Permit •. .-
r� CITY OF TIGARD , ELECTRICAL PERMIT
v
is - COMMUNITY DEVELOPMENT Permit#: ELC2015-00037
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/21/2015
Parcel: 2S112DD00200
Jurisdiction: Tigard
Site address: 15500 SW 72ND AVE 100
Project: Nike Vacancy Subdivision: 1994-006 PARTITION PLAT Lot: 2
Project Description: TI work to include:switches,receptacles,lighting,energy management,exit/egress,relamp. 4/15/2015: REPRINT
permit to add(1)branch circuit for HVAC.
Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES LP
16869 SW 65TH AVE, SUITE 311 ATTN: N PIVEN
LAKE OSWEGO, OR 97035 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-747-2503 PHONE:
FAX: 503-972-1861
FEES
Quantity Description Date Amount
9 crt Branch Circuits wo/Purchase 04/15/2015 $115.54
Specifics: Service or Feeder
1 ea 12%State Surcharge- 04/14/2015 $13.86
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $129.40
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 a ��'01 X0.0. You may obtain a copy of the rules or direct questions to OUNC by calling`3.503.232.1987 or 1.800.332.2344. /
Issued By: _ Permittee Signature: M/ /9/7,4 /e,9--/SON
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.
To Page 2 of 3 RECEIVE1)1:1 1 27(GMT) 15039721861 From Charlynn Leifsen
Electrical Permit Application FOR OFFICE t SE ONLN
City of Tigard APR 1 4 2015 Reee,ved
WWI* i Remit No ez.e(2._ois.--_000 27,
IN
-.--" 13125 SW Hall Mid..Tigard,OR 97223,
' g Phone: 503.718.2439 Fax: 503.598. Other Permit
1/GAILD Inspection Line: 503.639.4175 tsITY OF TIGARD rttle:.
Jar's: IiI See Page 2 for
Internet' www tigard-or.gov tified'Methed:
BUILDING DMSICI '0'Rea.'"'" Supplemental Inftwaiation
_____ , . . _ .
TYPE OF WORK ri-IY.4.:;;.,. .-..•:',.:-=-. . • PLAN REVIEW. 1
0 New construction 12rAdditton/alteration/replacement Please check all drat apply(submit 2 sets of plans wirtems checked belosv:
0 Service or feeder 400 amps or more 0 Building over three stories.
1..._0 Demolition (0 Other. where the available fault current 0 Marinas and boatyards
— —
CATEGORY OF.CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
kiss to ground,or exceeds 14,000 0 Commercial-use agricultural
t:11-and 2-family dwelii—Wafif-Commercial/industrial 0 Accessory building amps for all other installations. buildings.
o Multi-family 0 Master builder 0 Other: 0 Fire pumn 0 Installation of ISO KVA or
0 Emergency system larger separately derived system.
JOB SITE INFORMATION AND;LOCATION 0 Addition of new raOlOt load of 0-A","E","1-2",-1-3".
_.
Job no.: Job site address: /LC-572)0 cct,t) 72A.,0 I OM occupancy.
'or more.
0 Six or more residential units.
0 Recreational vehicle parks.
City/State/ZIP: 0 Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: /00 Project name: 14(iLkte ji ID Service or feeder 6')O amps or more.
FEE SCHEDULE
Cross streeUdirections to job site: ,....._
Mattiptlun QtY• r Fvv. T vow -7-
New residential single-or multi-family dwelling unit.
includes attached garage.
----
1 Subdivision: Lot no.: LIMO sq.fl..or less 16834 4
Ea.addl 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: limited energy,residential 75.00 2
• . DESCRIF'TION:(FWORK ... , (with above sq.ft)
,.
Limited energy,inulti-fairuly
4,del i rsess-vdietinitlie al(wih above sq.f ) 75.00 2
‘Erter*_ 'Ir-,See P_me 2
( 6 6/24A/ern e trte-tc,r fr---x.... 1-1-V4 e. fltz. -Ter-7--Services or feeders installation,Ater*ion.- an■-i/o relocation
0 PROFFATIFOWNER 1 0 TENANT g 200 amps or less 100.70
-- 201 amps to 400 amps 13336
Name: 401 amps to 600 amps 200.34
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or tolls 55226 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax.( ) relocation
I
, 200 amps cr les.s 59.361- I i
Owner installation:This installation is being made on property that 1 own which is not _
201 amps to 400 stops 11.11111001 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701.
401 amps to 599 amps 16834 2
Owner signature: Date: Branch circuits-new,altenttion,or extension,per panel
_________ ___
cils'APPLICANT -I- 0 CONTACT PERSON
I A.Fee for blanch circuits with
Shoves a-vice or feeder fee, /
7.42 7, a/ 2 •
• manic:. i L • -f.,--/e, 1,,L ...h brand GiTGUit
,
13.Fm e for branch circuits without I
Contact name: tit a.L.tm, et_, it,...A,...„..„ _ service or feeder fee,fast
-- 56.18 2
branch circuit
Address: /k g 4,f -I$--14.) 6,5 ic „lite_ iii, y Each add'I branch circuit 7.42 2
llaneous(service feedc net Included)Misce or
City/State/ZIP: tee...b 40s1,0e4 0 4'.4‹.. '91 --1Y3 Each manufactured or modults
, dwelling,service and/or feeder 67 84 2
Phone ( Fax: ( ): 4 •--7.17/3" : -.-
_ Reconnect on 67.84 ly
E-mail: . _.__ __. Pump or irrigation circle 67.84 II
. .
--
CONTRACTOR Sign ow lighting 67.84 2
._
Business name: ,..,17w.L Signal cireuiti-s)or limiteu-energ;-1--- See
.Panel?alleratiori•01...5xtension.._._.........._ P.M.5.2.. .
Address: Each additional in , lion over allowable in any of the shave
Additional inspection(1 hr min) 66 25/hr El
City/State/ZIP: Investigation(t hr mitt) hr II
Phone:( ) Fax( ) Industrial plant(I hi lo)n) 78.18/br
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical -•cal Lie.: Suprv.Lic.: 375/4:5 - • listed IA krona
. ELECTRICAL TERMIT FEES --
Suprv.Electrician signature,required: 41,4
Subtotal: I
dr-i
Print name:* ,..lbit 76.2 It je icreit Date: e /41*- - Plan review(25%of pennit fee):
State sumharge(12%of permit fee):
Authorind signaturie/ ----- ToTAL PERMIT FE'..
-
Print name:e.,A ,144,,_ /1/7 .6,1 I Date: g/4//;r- ' on This permit applicati expires if a permit is (t.gi lined within 180
days atter it bas bear accepted as
* Number of inspectiuns allowed per permit
IfiluntStipPotratits,111C PantitApp It ERE.dot,Rev 0572.1.10rA
ettow.yA/A1 —440-46151(11/crYCLIMAVED e4.),„ ,,,,, ,77,73.. F, ,,,,„,,,,„
Yeru- 6--- ) /N1-16&--e77e,v ,s- boNt
e 9 /5//s ,
--gc4/-----
To: Page 3 of 3 2015-04-14 21:11:27(GMT) 15039721861 From: Charlynn Leifsen
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
;:R ltig TL44*(11 ONLY: . ulfit
Fee for all residential systems combined........ $75.00 ut,.
Pmertp Qty I Pty t 7014
Renewable electrical energy systems.
Check Type of Work involved: 5 kva or less fi I 100.700 2
5.01 to 15 kva I 133.56 2
• Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind systems tems in excess of 25 kva:
B• urglar Alarm
25.01 to 50 kva 301.04 2
Ti G• arage Door Opener* 50.01 to 100 kva 552.26 2
100 kva(fee in accordance with 552''6 2
r Heating,Ventilation and Air Conditioning OAF(91
$1-309-00401
__�
Solar generation systems in excess of 25 kva:
System*
F.ach additional kva over 25 7.42 3
E Vacuum Systems* >100 kva—no additional charge tl_0 3
Li Other: Each additional inspection over allowable in any of the above:
Each additional inspection is
charged at an hourly(1 hr min) 66^251 hr 1
Inspections for which no fee is 90.0x/Iv
specifically lide9(1/:hr min)
COMMERCIAL WC#Rk ONL
Fee for each commercial system $75.00 Subtotal:_
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State.surcharge(11%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires ifs permit is not obtained within 180
rA• udio and Stereo Systems days after it has been avxepterl as complete.
Number of inspa:tions allowed per permit.
Boiler Controls
Clock Systems
✓ Data Telecommunication Installation
E Fir- a . t 1nsta : ion
-aa" AC (1/lA
nstrumentation
✓ Intercom and Paging Systems
J Landscape Irrigation Control*
• Medical I D '
Nurse Calls 0 0
C Outdoor Landscape Lighting* `!/"
r P• rotective Signaling /
ri O• ther
Total number of commercial systems: / w,
*No licenses are required. Licenses are required
for all other installations
1:buikiinY'.Rmmiiela('.a mitApp 1 LR_ERE.doi R.v 05!21%2(113
To Page 1 of 3 2015-04-14 21:11:27(GMT) 15039721861 From: Charlynn Leifsen
FAX COVER SHEET
TO
COMPANY
FAXNUMBER 15035981960
FROM Charlynn Leifsen
DATE 2015-04-14 21:11:04 GMT
RE Permit
COVER MESSAGE
I need this back today if possible to get our final inspection tomorrow.
Adding HVAC onto our permit ELC2015-00037, as per inspector.
v t� I
y P
,y
Thank you, v‘ cJ tf.
I 0(
Charlynn Leifsen P
*Secretary/Treasurer*
Johansen Electric, Inc. 0 /
P (503) 747-2503 I F(503) 972-1861
http://www.johansenelectric.com
WWW.METROFAX.COM