Permit CITY OF TIGARD ELECTRICAL PERMIT
` °'- ' ' COMMUNITY DEVELOPMENT Permit #: ELC2012 -00046
TWGAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/27/2012
Parcel: 2S112DD00200
Jurisdiction: Tigard
Site address: 15862 SW 72ND AVE 150
Project: Immunology Subdivision: 1994 -006 PARTITION PLAT Lot: 2
Project Description: TI
Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES LP
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 01/27/2012 $93.28
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/27/2012 $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 952- 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.
- Issued By: Permittee Signature: �� ri /i��1 d4
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.
RECEIVED
Electrical Permit Application FOR 01:1ICE 11 (1`..1.N
City of Tigard JAN 2 5 2012 Roceived . iffilawai
,
I- . 13125 SW Hull Blvd., Tigard, OR 97223
Plan Review
4 Phono: 503.639.4171 Fox: 503.50W OF TIGARD Dav/13 ; Other Partin!:
f , ,., , , , 13 'Inspection Line: 503.639.4175 BUILDING DIVISION DEM) Ready/fir El see Page 2 for
Tritornet: www.tigurd-or.gov • Notid/
fieMethod: M Supplemental Information
(A-!\;,cf:Xt4V,:,?8& .; , ,.1 „:,,, ,, , , , .. .. „,,,,,,,,,
0 New construction El Addition/alteration/replacement
1::IService or fcoder 400 amps or MOTU 1:j Huilding over three store Demolition 0 Other; where the available Ault current 0 Marinas and boatyards,
****( 14„ ; ,,..;c,,4!:,,,.!,fi s t .T;.,,'M exceeds 10,000 amps at 130 volts or 0 Floating buildings,
. loss to ertnintl, or exceeds 14,000 0 Commerciel.141 agricultural
El I- and 2-family dwelling IE Conutercial/industrial 0 Accessory building amps for all other installations. buildings.
El Multi-family 0 Master builder CI Other 0 Fire pump. 0 IruilsIbilioti '&1S Ii.VA or
larger voparatoly derived system.
, , i ' - ' T i r . : : 1 ? , 4 0 ; , V ) Z . W ; - ' i n ‘ 4 . , 1 * * 0 4 . 0 0 P ' ' ' . : t ; L I Addition anew motor load of 0"A”, "P, "1 "1
10011P or more. occupancy.
Job no.: Job site address: 15 8 6 2 SW 72nd osi c'tr Miro retidamial units. 0 Rogropliouril VailiCIC parks.
City/State/ZIP; ] Holth-care facilities. El Supply voltage for moro than
0 1 locations. 600 volts nominal.
Suite/bldg./apt. no.: 150 I Project name: immunology Consultant4 CI Sorvion or leodor OM amos or more.
10*
Cross street/directions to job site; De5cription Ow, I Froo, [ Tem I .
New residential single- or multl-family dwelling unit.
Includes attached garage.
. .
Subdivision: 1 Lot no,: .. 1,000 sq. it. or lost 1 168,54 4
Ea. add'l 500 sq. ft or portion 3392 1
Tax map/parcel no.: r.imilecl nnero, residential
75.00 2
***#*60**10Y,Ci 0 ,40100 ves1 11 0
75,00 2
Add cirCUitS residential (with above sq, it)
Services or feeders Installation 1tersIkinnd/or relocation
200 amps or less 100.70 2
01040itilt.O.iiiti ,,;,1,,i*
it., 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: '
601 =pm to 1,000 amps 301.04 2
.."
Address: Over 1,000 amp% or volts 552.26 2
Temporary services or ?ceders Installation, alteration, and/o
City/State/ZIP; relocation
Phone: ( ) I Fax: ( ) 200 amps or less 50.36 1
1
Owner Installation: This installation is being made on property that I own which is not 201 amts to 400 amps 25.08 2
401 ,
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. amps to 599 amps 16054 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: . . - Date: A. Fee for branch circuits with
..
' ' above service or feeder fcc,
:: each branch circuit
— 742 2
B. Poo for branch circuits without
Businessmmte: Johansen ElectriC 50tVit or fccdor fee, first
Contact name: charlynn Leifsen branch circuit I 56.18 56 j 2
Ennh nd‘I'l brunch uircuit V 7,42 i-i. ie..) 2
Address; 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
Each rnanefiteturnd or modular
City/Stole/ZIP: Happy Valley, OR 97086 dwelling, service and/or feeder 67.84 2
....
Phone: ( 5 0 3) 6 9 8 - 3 4 17 I Fax: : (503) 698 Roconnoot only 67.84 2
Pump or irrigation circle 67.04 2
E-mail: ' 777
- . Si p or ouiiine lighting 67,84 2
- 7 6 ' AV:' ' ' • • -
SivIMmmuit(s)orimimdmmgy —
ianel alteration or extension, Pk° 2 2
B081110880=0: Johansen Electric ' Each additional insenctiOn over allowable in any of the abov
Address: 10948 SE Valley View Terr Additional inspection (1 hr min) 66,25/ hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: Happy Valley, OR 9 7 08 6
industrial plant (1 lir min) 70.18/ hr
Phone: (503) 6 9 8 - 3 4 17 Fax: (5O3 698-2486 Inspections for which no fee is
90.00/ hr
spnvicicell Iktnd ' hr
CCB Lie.: 515 3 9 Electrical Lie.: 3 -243 C Suprv. Lic.: 2 0 5 3 8 ,ii„;, ii 4,,,:.:..1:1;
—
Subtotal: ' ..2,
Suprv. Electrician signature, required:
eter'f-' k/4-414141.aid‘d Plan review (25% of permit foe):
z"
Printna Carl. Johansen D a : 1/24/12 snite (12% of permit fix); / f / 7
'tOTAL PERMIT FEE: /Di/4 ri
.
Authorised signature:CA.-.---------_.,..... - Th rmit is pe application expires if a permit is not obealned wit 180
days alteril NI been erupted
PrintnonmCharlynn Leifsen Date: as coinplete. e: 1/24/12 • Number of int/lotions alloival par permit.
1: \Buildieecneinail.C-PermitApp.doo 07/01/10 440-4615001/05/COMMED
Z /I 'aDvd 98VZ669C09 98VZ869C09 'Darla MESMVHO2 WV Z0:60 ZTOZ"SZ'uEr