Permit CITY OF TIGARD ELECTRICAL PERMIT
t> ° PERMIT #: ELC2008 -00663
COMMUNITY DEVELOPMENT DATE ISSUED: 12/5/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 101 AD -03200
SITE ADDRESS: 12909 SW 68TH PKWY 190 ZONING: MUE
SUBDIVISION: TIGARD TRIANGLE CENTER LOT : JURISDICTION: TIG
PROJECT: BENEFICIAL
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/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: WISERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 2 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 12/5/2008 $60.15 LIC 51539
[TAX] 12% State Surchar 12/5/2008 $7.22 SUP 2053S
Total $67.37 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: � p, A ILE Permittee Signature: p 1 f o4l on.
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7 :00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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lectrical Permit A licati ECEI V . '
1 411 l ll l: t X 1:11\1.\
1 City Of Tigard f Received I rr 6 , 1
DEC 0 4 2063 Received
: 1 •0: _ A Permitxo. :E 0%.
' 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review -
Phone: 503.639.4171 Fax: 503.598. Other Permit :% P 6 . t/
!• inspection Line: 503.639.4175 Ci i Y OF TI Daa/g D ate Re : o Jms el See Page for
Internet: www.tigard or.gov ' , , Milled/Method t t ( Sup�ntalInformatlnn
K'y �•.'!. •5aJ11'h1 �v..;;:�IS 1 •• � i ^ -�Y3 ; {t(gV��r r, J$�
44 �i • MI -z r e S 7
�t {���,• IIiY. i�:�r3f y f�W1 'fi v, �3� f�.-t• +7• 7 . 1 y rl��� q ��ptj�l�� , �� � ru� r�. t of �{'�' t , ti.� ��
I4 XLti�I ..tiR_'?6i�l�;ty'1�°�. ' Lc u�' 9y1�.• {�•..��ff¢tfle�, Eui' A �k 'F��i �L�Il litktC3LL'. SIB:.. s* nR�. ��aLRlr�t� ...,ts1;��ilLL��il il {:R'i"Ii.15at,
EJ New construction ® Addition/alteration/replacement Please check all that apply (sulrnit1 of plans whams checked below):
❑ Service or Roder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards
; L iji`, ill" w 9 i ft... 5 1LIT sn iti air 4�y`tii My t `' ' I 11 exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
~v less to ground, or exceeds 14.000 ❑ Commercial -rue Waal
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building maps for all other installations. buildings. agricul
❑J�(Multi- family 1' , ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
i '6' 7,31 41i1 i ' 'xr•J:'v' c 'UCCR^ : q, t' Vt. , •v a R' I rr r>.' r Emergency system.
d a " i' ik1 I �' ' �I�1' t " t il' ,.rd r , • 1 4� ` ri a i 't( .�f� 111 `. tS� )S E X4 I I: i7 t Yat
.s � li •r:r. u u.. w47�iarc.'. � � n� ?• r? , :Q;},ul�tlhixia6�ilt�iimil_t ` `..'1. �;.E .; ❑Adulitianofnewtnotorloadof larger separately derived system. ❑ �A" ••g•' - l.2^ ••t_g••
Job no.: Job site address: 12909 SW • 68th t00HP or more. occupanry•
❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: ® Health-care facilites. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 190 l Project name: B enef i c i a 1 Financial ❑service ar feeder 600 amps or ,,.,tree.
MI ,ui •I't M :i: i 3 1f 1: ;1'•in ri
Cross street/directions to job site: eeer
aiRdoa Ott. tree. Te41 •
New residential sin k- or multi- family dwelling unit
Includes attached garage.
Subdivision: 1 l 120.: 1.000 sq. fl. or less 145.15 4
Tax map/parcel no.: I Ea. add•I 500 s q. ft or portion 33.40 1
'S � •t"1� r �g"ln�rrc�� K'Y :•rtu+taG-�Y.iro• n, ,pn �uex, a ,. ,�. Limited energy, residential
61H<!*.L"s,Y jl' 5�� r r, �, u 4 t I i' G� ..a 'iii ErSV i SIR
�' , F' I ( i i e' �..'. e,.:. :anatrvri�- `� ;:r•.siilim�tii,�:� n x �r�� , �.^r ", (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
Tenant Improvement residential (with above aq. R.)
Services or feeders Inatallation.alteratlon, and/or relocation
,II Y„�a� { IS,w°Vsrt u'` , Ilia' } i' i ° llfl' �p� z:t}i,t.- 200 amps or less 80.30 2
4 nit ifi ,,=lt,ti:1�. � _•+Z1;37fu ��.+ a• Ills$:;. INEIlfl> l) #All a �� ;i3 l;rt r 'i l 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
I relocation
Phone: ( ) Fax: ( ) 200 amps or Tess 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 1 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
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
i r 7 f e r ^ ��r��•t tw -s a! �r ;;:tt t Iry n x can err� ,.,, 1 A. Fee for branch circuits with
1 1 .. � m 1 �:: :1 S �Laitllr a�a' { nt M al 'see I' t �nn ?! 779, , . 7..+ 6 - 2
it :?1911'JtdkRJ...� z,rrita �d :.tai, ",i = , . t;, 1; .. above service or feeder fee,
each branch circuit
Business name: Johansen Electric Inc. B. Fee for branch circuits
Contact name: Cbarlynn Leit>aen witho service o f fee,
first branch circuit 46.85 t, ` . 2
Address: 10948 SE Valley View Terrace Each add'l branch circuit Z 6.65 4-41° 2 1; -3
Miatellaneous (service or feeder not included)
City/State/ZIP: Happy Valley, OR 97086 Each manufactured or modular 2
Phone: (503) 698-3417 I Fax: : (503) 698 -2486 dwelling, service and/or feeder
Reconnect only 66.85 2
E -mail: johanseneleet@msn.com Pump or irrigation circle 53.40 2
It • nr:9t;!v ,r. m r+;�w• - rte•
. i' Il! lt'L• If ; : Y3i i1 f E 'mtt: 1::,? ,� ,;.0 .. 11✓111 :iv414 M1(c Nile l 44P '+i d .tk`, Si or Outline 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 inspection over avowable In any of the above
Per inspection 62.50
Phone: (503) 698-3417 1 Fax: (503) 698 -2486 Investigation per hour (t hr inns) 62.50
CCB Lic.: 51539 1 Electrical Lic.: 3 -243C J Suprv. Lic.: 2053S Industrial plant . how 73.75
Suprv. Electrician signature, required: Coi K Qo �_ Subtotal: r r Print name: Carl K. Johansen Date: 12/4 /08 Plan review (25% of permit fee): •
State surcharge (12% of permit fee): 1 .
7 2..2
Autborized signature: TOTAL PERMIT FEE: �'L�l* .., - 7, 3
Print name: Charlynn J. Leifsen 12 / 4 / 0 8 This permit application' expires ire permit is not obtained wipe 180
... days after it has been accepted es complete
• Number of inspections allowed per permit
E1BmldilePermittAEI .C - PermitApp. O3R3A6 440-461$T(111051COM/WEB
I ' d X03d 13C2I3SIJ1 dH WdES : b 8002 b0 Oaa
. : . . . .
CITY OF TIGARD
1
BUILDING DIVISION PERMIT #: ELC200B..00663
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1 2/500(n)
Phone: (503) 639-4171 At_1
Inspection Requests (24 Hrs.): (503) 639-4175 .i.-01
:
INSPECTION WORKSHEET FOR DATE: 12131/7008 TIME: 700Am PAGE: 2
SITE ADDRESS: '12909 SW 68TH PKWY 190 CLASS OF WORK:
SUBDIVISION: TIGARD 'TRIANGLE: CENTER LOT #: TYPE OF USE: I
PROJECT NAME: LW:NEI:ICI AL
DESCRIPTION: °H. I
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: JOHANSFN ELECTRIC INC PHONE #: 503-698-3417
Inspection Request Scheduled For: Date: 12/31/2008 Pour Time:
Code # Inspection Description (( &:;ri i i r ri #\ Contact # Message
\
199 Electrical final ■ 079319-02 503•969-5262 N
\
• Corrections/Comments/Instructions: \
1
. ,
q i
t
,
I;K PASS El PARTIAL APPROVAL E CANCEL 0 NO ACCESS
fl FAIL H CALL FOR INSPECTION E ADDITIONAL FEES ASSESSED
Inspector: r N '62 5 Lk Date: 12-1 S111) Phone #: (503) 718- _________
CITY OF TIGARD
BUILDING DIVISION PERMIT #: L L t.200S 00663
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/5/100t)
Phone: (503) 639 -4171 1 1
Inspection Requests (24 Hrs.): (503) 639 -4175 __ . "'��!
INSPECTION WORKSHEET FOR DATE: 12/19/2008 TIME: 7 : 00AM PAGE: t3
SITE ADDRESS: 12909 SW 68TH PKWY 190 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE CENTER LOT #: TYPE OF USE:
PROJECT NAME: I~ 3i'NEFICIAI_
DESCRIPTION: TI.
OWNER: 'PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: JOHANSEN ELECTRIC INC PHONE #: 503- 598.3°117
Inspection Request Scheduled For: Date: /201902008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
130 Ceiling cover 079157 503 N
Corrections /Comments /Instructions:
/ ( I-s PN
•
I 1 PASS n PARTIAL APPROVAL ❑ CANCEL SS
AIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED •
Inspector:
U9-fla
Date: 1 L 19 Od Phone #:. (503) 718 -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: EL C2008-00663
3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/E42008
Phone: (503) 639 -4171 Avdowit (�
Inspection Requests (24 Hrs.): (503) 639 -4175 -•__.
INSPECTION WORKSHEET FOR DATE: 12111/2008 TIME: 7:00AM PAGE: 18
SITE ADDRESS: 12909 SW 68TH PKWY 190 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE CENTER LOT #: TYPE OF USE:
PROJECT NAME: BENEFICIAL
DESCRIPTION: 11,
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: . JOHANSEN ELECTRIC INC PHONE #: 503-698-3417
Inspection Request Scheduled For: Date: 12/11/2008 Pour Time:
Code # Inspection Description Confirm -# Contact # ' Message
125 Wall cover 078970.01 503- 956.6290 Y
Corrections /Comments /Instructions:
uk PASS ❑ PARTIAL APPROVAL ❑ CANCEL 111 NO ACCESS
FA ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
L-L Date: , Phone #: (503) 718- 2-
Inspector: 4\) � 1)--1 I � ( )