Permit p CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00552
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/02/2012
Parcel: 2S113AD01800
Jurisdiction: Tigard
Site address: 16756 SW 72ND AVE B14
Project: Pacific Realty Subdivision: ROSEWOOD ACRE TRACTS Lot: PTS 5 -1
Project Description: (3) branch circuits for spray booth
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: 503 - 624 -6300
FAX: 503 - 698 -2486
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 09/24/2012 $71.02
Specifics: Service or Feeder
1 ea Plan Review Electricial 09/24/2012 $17.76
Type of Use: COM 1 ea 12% State Surcharge - 09/24/2012 $8.52
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $97.30
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- 090. You may obtain a copy of the rules or direct questions to OUNC by calling 5033.2332.1987 qr 1.80 .33 .2344.
Issued By: Permittee Signature: /"' 98 (/`
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.
Electrical Permit ApsAvK
R eceived
City of Tigard PennitNo.: d
13125 SW Hall Blvd., Tigard, OR 97223 , ' . Plan Review
3 Phone: 503.639.4171 Fax: 503.598.1960 ' Date/By: 70 / /a. Other Permit:
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: ��, 1_ runs See Page 2 for
Internet: www.tigard or.gov CITY OF TIGARD Notified/Method: /O /PAP— /l)W/ Supplemental information
TYP3131AiiNt DIVISION 0 , 9 4 J PLAN REVIEW
El New construction ® Addition/alteration/replacement `/W Plea all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling IN Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 "1 -3 ".
Job no.: Job site address: 100HP or more. occupancy.
JO'S W 7 2 Et Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: `(p 75-0 ❑ Health -care facilities. ❑ Supply voltage for more than
($Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: Plastic Meta l s ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'( 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
(with above sq. ft.) 75.00 2
DESCRIPTION OF WORK ( 4�
Limited energy, multi - family
Connecting spray booth residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 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 552.26 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
20 Lamps to 400 amps 123.08 2
Owner installation: This installation is being made on property that 1 own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, er panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B Fee for branch circuits without
Johansen Electric service or feeder fee, first
Contact name: Charlynn Le i f sen branch circuit 1 56.18 6.18 2
— Each add'( branch circuit 2 7.42 14.84 2
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
City/State /ZIP: Happy Valley, e OR 9 7 0 8 6 Each manufactured or modular 67.84 2
PPY Y � dwelling, service and/or feeder
Phone: ( 503) 698 -3417 Fax:: (503) 698 -2486 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Johansen Electric panel, alteration, or extension. Paget 2
Each additional inspection over allowable in any of the above
Address: 10948 SE Valley View Terr Additional inspection (l hr min) 66.25/
City/State /ZIP: Happy Valley, OR 97086 Investigation (l hr min) 66.25/ hr
Industrial plant (I hr min) 78.18/ hr
Phone: (503) 698-3417 Fax: (503) 698-2486 Inspections for which no fee is 90.00/ hr
specifically listed ('V2 hr min)
CCB Lic.: 51539 Electrical Lic.: 3-243C Suprv. Lic.: 2053S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 71.02
Plan review (25% of permit fee): 17.76
Print name: Carl Johansen Date: 9/20/12 State surcharge (12% of permit fee): 8.52
.�� TOTAL PERMIT FEE: --1---715
Authorized signature:( /� ' This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Char lyrin s en Date: 9/20/12 ■ Number of inspections allowed per permit. #97 7 56 I:\ Building \Perrnits\ELC- PermitApp doc 07/01 /10 440- 4615T( I 1 /05/C OM/WEB 7