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Permit CITY OF TIGARD ELECTRICAL PERMIT 3'-! ° . COMMUNITY DEVELOPMENT Permit#: ELC2013-00462 Date Issued: 08/06/2013 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S113AB00600 Jurisdiction: Tigard Site address: 16165 SW 72ND AVE Project: CCK Restaurants LLC Subdivision:COUNCIL VIEW ACRES(LOTS 21-44) Lot: 30 Project Description: (10)branch circuits for TI Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES LP 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 08/06/2013 $122.96 Specifics: Service or Feeder 1 ea 12%State Surcharge- 08/06/2013 $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 - 0 90. Yo ay 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: 04/ 19'/'9,4-i eV-77 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 AiDlicatic G 1 2013 FoR erne t: l si•:()NIA City of Tigard IIteawivod G© :._ ('cnnit No . •/3 —OO 6 13125 SW Hall Blvd.,Tigard,C619 TIGARD , - Phone: 503.039.4171 Fax: fef:il(;pG DIVIcalr& EiSIMMINIIIIN OUwrPeri_.r , / 3%O I i I i l ('t htapecl1011 Lair; P+t)3,63').41 Date Ready/By. MI&o Paso 2 for Internet; WWW.tiganl-ar.gov Notified/Method; MI Supplemental Information . `, TY,PB of.WORK PUN,'t0VIEW', ❑New Construction CJ Addition/alteration/replacement Picas:check all that apply(submit E nets of plans w/items thanked below): ❑Service or leader 400 amps or wee ❑Building over throe stories. ❑Detnolition ❑Other: whom the available Muir current ❑Marinas and boatyards. 'CA,TKOONl`:,'OF'COiOri Y; ON exceeds 10,000 amps at 150 volts or ❑Floating buildings. 1-and 2-family dwelling -' ' - lets to ground,in exceats 14,000 ❑Ccnmmeroinl-use agricultural ❑ y ing El Conunercial/industrial ❑Accessory building amp for all other installations, buildings. ❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 75 KVA or Jcbll:91'1'E sIRV 9F14e`I11ON;•ANA 1,OCATION Fm• argarlcy.yvtum, larger separately derived system. ..... tt ' ❑Addition renew muter load of ❑"A","C""1-2""1-3" yJoh no.: ` Job site address: 16165 SW 72nd 100HP or more. occupancy. ❑Six or more re:RW*1liel units. ❑Itocrsatienal vehicle parks, City/Stato/ZIP: ❑Health-aacfacilities. ['Supply voltage for mote that ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt,no.: Project name: CCK Restaurants IJ Service orfccdcrti00 snips or atone. Cross strcot/directions to L ob site: flE BCHEW71:)1 J Description ) Qv, I rev I Total 1 , New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision: I Lot no.: 1,000 nq.ft.or loss 168.54 4 Ea.odd•'500 sq.ft.or portion 33.92 i Tax map/parcel no.: l.imitttunargy,residential . . .. 7s.(xt �. .,:.: . . ' - '. >.:.r:DSBCON 0A-,3iVtQ�i(.;' ':,'. .. :.; `' (with obeys so.ft.) I,imitnd energy,multi-family 75.00 2 T I residential(with above.sJt.It.) Services or feeders installation,alteration,and/or relocation 200 amps or less 100.70 2•`-.'.'.i.PROP*`1',X OWNER t'.;`' .'.,:.;- .,'::all11LAN'h::.,,.• :...... 201 amps to 400 amps -.- 133.56 2 Namc: 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 _2 Address: Over 1.000 amps or volts 652.26 2 City,c, ./7LP; Temporary service*or feeders installation,alteration,andlor _ relocation Phone:( ) - Fax:( ) 200 amps Or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation:This installation is being made on property that I own which is not intended for sale,'vise,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 579 amps 165.54 2 Branch circuits-new,alteration,or extenslon,rier panel Owner signature: Date: A.Too for brunch circuit,with b f . above service or ceder fee. 9,A'R>'IGl<CMr'. :.. p:VONrac°r$8,84 : 7.42 2• "' ' ' ' � ' "• � - - �� - � �'• �� mob brunch uiruult 01'ceforbranoboircuitawirbout 8usincssname: Johansen Electric A .service r,r Collar foe,first i 51'.18 G it 2 Contact name: Char l ynn Le i f sen 1 brnnuh circuit �/6 Each add'I branch circuit / 7.42 46,7g 2 Address: 10948 SE Valley View Terr Miscellaneous(service or fender not included) Each City/State/ZIP: Happy Valle OR 9 7 0 8 6 dwelling,in ,service a or modular 67.84 2 PPY Y r dwelling,serviv0 and/Or feeder Phone:(503) 698-3 417 Fax;;(503) 698-2486 Reconnect only 67,84 2 ■ Pump or irrigation uirvlo 67.84 2 E-mail: Sign or outline lighting 67.84 2••° 1: •• - -. Signal circuits)or limited-energy Business name: Johansen Electric peneLalteration,orextension. _ Page _ 2 Each addidonal inspection over allowable In any of the above Address: 10948 SE Valley View Terr Additional inspection(1 hr min) 66.25/hr Investigation(I hr min) 66.25/hr City/Staie/ZIP: Happy Valley, OR 97086 Industrial plant(I hr min) 78.18/hr Phone:(5 0 3) 698-3417 Fax:(503) 698-2486 Innpeetinna for which no fee is 90.00/hr specifically liated.0 hr min) CCB Lie.: 51539 Electrical Lic.:3-243C [ Suprv.Lie.: 20535 •..: E1;ECnRIC ''1.,P, B$ ',:' . .,; ',: Subtotal: l 'j-141* Suprv,Electrician signature,required: _ (25% permit fcc): �--� Plan review 25%of Print name: Carl Jol&ansen Date: 8/1/13 State suitharge(12%of permit fee): 4/, Xe TOTAL PERMIT FEE: /39,72 a/ Authorized signature: ((( _ Tits peiui apptkatlon asplrea If a pews'rnis rwtt obtained within tan days after him*bens accepted as complete. Print value: Char 1 yen Lei f S en Date 8/1/13 • Number of inspections allowed per permit. l:ltll nldlns■'rrmitaeLC-pumitApp.do,:Ova 1/10 444)-46151111/05/COMAVIiii Z /T -rive 9817Z869E09 98VZ869E0S I3 IZ NaSNVHO2 p ZE=TT ETOZ-TO -bnv