Permit + Q CITY OF TIGARD ELECTRICAL PERMIT
7 —
I ' COMMUNITY DEVELOPMENT Permit #: ELC2012 -00620
T'GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/30/2012
Parcel: 2S 112 DD01600
Jurisdiction: Tigard •
Site address: 15575 SW SEQUOIA PKWY 130 •
Project: MCPC Subdivision: PACIFIC CORPORATE CENTER Lot: 4
Project Description: (1) branch circuit for work in the telepresence room
Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES
10948 SE VALLEY VIEW TERR ATTN: N PIVEN
HAPPY V ALLEY, OR 97086 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
•
PHONE: 503 - 698 -3417 PHONE:
FAX: 503 - 698 -2486
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 10/30/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 10/30/2012 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 I 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or o ,
Issued By: ,� ���� 4Alit
��Y(.C/ti( Permittee Signature: OT 0/I
�
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.
. . .
RECEIVE'
Electrical Permit Application I`IIR(itI It I. 1 tit (1 \I.1
City of Tigard OCT 2 9 2012 dived 1 b
• 13125 SW Hall Blvd., Tigard, OR 9726 �'^ A ^^ Pisa Review
_ Phone: 503.639.4171 Fax: 503.598, Y IGARD Date/13 , Other Permit:
: I ,, „ t , Inspection Line: 503,639.4175 DI 11 C 111ti I S t O N /etc Ready/13y:
w
Internet: ww.tignrd- Or,gov D mile
.. J' /''1w . 111CY1�' �dµ' L7Cr�, �,M .,, A. x.. 4,.x.. .J.,:
.S'n.; :sew .1 �.,� :: np!,. 'SM... rk�i "!, ^, .;i 2 �.. :V T •5 �' y �, /;, A`:•d;
i �.,.�. 3.' .FYI ; a y�✓ q '� (' `" f: r .�. '•�`` �.� I, Ix, /. i/ �y d , ��� 4 ; xl,
+ - :- ^. u '.i � :�. � � ;S; ,�xx 1 .'`.,'�h•, .a }�„ty, i�id f. :''4 � i. �� n: �i �'C ✓i- /t a�',i'A�Ph�'a', 't • 9'A ��:;/ •,L
V- 'y
Please check all that apply (submit 2 seta plans w /items checked MMw):
❑ New construction ® Addition/alteration/replacement
0 Service or feeder 400 amps or more ['Building over throe stories.
❑ Demolition ❑ Other: wham tha available fault catmint 0 Marines and boatyards.
s� r. �b?i F +;`�k'h �� .'ti`• " , ��" a � � ; to !� r^ '' s :i�^ a' >. :',?�' '•et � : � + " exceeds 10.000 amps at 150 vult4 or ❑ Floating buildings.
1 . ,: ! .A .: ,;,...1,2. - , :>: , ;: .: • kv.,. . a -k ' t ; . +1C. ,. ,:;,f x r r>, :C a' �jjc: L,:;'e of % , ", . r ::
loss to ground, or exceeds 14,000 ❑ Commercial-use agricultural
0 1- and 2- family dwelling ® Commercialfmdustlial ❑ Accessory building amps fur all other installations. buildings.
❑ Multi- family ❑ Master builder 0 Other: ❑ Fire pomp. ❑ installation of 75 KVA or
,s -:y:. ,' ,' t t •�. r 1 , ', ,;; r .' , . , . `7n ❑ Emagenuy ayelem. larger separately derived system.
:'
aG, ;;i i;;i s;. 4 : 4: n v i ir..T ?i „'i!' l +'
. .:); ^.� s. r „ �'. ° i . �s:�.�r.r`�maerldct,:inai3: •A ' N''!;; "i, • :b.,r, -:: ?� � �> . � n ❑ Addition of now motor load of ❑ "A', "E" "1.2" "14"
Job no.: Job site address: 100HP or atom. ocdnrpency
15575 $W Sequioa, 130 OSi trmore roaidentielunits. ❑Recreationalvohioleparka.
City/State/ZTP: 0 Health-care facilities. 0 Supply voltage for more than
0 Hnzardnu. loeationa. 600 volts nominal.
Suite/bldg. /apt. no.: 13 0 J roJect name: MCPC ❑ service or feeder 600 amps or mum
CfOS3 street/directions g r � l / .t: : .." r �r : :4 ?. : ' . 0. I:R�f'?+�P,�"' +9:!; ., +Jy/Sr;��"'�''i�'Y'h a u+
�� Y.4 ... 4 � •} " 4• n �1�.1 r - + < Sl at,, ^•'.d. :l•er
Cet/directions to job site: Desaripllon I Qty. 1 Fe . l 'tote i
New residential single- or multi -family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea, add 500 aq. ft, or portion 33.92 1
Tax map /parnel no.:
Limited energy, residential 2
y i..'0.: '
ir" a ; :� ; � '
r1 /' ,.' sti i .� N' /7. J, f '.,-i:.i• ,tl � :;.!,i',. _ "iii' :: 'rr.'
!1):i r<. 7500
,j -, :' ::: :;'. •� :f"";'�, ..'r r�y: ' ,� .��!,. i+� :. ���.. , ,. •.,r. :6•.w' " �Sf�r, :;•s` :: k : � :;�r.. ( with above sq. ft�)
Limited energy. multi- family 75.00 2
Work in telepresence room residential (with above sq. ft.)
Services or feeders lnstallation,alteratlon, and/or relocation
200 amps or less 100.70 2
, .4it.T t ? , 79EZZZALTMLVE igg i" '!, v_.v.yt ;; : 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: 5 Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 snips or loss 59.36 I 1 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps 10400 amps I 1168.54 2 2 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps
BranchcircuIts — new alteration, orextensio , crpanel _
Owner signature: Date: A. Fee for branch circuits with
r.':'tr•. + k' f . - +
1 r_ . , ) Iij'<''4��t�� , ,"�` '� :1� ''+ti� :;:i !'.!i> �.'L:�ks 7.42 2
! i . �M3' ;'' .,;`.. «3 x; :, , 'i.a " above service or fecdcr foe,
e ach branch circuit _
Business name: Johansen Electric B . Fee for branch circuits without
service or feeder fee, first I 56.18 ,)s, 2
Contact name: Charl n Lei f sea branch circuit
- Each add '1 branch circuit 7.42 _ 2
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: Happy Valley, OR 97086 dwelling, service and/or fender 67.84 2
Phone: (5 0 3) 698 -3 417 I Fax; ; (5 0 3) 698 -2 4 8 6 Reconnect only 67.84 2
Pump or imigatiot circle 67.54 2
E -mail:
�; _ _ Sign or outline lighting 67.84 2
rtii4i1; Vii- } "' :%�.Y ii.... irf ..Siir . 7u : : �'iG> :.^'.: S ::P� ", t'r;!: 4 a)" :l i 'J'�. i r * ,::a. : .. "�+ :y':, - ild a r �';,• Signal eirduit(s)or limirodtaalq
Business allele: Johansen E1eCtrlc
panel, alteration, or extension. Pane 2 2
Each additional Inspection over allowable in any of the above
Address: 10948 SE Valley View Terr Additional inspodion(1hrmin) 66.25/hr
City/State /ZIP; Happy Val 1 ey , OR 97086 to veetigation (1 hr min) 66.25 / hr
Industrial plant (1 hr min) 78.18 / hr
Phone: (5 0 3) 698- 3 41 I Fax: (5 0 3) 698-2486 Inspections for which no fee is 9000 / hr
'mil listed 'fibrmin
CCB Lie.: 51539 I electrical Lie.: 3 -243C [ Su rv. Lie.: 2053 2053 : .. ' Y 11: r, . r 4' x' P .-- >x.
��
Subtotal: .
Suprv. Electrician signature, required: � • ,� `^- A Plan review (25% of permit fee):
Print name: Carl `+ • ans - n / Date; 10/29/12 State surcharge (12% of permit fee): 14
/j TO TAl . PFR 1v1If FEE: 2 , 72
Authorized signature' �'j/ am This permit *epitom s+ expire, If a penult to not obtained within 180
days after tt has been accepted as complete.
Prim muse: Char lynn Le i, f son Date: 10/29/12 • Number of inspections allowed pew petmlt.
LltluildinglPormitatALC.PVm1tA. p.doc 07/01110 440-4013T(II/05 /COM4VBP
Z / ' 3DVd 986Z869C0S 9817Z869SO5 ID 'rff MfSMKH01' Wd n:TO ZTOZ'6Z'4o0