Permit (176) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENTIN
Permit#: ELC2017 00330
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/25/2017
T t '" ` ' 9 Parcel: 2S112DD01601
Jurisdiction: Tigard
Site address: 15755 SW SEQUOIA PKWY
Project: Orthopedics Northwest Subdivision: PACIFIC CORPORATE CENTER Lot: 4
Project Description: TI-(12)branch circuits
Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES LP
16869 SW 65TH AVE, SUITE 311 ATTN: N PIVEN
LAKE OSWEGO, OR 97035 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-747-2503 PHONE: 503-324-6300
FAX: 503-972-1861
FEES
Quantity Description Date Amount
12 crt Branch Circuits wo/Purchase 05/25/2017 $137.80
Specifics: Service or Feeder
1 ea Plan Review Electricial 05/25/2017 $34.45
Type of Use: COM 1 ea 12%State Surcharge- 05/25/2017 $16.54
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $188.79
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law, All work will
be done ' accordance . 'th approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. TENTION: Orego law equires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 1-0010 through OAR 9^ •01-0 Os 'ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.3 344.
)/
Is ued By: _ / �� Permittee Signature: ,/t0 1.1.) / v,
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' < f y Date:
LICENSE NO. ---t--
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application FOR OFFICE USE oNLy
City of Tigard RECEIVED Date/Bed D� 4 /7 if &Z/?--0O337
Permit 6: EL
III 'I 13125 SW Hall Blvd.,Tigard,OR 972 PlanRevie
Phone: 503.718.2439 Fax: 503.5„1,9,60 8 DateBy:Date
l Related Permit#:
Inspection Line: 503.639.4175 /'�r 2017 Ready Date y: S7 /,,, Jurir. H See Page 2 for
TIGARD Internet: www.tigard-or.gov Notified/Method: �/ Supplemental Information
117 1775 _ I 9 ;"7 `
0 New construction ®Addition/alteration/r p • - -*I` Please check all that apply(submit 2 sets of plans w/items checked).
❑Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current ❑Marinas and boatyards.
CATEGORYOFF pt.i$T � • exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
AttiplIIIRIFII!!iili!:ii;:i!;;0431*70: 116:NlEIlli:04.00.$11141Emergency system. larger separately derived
0 Addition of new motor load of system.
Job#: Job site address: 15755 SW Sequoia Pkwy 100HP or more. ❑"A","E","1-z",°°I-3",
City/State/ZIP:Portland,OR 97224 ❑Six or more residential units. occupancy.
Ty D Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Orthopedics NW ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: BININERIIM1111111111:1024.0111111,141,11
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRQ00 OP:WOR „ Limited energy,residential
75.00 2
Tenant Improvement (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
See Page
0 Q1T ' Renewable Energy
,. . • :`1 R ° N� ; Services or feeders installation,alteration,and/or or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: _ Date: 401 amps to 599 amps 168.54 2
,i:�, 6 a c • 'EM T 'E n,or extension,per panel
Branch circuits—new alteratio
A.Fee for branch circuits with
Business name:Johansen Electric,Inc. above service or feeder fee,
each branch circuit 7.42 2
Contact name:Charlynn Leifsen B.Fee for branch circuits without
Address: 16869 SW 65th Ave,#311 service or feeder fee,first 1 56.18 56.18 2
branch circuit
City/State/ZIP:Lake Oswego,OR 97035 Each add'I branch circuit 11 7.42 81.62 2
Miscellaneous(service or feeder not included)
Phone:(503)747-2503 Fax: :(503)972-1861 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:office@johansenelectric.com
• Reconnect only 67.84 2
c T , .I , ,. Pump or irrigation circle 67.84 2
Business name:SAME Sign or outline lighting 67.84 2
Signal
Address: panel,alteration,oor extension.
0 See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) I Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
90.00/hr
CCB Lic.: 51539 Electrical : 43C I Suprv.Lic.: 5378S specifically listed(%hr mm)
, cT ,,. Ogg . M
Suprv.Electrician signature,required:`.A - Subtotal: 137.80
Print name: Jonathan Johansen _ Date: 5/8/17 0 Plan Review Required(25%of permit fee): 34.45
State surcharge(12%of permit fee): 16.54
Authorized signature: L�/ TOTAL PERMIT FEE: 188.79
This permit application expires if a permit is not obtained within 180
Print name: Charlynn Leifsen Date: 5/8/17 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELCPermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15755 SW SEQUOIA PKWY, LAKE
OSWEGO, OR
Record Type: Record ID:
Commercial - Electrical ELC2017-00330
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor