Permit •
4 CITY OF TIGARD ELECTRICAL PERMIT
114 a, • COMMUNITY DEVELOPMENT Permit #: ELC2013 -00047
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/04/2013
Parcel: 2S112DD00701
Jurisdiction: Tigard
Site address: 15800 SW UPPER BOONES FERRY RD 400
Project: The Upper Cervical Clinic Subdivision: 1994 -006 PARTITION PLAT Lot: 2
Project Description: (1) service and (6) branch circuits for health care facility
Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY TRUST
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:
FAX: 503 - 698 -2486
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 02/04/2013 $100.70
Specifics: amps or less
6 crt Branch Circuits w /Purchase 02/04/2013 $44.52
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 02/04/2013 $17.43
Electrical
Type of Const:
Occupancy Grp:
Total $162.65
Required Items and Reports (Conditions)
This permit i . •'ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done ' accordance wit' app • _ • 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. TENTION: Oregon , =w requi • you to follow the rules adopted by the Oregon Utility Notifi - e ter. Those rules, are set forth in OAR
952 -00 - 0010 th ugh OAR 9 •' 1 -00/ • may obtain a copy of the,rules or direct questions to OUNC b calli • • . .:7 or 1.800.332. •44.
Issu d By: _ L ■4 Permittee Signa re: , .����tVr 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: 4//
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 Appli v: Itq. E IVED FOR OFFICE USE ONLY
City Tigard ' JAN 2 2 201
lig Ci of Ti and Received Date/By. / OP" / f i( Permit No.: e�Rpysi 7
• ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review �� -
z ` '� Other Permit: /( nnom�`a
Phone: 503.639.41 Fax: 5 Date/By. t! / / D �7 f �"7 A
Inspection Line: 503.639.4125 `G� TI Date Ready/ ru ns:
'' `t° U DIVISION y 1 ,! 6.3 ® see P l I n
Internet: www.tigard- or.gov ! Notified/Me `t ' Supplemental Information
TYPE OF WORK ^ 1 '7111 4 ti 1 ' '° g'
PLAN REVIEW
❑ New construction ® Addition/alteration /replacement Please check 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: when; 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
❑ I- and 2- family dwelling ® 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 - ", "1 - ",
100HP or more. occupancy.
Job no.: Job site address:
15 800 S W Upper Boone s ❑ ix or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 400 Project name: Upper Cervical Clinic ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Descrlpuon I Qty. I Fee. I Total 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'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
Tenant Improvement residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation _
200 amps or less 1 100.70 2
❑ PROPERTY OWNER I ❑ 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
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
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, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT I ❑ CONTACT PERSON above service or feeder fee, fr 7.42 2
each branch circuit
Business name: Johansen Electric 13. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Charlynn Le i f sen branch circuit
Each add'I branch circuit 7.42 2
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
Valley, a OR 9 7 0 8 6 Each manufactured or modular
City/State /ZIP: Happy Y r dwelling, service and/or feeder 67.84 2
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. Page _ 2
Each additional inspection over allowable in any of the above
Address: 10948 SE Valley View Terr Additional inspection (1 hr min) 66.25/hr
City/State /ZIP: Happy Valley, OR 97086 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 698-3417 Fax: ( 503) 698-2486 Inspections for which no fee is 90.00/ hr
specifically listed ('h hr min)
CCB Lic.: 51539 I Electrical Lic.: 3 C Suprv. Lie.: 2053S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: etck /C o Subtotal:
Plan review (25% of permit fee):
Print name: Carl Johansen Date 1/22/13 State surcharge (12% of permit fee):
TOTAL PERMIT FEE: 1; Oa ( S
Authorized signature: This permit application expires lf a permit b not obtained within 180
days after It has been accepted as complete.
Print name: Char 1 ynn L f s en Date: 1 /22/13
• Number of inspections allowed per permit.
l:\ Building \Permits\ELC- PermitApp.doc 07/01 /10 490- 4615T(11/05 /COM/WEB