Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00616
�� DEVELOPMENT SERVICES DATE ISSUED: 8/22/2005
lip 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S101 AD -03200
SITE ADDRESS: 12909 SW 68TH PKWY 450 ZONING: MUE
SUBDIVISION: TIGARD OFFICE BUILDING LOT : JURISDICTION: TIG
Project Description: (6) branch circuits.
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: 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: 5 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 CLACKAMAS, OR 97015 -000
Phone: 503 - 624 -0727 Phone: 503 - 698 -3417
FEES Reg #: LIC 51539
SUP 2053S
Description Date Amount ELE 3 -243C
[ELPRMT] ELC Permit 8/22/2005 $80.10
[TAX] 8% State Surcharge 8/22/2005 $6.41 REQUIRED ITEMS AND REPORTS
Total $86.51
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. �� jj��
Issued By: lJ '''�� f 1/ Permittee Signature: � Q-Q. SZ:ipQ
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.
From: Charlynn Leifsen 503 - 698 -2486 To: City of Tigard Date: 8/22/2005 Time: 12:18:46 PM Page 2 of 3
:- E6eEtrical Permit A li ' 1 t ( F 1( 1. 1 .1: 1 1.
Ci of
SSW Hal B1 Tigard, OR 97223 �{ II)' ((�� `} ` Date : .1. - �` ./ - Permit No.. , O& . /1
l33
Au G 2 ,. .0 0 Plan Rip
Phone: 503.639.4171 Fax: 503.598.1960 ^A e'�,i,;.. f. p B • Other Permit:
Inspection Line: 503.639.4175 , r _1'_:, D ate •
ReadyBy: 01 See Page 2 for
Internet: www.ci.tigardor.us GiTY OF TIG ' - • Notified/Method: Supplemental Information
4 } 1 171 k $ ^d .1.-,,:;:i..,,::: t y.. _ -. F a ,.. , r 1.. ,! 1 d�, t hH{• .t.",-,. {..
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❑ New construction ® Addition/alteration/replacement Please check all that apply: 4
❑ Demolition ❑Other ❑ Service over 225 amps, comm'I ['Hazardous location
❑Service over 320 as - rating ❑ Buildng over 10,000 sq. ft.,
;. _ .; _.,. , , a. _.L ' r ... " z . .. i' ` ,': ..:- , k s,, t,, ... ;' of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi- family ❑Master builder ❑ ether;
s tr 1 , Occupant load over 99 persons structures or
Manufacdu ed structures
.,� � :, . , . - 1 •,: n _ .=' : , i]Egless/lightulg plan RV park
Job no.: Job site address: 12909 SW 68th Pkwy, 450 ['Health-care facility DOther:
Submit i sets of plans with any of the above.
City/ State / ZIP: The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name:
Description Qty. Fee. Teal ..
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential 75.00 2
l 1 , , t a 1 Limited energy, non - residential 75.00 2
- �. ., i
;1- r s! . . ' r. ` : ::'%) ::'%) !
'`" '' Each manufactured or modular
tenant expansion dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
t s' ' + k / '. "7. ` r r ` „ . w 201 amps to 400 amps 106.85 2
t ... 160.60 2
a L. ' ■ ■ % 0'(e 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) . ,23/ ^ 0 7 7 Fax: ( ) 00 amps am s
200 aps or less 66.85 1 1
Owner installation: This installation is being made on property that 1 own which is not 201 an to 400 amps 1 1 100.30 1 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: }} Date: Branch circuits - new, alteration, or extension, per panel
j' r . S. � fry I ! � F r ' ,i l k l.
t . t g 5 A. Fee for branch circuits with -
.:- ,- 1 ,.. , , , .:. _._., service or feeder fce, each
Business name: Johansen Electric Inc. branch circuit 6.65 2
B. Foe for branch circuits
Contact name: Charlynn Leifsen without service or feeder fee.
Address: 10948 SE Valley View Terr. each branch circuit 1 46.85 46.85 2
Each add'I branch circuit 5 6.65 33.25 2
City/ State/ZIP: Clackamas, OR 97015 Miscellaneous (service or feeder not included) _
Phone: (503) 698 -3417 Fax: : (503) 698 -2486 Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: johansenelect@msn.com Signal circuit(s) or lirnited-
t . ,' CI , ir,; I ; _, . ` 3 >, -. ' 7- -i , S," s . ., -Y. .. -. .:, °c , :f ::. orgy Panel, alteration, or
exten Descr Page 2 2
Business name: Johansen Electric Inc.
Address: 10948 SE Valley View Terr. Each additlonal inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: Clackamas, OR 97015 Investigation per hour (1 hr min) 62.50
Phone: (503) 698 -3417 Fax: (503) 698 -2486 Industrial plant per hour 73.75
CCB Lic.: 51539 Electrical Lie.' 3 -243 S , . Lic.: 2053S Subtotal 80.10
Suprv. Electrician signature, required: �� +, / iirwisP r Plan review (25 %ofpermitfee)
Date: 8/22/ State surcharge (8% of permit fcc). 6.41
�' / / TOTAL PERMIT FEE 86.51
Authorized signature: This permit appdatlon expires f a permit is not obtained within 110 1 days after it has been accepted as complete
Dace 8/22/05 • Fee methodology set by Tri .County Building Industry Service Board
•• Number of inspections per permit allowed.
i :lBuiidiu PnnhAE1.C- PaMtApp.doe 17103 440.461ST(10l02/COMIWEB
lC F TIGARD
. A B UIL DIVISION PERMIT #: ELC2005 00616
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/22/2005
Phone: (503) 639 -4171 �I�II
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/22/2005 TIME: 7:12AM PAGE: 62
x
SITE ADDR ' • 12909 SW 68TH PKWY 450 CLASS OF WORK:
SUBDIVISION: IGARD TRIANGLE CENTER LOT #: TYPE OF USE:
PROJECT NAME: T• ITY UNIVERSAL INSURANCE
DESCRIPTION: (6) b : ch circuits.
OWNER: PACIFIC '' ALTY ASSOCIATES, PHONE # : 503 -624 -0727
CONTRACTOR: JOHANSEN . LECTRIC INC PHONE # : 503 - 698-3417
Inspection Request Scheduled For: Date: 8/22/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 016358 -01 503-969-5263 N
Corrections /Comm- 1 ions:
It ■- 4.-2605 - - 002'13' be A >f irf Alt: 1" 1 S• 0,
2y\ `t- P+`I
65■^(> $• 23-Or -
I I PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 2 l� Phone #: (503) 718- 2 -