Permit CITY F TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00751
1 DEVELOPMENT SERVICES DATE ISSUED: 11/24/2004
' � I JI 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 112 D D -00200
SITE ADDRESS: 15618 SW 72ND AVE
SUBDIVISION: OREGON BUSINESS PARK III ZONING: I -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: 25 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: SIGNALIPANEL:
MANF HM/ SVCI FDR: 601 +amps - 1000volts: 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: 24 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: Phone: 503 - 698 - 3417
Reg #: LIC 51539
SUP 2053S
FEES ELE 3 -243C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 11/24/200' $206.45
[TAX] 8% State Surcharge 11/24/200' $16.52 Rough -in
Elect'I Final
Total $222.97
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 -800-3 -2344.
Issued By: Permit Signature:
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: g-0 5 3 5
Call 639 -4175 by 7:OOpm for an inspection the next business day
From: Charlynn � eifsen To: City Tigard E1 V r ® Date: 11/24/2004 Time: 11:54:56 AM Q Page 2 of 4
Electrical Permit App 'cation 1 — •
r O i < � i I i (1 i, r. ■ )\ i)
City of Tigard 0 2 4 20 04 Received 13125 SW Hall Blvd., Tigard, OR 97223
0 T t C 41° Pian Re ' o L4 • • Permit No.: _ _ ..A.A.Lta ■0 0
Phone: 503.639.4171 Fax 503.598.19 ®�jY O`v' Stj / ,- I i' I D Other Permit:
Inspection Line: 503.639.4175 g U1L D�N Q ....11- _ -.. Date Ready/ 63 See Page 2 for
Internet: www,ci.tigard.or.us Notified/Method: Supplemental Information
- ;. F - i r ( 7 ft 'r+ up ` r t - r ,=.-!:---t-::. t Y n.--;-' •
❑ New construction ® Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other Service over 225 amps, comet Hazardous location
Et, 5 'ice over 320 s rating Bull over 10 000
❑ amp 1' (; ❑ dng sq . ft
r,( i, a.:: -.. r ; , I' .- r ■ . .. :... ; ._ ' _T : � of 1 and 2-family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ® Coaunercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other; [Mudding over three stories ['Feeders, 400 amps or more
J ',.:1',..':-;„::::,,:."3,--,t.,: t load ova p
[Occupant 99 Manufactured structures or
c
: ;?-.,`,.;;4;`,4"::::.:, .' ' y ' ,r..1, - _ .. i ` 'i~n; .. ❑ Egress/li8htin Plan RV park
Job no.: Job site address: 15618 SW 72nd [Wealth-care facility ['Other:
Submit 3_ sets of plans with any of the above.
City /State/ZIP: Portland, OR 97224 The above are not applicable to temporary construction service.
Suite/bldg. /apt no.: Project name: `' , . . _ i : .: .... ' s.,,'„''
.. '' �.
nnvlpttm get. Fee. Total
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
Limited energy, residential 75.00 2
Tax map/parcel no.:
",'!";'`1°';','","..,;"`":"'" ' "'t.a .. , l- i ' 75.00 2
1
l t _ ,,, Each manufactured
Spruce up space for future tenant dwelling, service and/or seeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 ' 2
G •. ' - ' r ' ' i i f it ' r � , � • 201 amps to 400 amps 106.85 2
�_ i^ .. :' - ...... : x :.. < Ii , : F t -x3 401 amps to 600 amps 160.60 2
Name: Pacific Realty Associates 601 amps to 1,000 amps 240.60 2
Address: 15350 SW Sequoia Pkwy, 300 Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State/ZIP: Portland, OR 97224 Temporary services or feeders installation, alteration, and/or
Phone: ( 503)624 -6300 Fax: ( 503 ) 624 - 7755 2 2000 0 csttoa
amps or less 66.85 1 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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
l F4t `i - "� , , tK �, ' i _
' ' (' 1 1 rt ]it'il4 , t. ; k �il� t-,? W .,; 6 "`1, r , ~ - - .-, A. Fee for branch circuits with
s �. :, . r f. service or feeder fee, each
6.65 2
Business name: Johansen Electric Inc branch circuit
B. Fee for branch circuits
Contact name: Charlynn Leifsen without service or feeder fee,
each branch circuit 1 46.85 46.85 2
Address: 10948 SE Valley View Terr.
Each add'I branch circuit 24 6.65 _ 159.60 2
City /State/ZIP: Clackamas, OR 97015 Miscellaneous (service or feeder not included)
Pump or irrigation tie 53.40 2
Phone: ( 503 ) 698 - 3417 Fax: : ( 503 ) 698 -2486
Sign or outline lighting 53.40 2
E -mail: johansenelectt msn.com Signal circuit(s) or limited-
{, t : 'K . ,. s y , �f1F.r.l+t,; s r _ 4c �,� , l,t• -' :; energy Panel, alteration, or
�. _ . extension. Describe: Page 2 2
Business name: Johansen Electric Inc.
Address: 10948 SE Valley View Terr. Each additional iospeedon 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 how 73.75
CCB Lic.: 51539 Electrical Lic.: 3 -243C Suprv. Lic.: 2053S Subtotal 206.45
Suprv. Electrician signature, required: / / Plan review (25% of permit fee)
.0 _ _ `
Print name: Carl K. Johansen / Date: 11/24/04 State surcharge (8 %ofpermit fee) 16.52
TOTAL PERMIT FEE 222.97
Authorized signature: / / r. • , This perk appnptlon expires ifs permit Is not obtained within 180
days after irises beta accepted as compkte
Print name: Charlynn J. Leifs -, 110 Date: 11/24/04 • Fee methodology set by TriCounty Building Industry Servioe Board
•• Number of inspections pa permit allowed.
islBuildin Pumiu'ELGAamilApp.doe 12/03 4404615T(l0N7/COM/WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (5Q3) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
p BUP
Received Date Reque ed / " / PM BUP
Location / !8 /pd. e- Suite MEC
Contact Person C ( Ph ( ) 7 V' — /53L1 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner Cr AD D — 08
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL I
PLUMBING J
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
T FAIL
s ELECTRICA
Service
Rough -In
UG/Slab
Low Voltage
arm
Cetlii
❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line A `� y� �y
ADA Date -- 1 ""( Inspector IBS `G�- 0 \1 Iy Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL