIT FF/F?: 87.85 �/� Authorized signature: i ._ T 'I'Ida pe+m(t applicadon expires if a permit Is not obtained within 180 days Baer it has been accepted as complete. Date: 1/24/12 s Number of inspections allowed per permit. MHuildmg \Permits 07/01/10 440- M11'1(1 I /O5 /COM/NEB Z / T 'HDVd 98lZ869EQS 98t' S69 €OS SOH'IH NaSMVHOr NV ST:60 ZTOZ'17Z'uer