Permit lig °
CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2009 -00039
_ ° __ COMMUNITY DEVELOPMENT DATE ISSUED: 1/27/2009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S101 AD 03200
SRE ADDRESS: 12909 SW 68TH PKWY 430 ZONING: MUE
SUBDIVISION: TIGARD TRIANGLE CENTER LOT : JURISDICTION: TIG
PROJECT: SPEC SPACE
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: SIGNAUPANEL:
MANF HM/ SVCI FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 7 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 1/27/2009 $93.40 LIC 51539
[TAX] 12% State 1/27/2009 $11.21 SUP 20535
Total $104.61 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 one 'n accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspende • or more tha 80 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center.
Those r es are set forth in ! • • _ - 001 -0010 through OAR 952 -001 -0100. You may obtain copi hese rules or direct questions to OUNC at
503.24:.669 9 • r 1.800.33 . -{
Issued = : ' Permittee Signa ure: 119-t----
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:
- • NTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: , - ( • '
.%ri' tc- 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.
Electrical Permit A LE CEIVED F(11< (ll : i1 1 �':'! ".ti
City of Ti and Received to
13125 SW Hall Blvd., Tigard, OR 9 '^ 12 2 7 2009 > Review 7 `� }� Ponait No.: F g00 Qar)
. - Phone: 503.639.4171 Fax: 503.598.1960 Dar .: : Other Perm:
II ,,; ;, I , Inspection Line: 503.639.4175 CITY OF TIGARD Date >/Ety: Ism. , . See Page 2 for
Internet: www tigard- o r.gov Notified/Method: /
t !! ������ `^) � Supplemental Information 11 7
{, kii:111 ti'iy5.�114 ,.N; I l f� ^ ,T dY. ,t t lt2..010 71' `sr 7 t J f nsner.ta Zc iser I• afa f VAMP'. �. ,.' r t. 1fa+F. "a'4 > 4+iliati,.`,: ; A. IC A.
,1 9 , :) r -, Al l, ) 101 :itt i } ; f 4 f14 ;'.,4 vE.. I F., D ia 1 A � �� F •' mot
❑ New construction ® Addition/ alteration /replacement Please check all that apply (submit 1 sets of plans w/items checked below):
ID Service or feeder400 amps or more ❑ Building over three stories.
❑ Demolition ❑Other:
where the available fault current ❑ Marinas and boatyards.
1 •'�,41:'''i , 1 .: f, 'y .' "i, 'i sk 2 a• x`i y � "� is5 i+ �( I r! buildings.
t I .. I : :;. ti ;is ' ritA i ud ►�i 1Fu d+,dtL1{ 7u ii o,6t+IMl lj1 . t. a ea. `' less to grand exceeds 10,000 or 150 volts or Float' bu exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ®ColrlmeroiaUindustrial 0 Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
l�j�l �pI II '{xt :::.: u r x re,s xtr ,ea ( , . 7 . , , , . ❑ Emergency system. larger separately derived system
' tii �N ( I f, Ir.. mini: a':%iu�aal(.� tw�lr l ; , ,.,a_`ir'•.t: + 1 9� �,`iL t Addition of new motor load of
Job no.: Job site address: 12 9 0 9 SW 68th Pkwy 100HP or more' occupancy.
❑ Six or more residential units. ❑ Recrcational vehicle parts.
City / State/ZIP: ❑ Health - care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: 430 I Project name: Tri angle Spec Space 0 Service or fcedcr 600 aznps or more.
T o t
JI , Ic[uWl N .Y,IM„ 1•."°9Ltat..,)'� i 1 V
Cross street/d rections to job site: Description � `.i . • .
qer. rte
New residential single- or multi - fancily dwelling unit
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. tt or portion 33.40 I
Tax map/parcel no.:
above it 75.00 2
WEB! r. ,n,. t�NeN,N,. _ Limited energy, residential
33 t 4 ' f'''' ::` , (with
i �l, 7 lj 71:1 � 'r;,��.f'l� a . y, r .'.
Limited energy, multi- family
75.00 2
Prepare spec space residential (with above so. ft.)
Services or feeders Installation, Iteradon, and/or relocation
W I i
.! : .t. saew te;rf+,:,r q: 7tct an M rt I .. , 200 amps or less 80.30 2
j`r'+:. a .l • �•rk,a =i ;r:Aa. ;,;w, i i}. ' •' h 6i ,: 70,,E . e. i..iii c i s 201 amps to 400 amps 106.85 Name: 401 amps 10 600 amps 160.60 I 2
601 lungs 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, aud/er
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 I
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 133.75 2
Branch circuits — new, alteradon, or extension, per panel
Owner signatures Date:
't'� g�{g� i� .;. -•= t : ii���il;(�l i��•p� i • _� .p�17� -a�?,m , ,.. , ; A . Fee for branch circuits with
Athi MPER, ° �Ine E.1 . I II�FIIIIII 1? Ir',':•a j i ,,i rs siz `, ; : r above service or feeder fee,
Fee branch branch circus _
Business name: Johansen Electric Inc. 6.65 2
B. Fee for branch circuiu
without service or feeder fee, 1 4 6 . 8 5
Contact name: Charlynn Leifsen 46.85 2
first branch circuit
Address: 10948 SE Valley View Terrace Each add'I branch circuit 7 6.65 46 . 5 G 2
Miscellaneous (service or feeder not included)
City/ State/ZIP: Happy Valley, OR 97086 Each manufactured or modular
Phone: (503) 698-3417 I Fax: : (503) 698 - 2486 dwelling, service and/or feeder 90.90 2
Reconnect only 66.85 2
E -mail: johansenelecttmsn.com . Pump or irrigation circle 53.40 2
! A' c' Y. N ANYM MEL 7M 3 1 1 l"' 1 . i p S oroutl'Ile lighting 53.40 2
Business name: Johansen Electric Inc Signal circuit(s) or 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 inspecdon over allowable in aav of the above
Per inspection 62.50
Phone: (503) 6983417 I Fax: (503) 698 - 2486 Investigation per hour (I hr min) 62.50
CCB Lic.: 51539 Electrical 3A uprv. Lic.: 2053S Industrial .cant . Isola 73.75
Suprv. Electrician signature, required, Subtotal: • ' s
Plan review (25% of permit fee):
Print name: Carl K. Johansen Date: 1/27/09 State surcharge (12% of permit fee): 11 . 21
Authorized signature —.- TOTAL PERMIT FEE: 10 4 . 6 1
Print name: Charlynn J. Leifsen Date: 1 / 2 7 / 0 9 This permit application expires W a permit is not obniaed within 100
days after it has been accepted as complete.
• Number of inapeeoons allowed per permit.
11 BuildingipemctslELC- PemutApp.doc 03/2036 440.46157(1 I/05 /C OMlWEB
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CRY OF TIGARD
BUILDING DIVISION
PERM #: ELC2009-00039
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/2712009
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 109/2009 TIME: 7•01Am PAGE:
SITE ADDRESS: 12909 SW 68TH PKW)/ 430 CLASS OF WORK:
SUBDIVISION: TIc3ARD TRIANGLE CENTER LOT #: TYPE OF USE:
PROJECT NAME: SPEC SPACE
DESCRIPTION: Ti
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: JOI1ANSEN ELECTRIC INC PHONE #: 503.69i:3..34v
Inspection Request Scheduled For: Date: 109/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 080124-02 503.969-5262
Corrections/Comments/Instructions: •
•
ASS E PARTIAL APPROVAL El CANCEL NO ACCESS
r FAIL E I CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: Date: — 2 Phone #: (503) 718-
• ` _- ' '^
CITY �������N�������� ~
N m�«m m n��m���m�� °~ ' •T'^
BUILDING DIVISION PERMIT #: - EL(;2009'88039
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/2700X09
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 =4 ,���
INSPECTION WORKSHEET FOR DATE: 1128/2009 TIME: 7:01AM PAGE: 6
SITE ADDRESS: C LASS OF � 12�8�8VV08 THP|�V����0 �
SUBDIVISION: 1icARD TRIANGLE CENTER LOT #: TYPE OF USE:
PROJECT NAME: [�pECSPACE
.
DESCRIPTION: � ll
. OWNER: pACjF|C REALTY ASSOCIATES, PHONE #:
CONTRACTOR: JOHANSEN ELECTRIC INC PHONE #: 6O3-688-3411 •
Inspection Request Scheduled For: Date: 1/28/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
130 (|wi|in8co*er O8008'3-01 603.9&9-6262 N
Corrections/Comments/Instructions:
`
ASS '
0 PARTIAL APPROVAL D CANCEL E NO ACCESS
El FAIL El CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
�� ��
Inspector: ..�\ Date: � °-�� - ~ r Phone #: (503) 718-