Permit CITY OF TIGARD ELECTRICAL PERMIT
2 r i COMMUNITY DEVELOPMENT Permit #: ELC2013 -00447
Date Issued: 07/30/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 270
Project: Williston Subdivision: WEST PORTLAND HEIGHTS Lot: 9 -25, PT
Project Description: (2) branch circuits for workspaces
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:
PHONE: 503 - 698 -3417
FAX: 503 - 698 -2486
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 07/30/2013 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/30/2013 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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- - 0. Y ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 21 Permittee Signature: 6 A/ /97 / L O '
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.
RECEIVED
Electrical Permit Applicatiplit lt ctrrlrh: (.�h. v�1.)
U l
City of Tigard R �p� uate,..te/b vud
: 7 J •cnnitNo &-�� DD/
. i' M 13125 SW Ilan Blvd.,'figar i {'j • TIGARD Plan Review
Phone: 503.039.4171 P t y 0 nate/B : Other Permit: l' 1 t ; ,. l; l , Inspection Lint:: 503.639 I ' DIVISION Date Ready /By: / ® Nee Page 2 far
Internet: www.tigard- or,gov Notified/Method: Supplemental Information
. TYPE OF WORK ' ' .. PLAN REVIEW • • •
❑ New construction ® Addition/altcration /replacement P en..e cheek n11 that apply (submit 2 sets of plans w /items checked below):
❑ Demolition O Service or feeder 400 amps or more ❑ Building over three stories.
❑ Other: whore the 6v fault current 0 Marinas and boatyards.
CATEGORY 'OF` CONSTRUCTION ' • � • uxueJa 10,110(1 alllpx at 150 robs or 0 Floating buildings,
less to ground, or exceeds 14,000 ❑ Commercial -use agricultwal
❑ 1- and 2-family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
El Multi - family ['Master builder ❑ Other' ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Gmergency system. larger sepaatdy derived system.
❑ Addition anew motor load of ❑ "A" "E" "1-2", "1.3"
Joh nn.: Job site address: 12 9 0 9 SW 6 8t [] 100HP or more occupancy,
Six or more residential units. ❑ Reureationul vehicle parks.
7 ty /State/LIP: ❑ Hetlllh care tit 0 Supply voltage for more than
--••
Dl lazarduus locutions, h(m vpu nominal, no.: 2 7 0 Project name: Williston ❑ Serv Or fender cilities. 600 amps or more.
FEE SCHEDULE .. '
Cross street /directions to job site: Description J,9 I Fee. I Total 1
New residential single- or multi -family dwelling unit.
—__ Includes attached garage.
Subdivision: Lot no.: 1.000 aq. ft. or less 168.54 4
En. ndd'I 500 sq. a. or portion 33.92 1
Tux map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK' . , • (with above se. R.) 75 - Y 2 '
Limited energy, nudti•fantily 75,00 2
furniture work it) O k( - (E residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or lam 100.70 2
' C1 PROPERTY 'OWNER I • . 0 TENANT : 2M iunps to 400 amps 133.56 2
Name:
401 amp. to 6011 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 umps 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
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, )ease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT I 0 CONTACT .PERSON abor service or feeder tee, 7.42 2
each branch circuit
Business name: Johansen Electric B. Fcc for branch circuits without
service or feeder fee, fort 36.18 2
Contact name: Charlynn Leifsen branch circuit
Each add'l branch circuit 7.42 2
Address: 10948 SE Valley View Terr _ Miscellaneous (service or feeder not included)
City /state /7_IP: Happy Valley, e OR 9 7 0 8 6 Each manufactured or modular 67 84 2
PPY Y dwclltn 1 .v vice and /or feeder
Phone: (5 0 3) 698 Fax::(503) 6 9 8 - 2 4 8 6 Reconnect only 67.84 2
E Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
C ONTRACTOR Signal circuit(s) or limited- energy •
Business name: Johansen Electric panel, nitenttion , urextension. Pagc2 2
Each additional Inspection over allowable In any of the above
Address: 10948 SE Valley View Terr Addilionol inspection (1 hr min) 66.25/ hr
City/State/ZIP: Investigation (1 br min) 66.25/
i
ri Happy Valley, OR 97086
Industrial plant (1 hr min) 78.18/ hr
p/
hone, (5 0 3) 698-3417 Fax: (5 0 3) 698-2486
Inspections for which nu f is 90.00/ hr
specifically listed (Vi hr min)
CC13 Lic.: 51539 Electrical I,ic.: 3 -243C Suprv, Lie.: 20535 .
' ' 'ELECTRICAL. PERMIT FEES—: _ .
� (//{ Subtotal:
Suprv, Electrician signature, Ie g6 , 4r -
Plan review (25% of permit fee):
Print name: Carl Jo ansen hate: 7 / 2 6 / 13 State surcharge (12 %u of permit fee):
Authorized signature; x IOTA I, PHRMI'I' FEN: e 023 L.-- Thta permit application expires Ifs permit is not obtaine within 180
days after It bin been accepted as complete.
Print name: Char n Leifsen Dam 7/26/13 . Number of inspections allowed per permit.
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