Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00291
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/21/2012
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 155
Project: Avanti Subdivision: WEST PORTLAND HEIGHTS Lot: 9 -25, PT
Project Description: 200 amps or less service or feeders, branch circuits with service
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
1 ea Services or Feeders - 200 05/21/2012 $100.70
Specifics: amps or less
6 crt Branch Circuits w /Purchase 05/21/2012 $44.52
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 05/21/2012 $17.43
Electrical
Type of Const:
Occupancy Grp:
Total $162.65
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 R 52 -001 -0 90. You may obtain a of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
A �•
Issued By: .L! t.ta Permittee Signature: Di b\ PP`I vI ro Dig
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.
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Electrical Permit Analicat>< t �l , ,�
City of MAY 17 2012 s -4, ) ,., s -4, ) ,., ►i . ) , - Permit No. a O noel- - e, 0
13125 SW Hull Blvd.,Tigard, OR 97223 vim, Review
- _ • Photos: 503.639.4171 Fax: $03,59 ) , O�.1 Ail p DDate/13 Hitter I�m,ir , Z /1'
1 1 ., „ t , Inspection Line: 503.839.4175 p 1' . , , Date Ready/Hy: IE Page 2 rot
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Internet: wwweigard- rr.gov UI :. I. f; ? i I ! ( ON Notifiod/Momod: 3upplorrnatelInromutlar
❑ New construolion ®Additiott /alteration /replacement Please cheek all u,at apply (a,bauc =eon (Apnea Whom e heeke ''.•:.•:.•'
b elow)
:Ise/vice or feeder 400 amps or more ❑ 1iuilding over throe ateries.
❑ Demolition ❑ Other: Melo the available fault current IJ Marinas and boatyards,
cltccm 000 nm al 15o volts or 13 Floating buildings
a
. - " i:. Ten to ground. of =ands 14,000 ❑ Commercial-= agricultural
❑ 1- and 2- family dwelling M. Commercialfindustri.al 0 Accessory building amps for all other installations. buildings.
❑ Multi- family ■ Master builder 0 Other: Li Fire paw. 0 lavelleum, of 75 KVA or
. load f "F.", separately derived sysuan.
'.:. .
Emergency system
larger : :. 013 TIt r t r : v, ..'MN 'ASD 1L A� ION: oar o CI - A ,, " .
❑ Addition of now motor
/ .2 )/ $ SJ I ix o r ev a rest occupancy.
Job no.: Job slid address: 6 ❑ 10 more residential units. [] Recreational vehicle perks.
City/StatclZIP: /04 ❑ Health-care facilities. ❑ Supply voltage for mom than
❑ Hezerdoua batuune. 600 volts nominal.
Suite/bldg. /apt. : J 5 rojeet nano 4 m morn .
Imo .
Cross street/di Ions �/ ❑ Service or fonder 600 amps o f ob site: I : a mmo a _ ' r M ee. I Taint I •
New residential single-or multi -family dwelling unit.
Includes attached garage. __
Subdivision: I Lot no.: 1,000 eq, n. or less 168,54 4
Pa. add'I 500 sq. ft. or portion 33.92 I
Tax map/parcel no.: Limited energy. residential 75 2
.; . .,. — .. -..—,.7. .r. above K. ft`
:; .< multi-family vn
• - � . . Limited energy, 75R0 2
residential (with above sq. ILL _
Servkes or feeders inttallatlon, alteration, and/or relocation
200 amps or loss i 100.70 /C602) 2 igi ' 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1.000 amps 301.04 2
Address: Over 1,000 amps or volts $52.26 2
Temporary services or feeders installation, alteration, and/or
City /State/ZIP: relocation
Phone: ( ) [Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 1 25.08 12
Owner Installation: This install ltion is being made on property that Town which is not 401 amps to 599 amps I. I 168 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
7777 ' abero orvieoo or feed er fee,
AtI Al 1 A-'. N each v br circuit 6 7.42 illisz 2 •
Business name; A Fee for branch circuits without
Johansen Electric service or feeder fee,frst $6.18 2
Contactnnme: Charlynn Leifsen Dr
Each edd'I branch circuit 7.42 2
Address: 10948 SE Va L ley View Terr NBscellaneoui (aervke or feeder not included)
Each manufitctured or modular 67.84 2
City/Stato/ZIP: Happy 1/..• 11 ey, OR 97086 dwelling, service and/or fender
Phone: (5 0 3) 698-341/ "Fax :: (S03) 698-2486 Reconnect only 67.84 2
Pomp or irrigation circle 67.84 2
E •mail; S ignor outline lighting 67.8 2
Signal oireuit s or limited -timer
Business name: Johansen Electric
panel, Each alteration. additional or extension. Page any 2
Each addltianal Inapecdoa over allowable In env of the abov
Address: 10948 SE Valley View Terr Additional inspection (I hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City /State /ZIP: Happy Valley, OR 97086 ,_ Indu atrial plant (1 hr min) 78.18/ hr
Phone:(503) 698 -3417 I Pax: (503) 698 -2486 Inspectinsfor which no fee is 90.00 /hr
` re:au u listed hr min .
9CB Lie.: 51539 c 9,0 1 Fiectrical Lic.: 3. 243 .1 1 \ 1 1 . t Wrv. Lic.: 2053 g Z4a e ,:.'w,=.r t: 7-... , :' '
A Subtotal: /vs, `2,
2
Suprv. Elccu'ician signature, rc �iled: a �j ' / ,A ^. / Plan review (25%ofperatil fee):
Print name: Carl Jo 1 s en Date: 5/17/12 State surcharge (12% of permit fee): /7.5/3
TOTAL PERMIT Rig: / 4,2 S e
Authorized signature: W 7'!da permit application expires Ira permit Ia not obtained wnhln 180
I days after lthas been accepted as complete.
Print name: Charlynn L e i f e en I Dote: 5/17/12 • Numbcr of inepeetions allowed per penult.
I: inaildinerandu1.aL0- Pmmi,App.doc 07/0111) 440.46111(1 I PoSICOMwm
V /T '3DVd 98VZ869£09 98tZ869£05 Zo3Z3 NaSNKHOr cud 6T:£0 ZTOZ'LT'AEN