Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2008 -00659
COMMUNITY DEVELOPMENT
DATE ISSUED: 12/2/2008
TIGARD,, 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S113AA-00700
SITE ADDRESS: 16436 SW 72ND AVE B5 ZONING: I -L
SUBDIVISION: OREGON BUSINESS PARK I LOT : OOD JURISDICTION: TIG
PROJECT: JK SERVICES
Project Description: TI.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVCI FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: 8 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
PACIFIC REALTY ASSOCIATES JOHANSEN ELECTRIC INC
15350 SW SEQUOIA PKWY #300 -WMI 10948 SE VALLEY VIEW TERR
PORTLAND, OR 97224 HAPPY VALLEY, OR 97086
Phone: Contact #: PRI 503 - 698 -3417
FAX 503 - 698 -2486
FEES
Description Date Amount Reg #: ELE 3 -243C
[ELPRMT] ELC Permit 12/2/2008 $133.50 LIC 51539
[TAX] 12% State Surchar 12/2/2008 $16.02 SUP 2053S
Total $149.52 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: i � 'ermittee Signature: / ' •
'• WNER 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'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
. i K
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Electrical Permit Application `� 1.0k iiii i. I `l: t).1.,
City of Tigard ��� �- . ,
13125 5W Hal] Blvd., Tigard, OR 22 t' • :
J Phone: 503.639.4171 Fax: 503.598.1960 v (, (�P a Other Pamir:
1:I Inspection Line: 503.639.4175 `�`� a See Pap 2for
Internet wwvti trgard or.gov K am O
! ` `\ t I Supplemental Information
,r t � t u,:,w a � :d => v �a� I ` 1I !� � °fi t lt�C� i t I 1 S i h. +i i r t � F r + :Ii� „r
2� 1l. ;tit lJ,6 Y( ...` 1 t }, Ilti rii ,�''!`,il II $l ?o 0 .. ', `i I.. Id, (y 1 �, ' _ , ,? f,;e1 i t ji d 1 a . , !t t n • t4, l iiii�1 ,'
❑ New construction ra Addition/aItemtiodlWement Please check all thee apply (submit j sets of plans wfitems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition
❑ Other: where the available fault current ❑ Marinas and boatyards.
$ml'i h .l-al { yfi" ; NI, 4:4 f " :a•, 1e " 3 >rr . y r le g . +f ear ‘1:1,,,,,.,:i.:1.1,,, exceeds 10,000 amps at 150 volts or ❑ Flo buildings. o- 4''':"-".',:.41,•` 3.1', ', . 1. IWr -,., , -!'. t, i :'b f 7 ,1, :''z .ir 31 : ,,Ip4.',.. aQ�P Floating s.
, $
1 -and 2-family dwelling less to ground or exceeds 14.040 In Commercial-use agricultural
❑ y g 21 Commercial/industrial ❑ A ccessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KV A or
, .1''' i 4'x t . y. , a. I ❑ Emergency system. larger separately derived system I'i i )5 `r .. I !': t.1 km m Ir .,, ; r • i! rld I N 1 ' ' : : : ,t., f , � .. " � � r : : .. .. ❑ Addition ofnew motor load of ❑ "A „ E" . `1 - 2 .... 1 - 3 ..
Job no.: I Job site address: 16436 SW 72nd 100HP or mare. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ® Health - care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: JK Services ❑ Service or feeder 600 amps or more
.il i { '.l x, {>•i : 3? ` "',, tl l kat °. ` tt' iV`
Cross street/directions to job site: D escription ` Qty. I Fee Total 1 , •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no
1 , � , � ,... n t 1 F Limited energy, residential 2
1 1 0 - l :tt'ji;f { ,1l1 Rtl' 1l C Ori . ti yit:1.,7';1, F, 111 "(�1i :lip (with above sq. a.)
Limited energy, multifamily 75.00 2
Tenant Improvement residential (with above sq. a )
Services or feeders imstallation,alteradon, and /or relocation
' ,! _ s 200 amps or less I 80.30 $t�. ,D 2
+f�f , :Ji:, -1,i n611Ci i iiig# „1�i3:iiiirtill ,-, alit 1 1 , 'ii ' ii" 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less I 66.85 I 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps I 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date:
A. Fee for branch circuits with
,jl k 4q s `lm * T i;+r d�T : r s, t t. t, , +.: i.,F abo service or feeder fee,
u 1 4 t . f r , �^ r 1
0 :.17i7s mil% m a ,> g 6.65 53,20 2
each branch circuit
Business name: Johansen Electric Inc. B. Fee for branch circuits
Contact name: Charlyna Leifsen without service or feeder fee 46.85 2
fast branch circuit
Address: 10945 SE Valley View Terrace Each add'1 branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Happy Valley, OR 97086 Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: (503) 698 - 3417 I Fax: : (503) 698 - 2486 Reconnect only 66.85 2
E -mail: johansenelect®men.com Pump or irrigation. circle . 53.40 2
l I;'t`tiii.f le . 4' , ,... - 1 1 ; ,t t : tr,.;1 , . 1 IL' 1; `droller aF tIc1r ..;,; i , - ,, i _ t - ... die,.; , . ` e .,'i1;1 Sign or outline lighting 53.40 2
Business name: Johansen Electric Inc. e p a e r limited-
energy panel, alteration, or
Address: 10948 SE Valley View Terrace extension. Describe: Page 2 2
City /State/ZIP: Happy Valley, OR 97086 Each additional inspection over allowable in any of the above
Per inspection 1 62.50
Phone: (S03) 698 417 I Fax: (503) 698 -2486 Investigation per hour (R hr mm) 1 62.50
CCB Lic.: 51539 1 Electrical Lic.: 3 - 243C I Suprv. Lie.: 2053S Industrial plant per hour 73.75
.,,,'.
'.: Yl ;Ar".r r ,, r iiP..E.:O.J 13. 0.S14i 1ffie : :; , l, ill I;
Suprv. Electrician signature, required: _ /f Subtotal: '33.
Print name: Carl K. Johansen f �,e ate: 12/2/08 Plan review (25% of permit fee):
State surcharge (12% of permit fee): Up . O Z
Authorized Signature: 1' TOTAL PERMIT FEE: 14' • 51,
Print name: Churl nn J. Le ifsen Date: 12 2 0 8 This permit application expires if a permit is not obtained within 180
Y days after it has been accepted as complete.
• Number of inspections allowed per permit.
1.1 Build,ng\ Penniu\ELC- PerminApp doe D5123/06 440- 46157(11/051COM/WEB
I . d XE=d 13C213Sdn dH Wd9 T :2 T BOOZ 20 pea
_ . _.—.. ‘. ...
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: FLC20013-00659
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/2/2008
Phone: (503) 639-4171 al ', !• ' i l i? '
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 2/3/2009 TIME: 7:00AIVI PAGE: "I 1
SITE ADDRESS: 16436 SW 72ND AVE 35 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK I LOT #: OM TYPE OF USE:
PROJECT NAME: ,jk. SERVICES
DESCRIPTION: TI.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: JOHANSEN ELECTRIC INC • PHONE #: 503- 690- 3417
Inspection Request Scheduled For: Date: 2/312009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 000237-02 03 969-5262 N
Corrections/Comments/Instructions:
I ft'
l a PASS
..a 0 PARTIAL APPROVAL • 0 CANCEL 0 NO ACCESS
fl , 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: GI NO6 LL Date: 1/ c t Phone #: (503) 718- VI
i