Permit CITY OF TIGARD ELECTRICAL PERMIT
• a COMMUNITY DEVELOPMENT Permit #: ELC2012 -00308
T (GA R j? 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/23/2012
Parcel: 2S113AB00600
Jurisdiction: Tigard
Site address: 16165 SW 72ND AVE
Project: Option Care Subdivision: COUNCIL VIEW ACRES (LOTS 21-44) Lot: 30
Project Description: (2) branch circuits for 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
2 crt Branch Circuits wo /Purchase 05/23/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/23/2012 $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 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 OA 2 -001- 090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
at/ 4 PPC /477
Issued By: Permittee Signature:
(/
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.
A/'
Electrical Permit ApplicatioiRECEIVE .
City of Tigard 2 12 X00rraw1 "°d is a�ia- Sot Pemtit 003 r
13125 SW Hull Blvd., Tigard, OR 977223 MAY 2 Hy
Pltm Review
N Phone: 503,639.4171 Fax: 503,598.1960 � /� !-dry �By. Atlterpertnit:
i l , is t i Inspection Liao: 503.639,4175 CITY I / 2ARD OF TI Daro Managing' rad,: I El See Page 2 for
Internet: WW,tlgard- rx.gnv j Dt� fl HtM
NOti/Motbod: '1 �� Supplemental lnlbrrrmtlnn
av
❑ New construction ® Additi • alteration — lacement Please the& all that apply (sulxnit 2.au of plans w /hams checked below):
❑ Service or feeder 400 amps or more 0 Building ova three merles.
❑ Demolition ❑ Other: where the availehie fault currant CJ Marinas and boatyards.
:.. ; ,... :: .: ... : ... .... exceeds 10,000 am at 150 volts or CI Pleating buildings
t lees to ground, tx ar :eeda 14,000 0 Commercial -use agrioulhurnl
' ❑ 1 - and 2- family dwelling IN Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi family ['Master builder Q Other: C] Pho pump ❑ Installation of 75 KVA or
❑ Pmaaeney system. lager separately derived system. •
. MO' its. "1 ❑ Addition efaew motor load of fl "A ", - E" "1-a", "1 -3" • 100HP or more. amp
Job no.: Job site address:
16165 SW 72nd ❑ ID or Moro residential units. Recreational tional vehicle parks.
-
City / State/ZIP: ❑ Health -we facilities. ❑ Supply voltage for mote than
- ❑ Hazardous hsationa. 600 volts nominal.
Suite/bldg. /apt.uo.: I Project name: Option Care ❑ Sevim nr reader 600 amps orMOM.
; 1St tip ; '
Cross street/directions to job site: Descriptive 174a. TAI •
Now residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1 nco sq. d, or loss 168.54 4
te. odd' 1 500 sq. ft or portion 33.92 1
Tax map/parcel no.: ,, energy. residential 75.00 2
• •.' '.7".',' . • "a l0N e>. *ORX. ::-''''' :..: with shove . R.
Limited energy, multi- fancily 75.00 2
Furniture feede residential (with ribos q. 9
... Services or feeders installation alteration, and/or relocation
/. fgfC1if e(P—e(,t..\ i 200 amps or less 100.70 2
1, g•A :. 201 amps to 4110 amps 133.56 2
401 amps M 600 ampa 200.34 2
Name: 301.04 2
601 amps to 1,000 amps
Address: Over 1,000 amps or volts 552.26 — 17
. Temporary services or feeders installattnn, alteration. and/or
City / State/ZIP: me eation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1 I
Owner Installation: This installation is being made on property that I own which is not 201 amps to 400 amps 1 68 . 54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
401 amps to amp. 169.54 2
Branch circuits — new, alteration or extension. r Panel
Owner signature: Date: A. Fee for branch circuits with
- above service or feeder foe, 7.42 2
- ., , ,, +ACA !(; : : ,I . IN1 er, v t PER . . each branch circuit
Business name: Johansen Electric lt, Fee far branch circuits without
aervico or feeder fa, first 1 56.18 6.18 2
Contaotnamc: Charlynn Leifsen branch circuit 1 7,42 . 2
FAch add'I branch °instil
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 97086 dwelling, service and/or feeder
Phone:(503) 698 -3417 I Fax::(503) 698 - 2486 Reconnect only 67.84 2
Pump or irrigation Wrote 67.84 2
E - mail: ...-- Sign or outline lighting 67.84 2
... .. '�� . . ': - ... _ Sitynal areurt(a) r Imcted•onergy
Business name: Johansen ElectZ'2C panel,addition,li Inspection Page 2
Each additional Inapcctlon over allowable to any y 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 97086 Industrial plant (I hr min) 78. l8/ hr
Phone: (503) 698-3417 I Fax:( 5 0 3) 698-2486 inspections for which no fee is 80 .00/ hr
deal listed 'h hr min
a/B Lrc.:
CC 51539 I,�ioclrical Lie.: 3 - 2 4 3 C I ' .. ' :.. ::: :. ' ..a.;.'�i', ° ri • iii C t = . " ,.
.��� '- � � p iC 1v. Lic.: 2 0 5 3 S .D►1
Suprv. Electrician signature, rcquiyr�^'"r / Subtotal: 63.6 a
\ � Plan review (25% of penult it fo foe): '
Print name: Carl J. ansen Date: 5/22/12
State surcharge (12% of permit fee): 7.63
TOTAL PERMIT FEE: 71.2 3
Authorized signature: • ... This penult applteatlon expires If a prom Is not obtained within 190
Print name: Charlynn L e i f s e n I Date: 5 /22/12 days aver It a
has been accepted as complete.
1 • Number of inspections allowed par permit.
1:tBvUdire hilts C- Pormtwpp.4oc 07/01/10 440.4615T(1t/0s /COMnvsn
Z /T •3DVd 986Z869C0S 986Z869£09 203'3 NaSNVHOf cud SS:CO ZTOZ'ZZ'AEw