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Permit CITY OF TIGARD ELECTRICAL PERMIT Permit �. COMMUNITY DEVELOPMENT #: ELC2012 -00292 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/21/2012 Parcel: 2S101A003200 Jurisdiction: Tigard Site address: 12909 SW 68TH PKWY 320 Project: Therell Law Group Subdivision: WEST PORTLAND HEIGHTS Lot: 9 -25, PT Project Description: TI; 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 12 crt Branch Circuits wo /Purchase 05/21/2012 $137.80 Specifics: Service or Feeder 1 ea 12% State Surcharge - 05/21/2012 $16.54 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $154.34 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 9 - 2 01 -0090. You may o tam a copy f the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. I Issued By: t Permittee Signature: 0/11 , L " 1 f P _ I77L kL 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. S. RECEIVED - o Electrical Permit Application MAY 17 2012 rOR o Fri 1. I ,I` 41.\i.' City of Tigard n Permit N'� ' - ► ( a.' DDeZ -Q 13125 SWHn11 Blvd.,Tigard,OR 9 OF TIGA octetPertnil: Phone: 503,639.4171 Pict: 503 1.);': I h'' '' I 1. N Dab heady /il / la See Page 2 for ;, u inspection ter e: Line: ,ar - Or.go I �° `•1 N,41C.ed/Method: Supplemental Worennton Internet: www.tigard- Or,gov Please abaci ell that apply (submit' sets of plans w/iteme checked wcked blow): CI New construction ® Additiott /alteration/foplaccnnont ❑ Service or feeder 400 amps a mom 0 Building over three stories. ❑ Demolition � : where the available nultcurrent ❑ Marinas and boatyards. : 000 amp at I50 volts or ❑ buildings • excem 10, • • less to sr mod, or exceeds 14,000 ❑ Cimm iel -use agricultural ❑ 1 - and 2- family dwelling ® Comineroial/industrial ❑ Accessory building amps Air all other installations. buildings. ❑ Multi-family ❑ Master builder ❑ O ❑ Fie pump. D Inatallaton of 75 t�vA m. Y Emergency system. larger separately derived system. .. . •... E nt • - '... W - 14:EMMA1'ttIN AND ;11OC 'tIflQ.. ❑ Addition f new motor load of ❑ "A "." "1-r, " a .• Job no.; Job site address: (7 / • (y • r sitter or aloft. Roc occupancy. 12 909 ��j/� /7 ❑ Six or more oft. ial units. ©Racnmtionol vesicle perks. City/State/ZIP: ..--- ❑ Healthcare facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suitc/bldglapt. n . 320 eject name: ;1itinal L UO (fibic, C15omiee or ftodcr 600 am. ur Cross street/direc site: neacripUan c,ny. Pee. Torah • - New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: I Lot no.; 1,000 sq. f1. or less 162.34 4 • Ea, add'l 500 eq. ft. or portion 33.92 1 Tax map /pastel no.; Limited energy, resident's/ 75.00 2 ��aayyr ' i (with above aq. 0 ) �� `• - �- I,imiled energy, mil¢- family 7500 2 residential (with above sq. ft.) S ervices or feeders Installation alteration, and/or relocation 200 imps it lose 100.70 2 }) JgR r.. 201 amp' lo4(i0 amps 133.56 2 401 amp its 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1.000 amp, it volts. 552.26 2 - Temporary actvlcee or f seders Installation, alteration, and/or City /State/ZIP: relocation - Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps l 125,08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps I r 168.58 I 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701, Branch circuits — new, alteration, or extension, per panel Owner signature: Date: _ A. Fee for branch circuits with r� I�!�.tr �rw� above cerviee or feeder lcc, 742 2 :..0 '10...1410441'.,1 ., • :. ..I: : .car+ ' 'Ac . each branch circuit D. Foe for braskoh eireati. wtihnur Business name: Johansen Electric feeder service or killer foe, firer t 56.15 ,54/./g 2 Contact name: Charlynh Le i f sen branch circuit Each add'I branch circuit I / I I 7.42 15/42. 2 Address: 10948 SE valley View Terr Miscellaneous (service or feeder not included) Each manufactured or modular 67.84 2 City/State/ZIP: Happy V , OR 97086 dwelling, service and/or feeder Phone:(503) 698 -3417, Fax: :(503) 698 -2486 Roomed only 67.84 2 Pump or tr igaton prole 67.84 2 E -mail: i Sign or outline lighting 67.114 2 ' . ' ..; ' ' ' •` .... ;, 1 ''40 :-.',..%:: Si circuit(e) or Iimitod.en alteration, mgY • r . Business Johanse4 Electric Each additional in io s aonaion, Pagan 2 Each inspection over allowable in any of the above Address: 10948 SR Valley View Terr Additional inspection (I hrmin) 66.25/hr City /State2IP: Happy Valley, OR 9708 Investigation (►brmin) 78 0/ hr pPY I Y, Industrial plant (1 hr min) .1 Phone: (5 0 3) 6 9 8 - 3 41 , f Fax: (5 0 3) 6 9 8 - 2 4 8 6 Inspections for which no foe le 90,00 / hr •tacall listed % hr min B Lic.: 51539 , • ectrical Lic.: 3 - 2 4 3 prv.Lic.: 2 \l .; } ' ' S"'!: 4`y ;; •:r: • I Subtotal: ,3. 0 197 - Suprv. Electrician signature, required: e + l iC J Plan review (25% of permi fee): Print name: Carl J arisen R� Da1e :..5 / 17/ 12 State surcharge (12% of permit fee): /4. t t2- TcYrAL PERMIT FFZ: �/u $4:34 Authorized signature: 1 This permit application capita If permit is not obtained � � 80 I n Le i f s en { Date: 5 / 17 / 12 • days attar It has beer ponni as cor Print name: Charlynn yn Numhor of inspections allowed par penult. l:hauildii We n, la0i1.0 PennitApp.doo sin 1 /1O 440.4615TO 1/b5Mf1M/WEa • 1 /C - HWVd 981Z869C09 986Z869E09 'DaZ3 N3SNVHO2 Wd 6T:E0 ZTOZ- LT'AeN