Permit CITY OF TIGARD ELECTRICAL PERMIT
s • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00718
T [ G AR L3 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/18/2012
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 250
Project: Common Sense Investments Subdivision: 1996 -048 PARTITION PLAT Lot: 2
Project Description: (1) branch circuit for light fixture
Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES
10948 SE VALLEY VIEW TERR ATTN: N PIVEN
HAPPY VALLEY, OR 97086 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 698 -3417 PHONE: 503 - 624 -6300
FAX: 503 - 698 -2486
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 12/18/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/18/2012 $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 5 -001-00 0. You ma obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. C 322 1
Issued By: Permittee Signature: 0)4 I t pYf �l e4-7
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 ApplicationCEIVED 1'(►R 01-1 . 1. 1 'I (1.I
City of Tigard ratan 1 "`d. ! � r s /Y ''1 P errmt Nn.: aGt�O/a - 0/01"
• • [ ( ` 1 7 � n I �
13125 SW Hall Blvd,. Tigat�d, OR 972230 1 1 iJ
I Phone: 503.639.4171 Pax: 503,594.1960 Faill. co.Perino PAAPJOIJ -00)5i
,‚ . t t: r e Impcctitxtt l.irle: 503.639.4175 CITY %Till A D T d Y: '
Internet: wwW.tigard- er.gnv •+ + VI (( �� iIL (Ul�1fJ
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:
' ,.. i f.1, .;Air l,C4i::J.1�"%''X ''1 ,. �..f. }9 . 55 `
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•,�]. LIN w . ` i.•;.•t „ 3 °V,_ TT c -'�;'. �:....r .. .�i Y, � ,. ,:.. .�t,�i• i ,. ... • �}.+l? 'R�`aAiW -- : • 0 New Construction ". Addition/alteration/replacement . a ' .. y (submit 2 sots of plans shams , -• below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
0 Demolition 0 Other; ,a where the svailahle mall current a Marmax and boatyard'.
t ySli ...,.. ;Ar ,�NI:�,;t1�, S�Y �aVR '� j t7>V7F . 'Y;f j :r wtceads 1(1°1°mil° II 15° "I" nr [] Floatin building'.
❑ 1• and 2- family dwelling ® Commercial /industrial D Accessory building loss u , ie a ll o kV exceeds 14,[100 El h sl•usc agricultural
amps lie all other hultnllaliwla. b
Multi fame 0 Master builder 0 Other: 0 Fire puntp. ❑ Installation of 75 ICVA or
t Ji c e 1i y + ,• e. -. r,;,,.., 0 Ematgetwy a stem, larger separately delved system.
,�y,, a ,v; y . . t y_ 8 Y
S c _
l .�� ' 1 �r. .' �s 1 � Rey ;';.• ❑AdditioaofnowmoMr ❑ "A ", "1 .. 1.2 ", "1.3'•
Job no.: Job site address: 15350 1001IP or more. occupan
S W S gat i o& j 5 0 0 Six or more residential units. 0 Reactances! vehicle parka.
City /State/ZIP: O tloeltb.eero f&edd ies. 0 Supply voltage for more than
0 lla erdous toeationw. 600 volts nominal,
Suite/bldg. /apt. no,: 2 5 0 [Project name: Common sense D Service or Ikeda 600 amps or more.
Cross street/directions to job site: '� `' "I // • t'
J LMaitolM � ' '� reta( r.
-" - Now residential single- or multi - tamely dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 aq. ft. or less 168.54 4
Eft, add'I 500 sq. ft or portion 33.92 1
Tax map/parcel no, - Limited energy, residential
75.00 2
ehoves n
S ::;f7:: :r. r . :L '1V'� r , '7 b?SC`Fail NdP R i 1 :: .. .A.., re.. �' a(.. 6,4
. tlt .)
Limited energy, multi - family
Light fixture residential (with above ay fl.) 75.00
Services or faders Instalatloa,alteratton, and/or relocation
200 amp' or leas 100.70 2
r ; 1': 1. 'r f '- P >•�!: t / .� r «,. . .,: mo t.• } r. >,,�
i' . .>,'f. ; tq � �(' ':,, 1i.1; •,n fi:' ;. ",.r!'1' ;C'','it ':..s55' . �.' , '�:1.,; , 201 amen in 400 am!" 133.56 2
401 amps to 600 amps 200,:4 2
Name:
. 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volt' 552.26 2
City /Statc/ZIP: ' Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) 200 wept or lean 5936 1
201 amp. to 400 amps 125,08 1 2
Owner installation: This installation is being made on property that I own which is not
401 amps in 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701,
Branch ctreults ttew or extension, r panel
Owner signature: _ Date: A. Fee for branch circuits with
�:; + *�! +-�' above amore or feeder fee,
r i +* , x.. ': R :::.' ..<,p7,;. � � . '., � �.' y;,....:41,.:./.!.,- 7.42 2
r r +n:e'r.,: f .,.a •: ., r.. each brunch circuit
Bnsinese name: R. Fee for branch circuits without
Johansen Electric
sct•vicoor feeder fee, first 1 56.18 6.18 2
Contact name: Charlynn Lei f sen branch circuit
- Each add'1 branch circuit 7,42 2
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
City/State/zIP. Happy Valley, OR 97086 lsohmanufacturedurmodular
67.84 2
ppY Y r dwelling, service and /or feeder
Phone(503) 698-3417 I Fax:: (5 0 3) 698-2486 Reconnect only 67.84 2
Pump or irrigation uirclo 67.81 2
y B mall
c Sign or outline lighting 67.84 2
. • , .0 - bh � : i . , `.r. _.j, :` e`t pv -i . i : • :' " i , ; i ^i'`.4 •:14 .: _ , S c knitted-energy
panel, alteration, orexteision. Pape 2
BusinessnamC: Johansen Electric
Each additional Inspection over allowable In any of the above
Address: 10948 SE Valley_ View Terr Addiltenulin� 66.25 /hr
Investigation (1 hr min) 66.25/ hr
City/StatcI7.IP: Happy Valley, OR 97086
Industrial plant (1 hr min) 78.18/ hr
Phone: (5 0 3) 6 9 8 - 34 1 7 I Fax: (5 0 3) 698-2486 Inspections for which no fee is 90 / hr
- s, kali listed le hr min
CCBLic.: 51539 I Electrical Lie.: 3-243C I Suprv. Lie.: 2 05 3 5 , _„„t ,., '. i' :.' .
Subtotal: •
Suprv. Electrician signature, required / (� / / 1 './ Plan review (25% of permit fee): •
Print name. Carl J !/ ri D :12/14 12 State surcharge (12% of pramit fee): 6 . 74
{Y ` '101 A L PERMIT FEE: 6 2 . 92
Authorized signature: �� 'fhla permit appacaturn eaptrta If a permit In not obtained within 180
days after a khaw dpo ponni educosnpkts
Print name: Charlynn Leifsen Date: 12/14/12
• Number of in'.poolions allowed pot permit.
I:1Dalldlaa'PconiticLc- ramltApp doe 07ro1 /10 440- 4615TO 1 r05 /r;r)M/W it
Z /T 'HOldd 98VZ869CO5 98VZ869805 ZOS'IE NESNVHO2 I-1d 5660 ZTOZ'6T'eaU