Permit 11 CITY OF TIGARD ELECTRICAL PERMIT
1 1 1/ 1- COMMUNITY DEVELOPMENT Permit #: ELC2013 -00437
Date Issued: 07/25/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 7/25/2 D03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 350
Project: Williston Finacial Group Subdivision: WEST PORTLAND HEIGHTS Lot: 9 -25, PT
Project Description: (10) branch circuits for interior TI - expanding into adjoining space. •
•
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:
FAX: 503 - 698 -2486
FEES
Quantity Description Date Amount
10 crt Branch Circuits wo /Purchase 07/25/2013 $122.96
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/25/2013 $14.76
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $137.72
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 9 - 1 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
Issued By: _ Permittee Signature: D4( ( 6 G/ e�TON
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 603.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept In a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit A lice CE1VED FOR OFFICE 1.51.1 0 \i,1
City of Tigard D o01 71ringral Permit No. LC —de; 3 J
• 13125 SW Flail Blvd., Tigard, 97?JL 2 5 2013 Plan Review
I , O
Phone: S503.639.4171 .G39,4171 Pux: 503.598.1960 Ihdd/14 : OtharPenni„ a/O / 3— /7�
Inspection Line: 503.639.4175 CITY OF TIGARD
I MM ® See Ng" z for Internet: www.tigard- or.gov 0 see .Pa nemnl Information
lyckr arrori
❑ New construction E Addition /alteration /replacement Please check all that apply (submit seta of plans w/itema ch below):
El Demolition ❑Outer, 10 Sarvise or fonder 400 amps or more In Building over three stones.
Demolition _ whom the available fault current ❑ Marinas and boatyards.
' .` CA''1`]tWR'Y :0i"- Cif($' JJ ON . " : exceeds 10,000 amps at 150 volts or lJ Floating buildings
Ion to 'Tamil, or exceeds 14.000 ❑ Commercial -use agricultural
C11 and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder 0 Other: ❑ Fire pump, ❑ Installation of 75 KVA or
IJ;StY7It' IN1+0kh?,4[)<Ol+i °A3d1D 7y1DCATIQN'. ❑Emergencysyatcm. la•ger separatelyderivedsystem.
YO
❑ Addition anew motor load of ❑ A "'•F" "1 -2" "1 -3"
Job nn.. Job site address: I Aga, %L/ /��p �t� � ,J 1n in. morn occupancy.
get) If/ `a n �/ (�l ❑ Six nr m m ra dnniinl units. ❑ Recreational vehicle parks.
City /State/ZIP: P' ❑ l leelth.cata facilities„ ❑ Supply vuHnge list MOM Item
❑ Hurwdnux In°ationa, 600 volts nominal,
Suite/bldg. /apt. no. J Project name: 1 / / / / , ❑ Servi or feeder 600 naps or more.
Cross street/directions to job situ: o.$wroto a Peer. I . / Turat
J •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: J Lot Ito.: 1.000 sq. ft. or Ica; 168.54 4
Fu. add .500 so. ft. or portion 33.:12 1
Tax map /parcel n0.: Limited energy. residential
7500 2
(with .... (w e y. n.)
. ....... .... .. v
�Limited energy, multi - family 75.00 2
ree /n pai n // , residential (with above sq. ft.)
'�°'�� Services or feeders installation, alteration, and/or relocation
200 amps s or leas !00 70 2
,_, . { P
1
- : .. � .., _ ' d ' 'llyRfl'�►�lifr'Y'(fW1VER.• .... .
, ,- ;� '' D. 201 amps to 400 amp; 133.56 2
Nome, 40 t amps to 600 amps 200.34 2
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: ( ) I Fax: ( ) 200 amps or loss 59.36 1
Owner installation: This installation is being made on property that I own which is not — 2u l amp.. to 400 saga 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. ail l amps In 599 amiss 168.54 2
Branch drtuite— new, alteration, or extension, per panel
Owner signature: Date: ..__.. _ . . . _, A. Fee for branch circuits with
APP7.ICAiVT,•: i : , service or feeder foe,
t U1d1'3ACT,1? , • '' � l i orch brand circuit 7.42 2
Business name: Johansen Electric 11, Fee for branch circuits without
service or feeder too, first ) 5(; l R �/ I /p 2
Contact name: Charlynn Lei f sen branch circuit . (P D
Each add - 1 branch circuit i 7.42 64 „ •7g 2
Address, 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
City /StaterzlP: Happy Valley, OR 97086 Eechmaaufeerorod
PPY Y r dwelling, service and/or feeder 07.84 2
Phone, ( 503) 698 -3417 I Fax:: (503) 698 -2486 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
— Sign or uuttine lighting 67.84 2
' . •CO1qRACTOR a .. Signal circuit(e) or limited - energy
13usincssname: 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 (1 hr min) 66.25/hr
City/State/ZIP: Happy Valley, OR 97086 investigation (I hr min) 66.251 hr
Induslriul plant (1 hr min) 78.18/ hr
hone: (5 0 3) 6 9 8 — 3 917 I Fax: (503) 698-2486
Inspections few which no leer is
80,00/ hr
C CB Lie.: 5153 9 I Electrical Li C.; 3-243C I Suprv. Lie.: 20535
- specifically listed ('/d hr min)
�� 4. 1/ n k (41,4440,84.4.4.1 S alt fe e): � r 5 Suprv. Electrician signature, rcquilrxl: Plan review (25% lxmmit foe);
Print name: Carl J hansen Date: 7/25/13 State surcharge (12% of permit fee): not obtained within 1 /y /y .7 ,
Authorized signaturo' c TOTAL AL P> RMI I' PPE: �� /r 7.2 Thls Permit application expires lire permit is 110
days after It has been accepted as complete.
Print name: Charlynn L i sen Date: 7/25/13
• Nuanher of inspoes. x allowed t ear permit.
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