Permit CI OFD TIGARD ELECTRICAL PERMIT
I '" COMMUNITY DEVELOPMENT Permit #: ELC2009 -00370
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/24/2009
. - . Parcel: 2S112DD00701
' .
Jurisdiction:
r
Site- address:. 15800 SW UPPER BOONES FERRY RD 120
Subdivision: Lot: •
Project: Jonathan Plant DVM
Project Description: 20 branch circuits
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY
#300 20 crt Branch Circuits 07/24/2009 $173.20
wo /Purchase Service or
PHONE. Feeder
1 ea 12% State Surcharge - 07/24/2009 $20.78
Electrical •
Contractor:
JOHANSEN ELECTRIC INC
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 $193.98
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 p 9 100 You may - obtain copy of the rules or direct questions to OUNC by calling 503 246 6699 or 1 800 332.2344 •
• 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 an inspection that business day. •
1 .
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
I,
Electrical Permit Application
JUL 2 3 2009 Mk Mk l kill I. I.I 11.1 ti
City of Tigard Rec
13125 SW Hall Blvd . Tigard, OR 97 T OF T IGARD C MIN t
- Phone 503.639.4171 Fax 503 Stitt Date ; Other Permit:
1 . I .: , Inspection Line 503.639 4175 ING DIVISION Date Ready/By lures' ® See Page 2 for
Internet www ttgard or.gov fSSN711��!�1�1ttyp�� Notified/Method Supplemental Information
tR 4 I+ ttMMEEMI 1" 4, ;tt 1 n t - I'E, u(;v:>b,x,wr i 2r ` 1..
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- � +,:`' .�.. � � i .u{a ` �c� IIR� �s1i + T ' :;.: • ai : t) , . ikl'�I" Ir + ; � . , 1�_�',d.���:�.- �,:51�:.� iii „ ���� i �� ,;ti,
El New construction ® Addition/alteration/replacement Please check all that apply (submit 2, ads apt= w/item5 checked below
El Demolition
CI Service or feeder 400 amps or more ❑ Building over throe stones
❑ Other
Il l b;llil I It�,.� r°r n p � where d m available fault current ❑ Marinas and boatyards.
' 'id An,'.� ��� � 1 �?� t'ar;;llEll: i a1.711et+ 111i't'!I 3tatac;-3tulry a., ..
, S • ,�- .il�lllllJ�':•,�.� III,- ������ ;, a � s,,�l , I t C .; :.'1':- exceeds 10.000 amps at 150 volts or ❑ Floatrgg buildings.
ID 1 -and 2- family dwelling ®CommerciaL'industrial less m ground. or exceeds 14.000 ❑ Commercial -use agneu t ral
❑ Accessory building amps for all other ir[mllanons. buildings.
❑ Multi - family ❑ Master builder
❑ Other 0 Fire pump. ❑ installation of 75 K1 A or
del i I =�I i o fr. � 'r i s Ile,^.. iMC ; ❑ Emergency ayetcm m I • ra4U+� 1'i
_ e•:: �l r ' : /i:le / : ":I ri5 i, ' }'e�7_:s',',''1Fz r Il �Ah ��j�"��} � � 1 � lug sepom Iydenvedrynem
i
' tta�zt rmtiV_Irna+ry .h .I,>;vvr. "IO'•,., `'ll�eill:itlltW��'U!:il ❑Additiveafrsew motor load of ❑`A " "E ", "I- 2 ", "I -3 ",
Job no.: Job site address: 15 8 0 0 SW Uj' t &DPE.53 100H1' or more. Recreational occupancy.
Six or more residential units. ❑ Recremonal vehicle parks
City/State/ZIP: ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt.no.: 120 1 Project name: Jonathan Plant ❑ Service or feeder 600 amps armore.
Cross street/directions to job site: Description 4n, sae Taat •
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 I
s "r' ,.. , 1 t E� a1,'S �,rnw.rir vw::lr;;. , y � I I Limited energy, residential 75.00 2
rr •�' +! ftibd�i` ' lau��+r .lurim M}' sJ• `hr'P i{ " .ih (with above sq it)
Limited energy, multi-family 75 00 2
Tenant Improvement residenaal (with above sq. d)
Services or feeders iustallation,alteretion, and/or relocation
-•�.,� RupY::w rrr e e . y� 200 amps or less 80.30 2
-N . `' (a,¢tl ti , ;rV Y I .ii ifini ( fi+I c 4 +' : l ' i . ' 1 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160 60 2
Address:
601 amps to 1,000 amps 240.60 2
Over 1,000 amps or volts 454 65 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) l Fax: ( ) 200 amps or less 66.85 1 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100 30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 1 133 75 2
Owner signature: Date: Branch circuits- new, alteration, or extension, per panel
Ii�'}� s ign y � I. _ _ A. Fee for branch circuits with
'1' I h+�Jrrl'YlitPEZl� e.e _� t fj'' N '�1k r, ' - I �y� .�nF' ry,ggq,,, t r r, M� 1�n��1 �p A f,. !A.
= l • i Mr:_CYii1C +f�If,.�,�rY.+;IIrit.s���(;� above service or feeder fee, 6.65 2
Business name: Johansen Electric Inc. each branch circuit
B. Fee for branch circuits
Contact name: Charlynn Lelfaen
without service or feed fee, 1 46 85 46.852
fast branch circuit
Address: 10948 SE Valley View Terrace Each add'l branch circuit '3. 9 6.65 12 6 • 352
Miscellaneous (service or feeder not 'Waded)
City/ State/ZIP. Happy Valley, OR 97086 Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: (503) 698 - 3417 I Fax: : (503) 698 -2486
Reconnect only 66.85 2
E -mail: jobanseneleet@msn.com Pump or irrigation circle 53.40 t 2
4tI!{- aTrt V[,
, "a �e@Jf�: +i IF I t1 1 r �da .`R �'4 (q�t�'n�tap�' ���� , I -, i p .
Sign or outline lighting rat: kill � � a�rblJ::�i.l��.f,,,e' : :�a�1ai4�jti ?Ei!uio_7�lmtli;.,�' e} + 5 1 : � ;r �.'' � ;lighting 53.40 _. 2
Business name: Johansen Electric Inc. Signal circuits) or limited -
a
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 In any ofthe above
Phone' (503) 698 -3417 Fax: (503) 698 -2486 Per inspection 62 50
Investigation per hour (1 hr min) 62.50
CCB Lie.; 51539 � i � I Electrical Lic.: 3 -243C I III I Lic.: 2053S lo x bo Industrial plant hour 73 75
/t t r. i„ t
attir
Suprv. Electrician si e, requited; / - Subtotal: 173.20
`
Print name: Carl K. Johansen I 2 2 / Plan review (25% of permit fee).
C , /\ ......
State surcharge (12% of permit fee): l U • / K
Authorized signature: _e TOTAL PERMIT FEE 193.9 B
— Print name: Charlynn J. Leifsen Date: 7/22/09 Th'" permh °jspa"n°O° expires if. permit is not obtained wteaia ten
days after it has been accepted as complete.
L PevmitAppdoe 05lL3N6 • Number of inspections allowed perperrmt.
w0-46I5T(I 1105/COM/wes
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