Permit CITY OF TIGARD ELECTRICAL PERMIT
Permit
COMMUNITY DEVELOPMENT #: ELC2009 -00242
T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/27/2009
Parcel: 2S 112 DA00800
Jurisdiction: Tigard
Site address: 15055 SW SEQUOIA PKWY 170 )
Subdivision: Lot: 0
Project: Spec Space
Project Description: Install (1) 200 amp or less panel and (10) branch circuits.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY 1 ea Services or Feeders - 200 05/26/2009 $80.30
#300
PHONE: amps or less
10 crt Branch Circuits w /Purchase 05/26/2009 $66.50
Service or Feeder
Contractor: 1 ea 12% State Surcharge - 05/26/2009 $17.62
JOHANSEN ELECTRIC INC Electrical
10984 SE VALLEY VIEW TERR
HAPPY VALLEY, OR 97086
PHONE: 503 - 698 -3417
FAX: 503 -698 -2486
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $164.42
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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
)I4 00.33 32..23
Issued By: LiQ � I� Permittee Signature: S� n v . ` ( (
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'N Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an Inspection that business day.
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 Application 1'(1I. (il I'I(I 1 I .I: ()\I.)
City of Tigard MAY 2 2009 Received i
Dat : a ' - fie • r sjt 1
SI 13125 S W Hall B lvd., T igard, OR 97223 Ran Review
Phone: 503.639.4171 Fax: 503.59 4G ' Date/By: Other Penult:
Inspection Line: 503.639.4175 p � " , g��` See Internet: www.tigard- or.gov �' )-, 3ttt.� !i Noosod/Method: `� I S pple ad fonf� . � o
S ":^ t` ^ r b;.�rF:f�l ' .il 3.. qSi 'n1C�:1L:. �9I1k1'on bi I � .. ` ; /; t� tl Air • i� � � � °.c � a, y�; �� )t 1 [ 1 -
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,
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit sets of plans w/iteme checked bdow):
13 Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other:
Ii t rt 11..:.-',' 1'i ,17:4 i ltjk* :t� p � rum t: :ran r+ - ..
where the available fault current ❑ Marinas and boatyards.
) � '�.'�` ' +r�n ww17,�1': � - r' „ai;x i1� - S o �: r t • s ,ta r � q FI '� .. l ��^I l � re '•t b '�+t: I N exceeds 10,000 amps at ISO volts or ❑ Floating building&
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ® Commercialindustrial ❑ Accessory building amps for all other installations. building&
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. 0 Installation of 75 KVA or
' > f(y ' t " f '(� nanM sum+ rw j N; y ' �! a r ,:: ❑ Emergency system. larger separately derived system.
ft •,i. `i liwl cnaflu A;; l( ,.Z, ,gl.,n;;z,, r. .,,. >rI ;'.�' �, I '' I� `t1t Itl ! Addition of new motor load of
100HPOrenere. occupancy.
Job no.: Job site address: 150 55 SW Sequoia
❑ Six or more residential wits. ❑ Recreatiemal vehicle parka.
City / StateZPlP: ❑ Health -care facilities. ❑ Supply voltage for more than
J t no.: 17 0 ❑ Hazardous locations. 600 volts nominal.
Suite/bl
dg ap I Project name: Va cancy ❑ Service or fender 600 amps or more.
Cross street/directions notions to job site: ' I ' d;l I. ! '13 !' EJ 1. •• 11 ''J' S.q :: , u.
Description OD. Pea Total e
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no. Ea add'I 500 sq. ft or portion , 33.40 1
r�,�j uau ,amwuptMlgp�gb m,r ,!{1, , . , Limited energy, residential 75.00 2
l.1 n l 4im l ��® 9 6 -A pI l i•• .l a •, d , - '4"ips ` c.-i �; ,. (�-^ �i • '' (with above sq. ft.)
l, .. �.iil>iiT.LiailY.r 1��, '� YSMa ?sill') !' C'•h'�! 1
'
Limited energy, multi- family 75.00 2
Tenant Improvement residential (with above sq.ft.)
Services or feeders installation,alte ratio a, and/or relocation
E( 5 , } 200 amps or less t 80.30 2
�,; y r ,, ,;: •:�� �>; r sFx t iY ''k.11e d y tilt' a' li r lt n„i�. I' r., I I?f'Ir," i
. 406 l 0112 Ili :�y;�i:l�i` :Jt`t: !.��I�I,: :1I�i,:! 4'111' t;i: 20l amps to 400 amps 106.85 2
.l lrr.., .A
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City / State/ZIP: • Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps I I 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 1 33.75 2
Owner signature: • Date: Branch circuits - new, alteration, or extension, per panel
a A. Fee for branch circuits with
wi I, 7; r �g a1rs Q
�€j�;, E�1l ,lf :.- lill tfS�t i+ ` yIr1!�!��t' q 1 �I'gg above service or feeder fee. 10
S 1 IBMI:: IE sah.aa, .rt�f tl1�161i:: agard aka d2 a 131 I' 6.65 2 it
Business name: Johansen Electric Inc. B. Fee Fee or branch circuits
without service or feeder fee,
Contact name: Charlynn Leifsen first branch circuit 46.85 2
Address: 10948 SE Valley View Terrace Each add') branch circuit 6.65 _ 2
Miscellaneous (service or feeder not Included)
City/State /ZIP: Happy Valley, OR 97086 Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: (503) 698 - 3417 I }ax • (503) 698 -2486 Reconnect only 66.85 2
E -mail: johansenelectQmsn.com Pump or irrigation circle 53.40 2
' , DINEMIffititiktiEDIKOITISMENIIERIBROMMirdeiff si or outline lighting 53.40 2
Business name: Johansen Electric Inc. Signal circuit(s) or limited
energy panel, alteration, or
Address: 10948 SE Valley View Terrace extension. Describe: Page 2 2
City /State/ZIP: Happy Valley, OR 97086 Each additional Inspection over allowable to a . of the above
Phone: (503) 698-3417 I Fax: (503) 698 -2486 Per inspection 62.50
Investigation per hour (I hr mint) 62.50
CCB Lie.: 51539 I Electrical Lic.: 3 -243C I Suprv. Lic.: 20335 Industrial plant per hour 73.75
Suprv. Electrician signature. required Ij ;,r.tt a r.d��'I'�Ipt �,::. .
/L Subtotal:
Print name: Carl K. Johansen ] Date: 5/22/09 Plan review (25% of permit fee):
stare surcharge (12% of permit fee):
Authorized signature:
C TOTAL PERMIT FEE: I 04 - Lt.-
Print name: Charlynn J. Leifsen I Dare: 5 / 22 / 0 9 This permit appleation aspires if a permit is not obtained within 150
days after It has been accepted as complete.
L•1amlthrltlPaetits�C1.C PermitA doe 05/2346
• Number of inspections allowed per permit.
440.46I5Tt1 I I05 /COM/WEB
•
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