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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2004 -00599 lr DEVELOPMENT SERVICES DATE ISSUED: 9/20/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171 PARCEL: 2S112DC 00201 SITE ADDRESS: 15865 SW 72ND AVE BLDG -C SUBDIVISION: OREGON BUSINESS PARK III ZONING. I -P BLOCK: LOT : 003 JURISDICTION: TIG Project Description: T.I. (1) service & (20) 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 HMI SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: W /SERVICE OR FEEDER: 20 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: SVCIFDR >= 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 9/20/2004 $213.30 [TAX] 8% State Surcharge 9/20/2004 $17.07 Rough -in Elect'I Final Total $230.37 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: 17),1 ��2� Permit Signature: s e p OWNER INSTALLATION ONLY 1 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: CaII 639 -4175 by 7:OOpm for an inspection the next business day From: Chartynn J. Leifsen To: City of Tigard Date: 9/17/2004 Time: 10:32:24 AM Page 2 of 4 • ` o A. . 6O -oW.Y Electrical Permit App )? I ''< mil( r l ,1 ().1 l City f Tigard Received 131 SW Hall Blvd., Tigard, OR 23 G C 1 r l 600 c- G/ I Permit ' CJ86f V A9 9 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 ` 1 , • l' ' 9111 A `tip~ pud OtherPermrt: Inspection Line: 503.639.4175 S j _ ..: .. ''1 i Date Ready/By runs: L., WI See page 2 for Internet: www.ci.tigard.or.us `'C� Q 1%4 1 Notified/Method: 1 V Supplemental Information ( I - - \t f ❑ New construction ® Addition /alteration/replacement Please check all that apply; ' ❑ Demolition 0 Other ['Service over 225 amps, comm'I ❑Hazardous location V i t ❑Serv over 320 amps - rating j]Buildng over 10,000 sq. ft., 1 . .:. - r , ' ,r.. .' t i of 1 - and 2-family dwellings 4 or more new residential ❑ 1- and 2- family dwelling ® Commercialindustrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi- family ❑ Master builder ❑ Other; ['Building over three stories ['Feeders, 400 amps or more . '',-..r,.-- , Ocau ant load over 99 persons ['Manufactured structures or : , t , � n _ �. :.. .. -.:- E= - - . gtess/lighting plan : .'fl:, � ❑ E RV perk Job no.: 8761 Job site address: 15845 SW 72nd ❑Health - care facility ['Other: Submit 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.: 1 Project name: Chemwest , ,• - , . , .. , Description Qty. Fen Total •• Cross street/directions to job site: New residential single- or multi- family dwelling snit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 - Subdivision: Lot no.: Ea. add, 500 sq. ft. or portion 33.40 I Tax map/parcel no Limited energy, residential 75.00 2 s : sF .I IU I j - - n} -ii1t t e j. s 55,3. Limited energy, non- residential 75.0() 2 ..,....�: ,..:.r .. S� ' ''.,, _ n. ,!..,''',',24.' ,f ... l, i ; ;: :.. ._. ; Each manufactured or modular Tenant Improvement dwdlling, service and/or feeder _ 90.90 2 — Services or feeders installation, alteration, and/or relocation 200 amps or less 1 80.30 80.30 ' 2 ;1 l ob t r I `: ,. ,,: I ' '� - 201 amps to 400 amps 106.85 2 Y: ir-, IfI;:' . -.3 .. , . 5,. + . ` ,, 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 relocation 200 amps or less 66.85 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 ' . iii i t' ` ,i A. Fee for branch circuits with :r P service or feeder fee, each Business name: Johansen Electric Inc. branch circuit 20 6.65 133.00 2 Contact name: Charlynn n Leifsen B. w ee for branch ofeeder circuits fee, each branch circuit 46.85 2 Address: 10948 SE Valley View Terr. Each add•I branch circuit 6.65 2 City/State/ZIP: Clackamas, OR 97015 Miscellaneous (service or feeder not included) Phone: ( 503 ) 698 -3417 Fax: : ( 503 ) 698 -2486P or irrigation circle 53.40 z Sign or outline lighting 53.40 2 E -mail: johansenelectQmsn.com Signal circuit(s) or limited - ..?' ` 1 , .,tt _ • ' : , . ; , .. « - ... - < g le ra p anel , 8ltd Or extension. Describe: Page 2 2 Business name: Johansen Electric Inc. Address: 10948 SE Valley View Terr. Each additional Inspecdom over allowable in any of the above Per inspection 62.50 City/ State/ZIP: Clackamas, OR 97015 Investigation per hour (t hr min) 62.50 Phone: (503) 698 -3417 Fax: (503) 698 -2486 Industrial Plant per twat 73.75 is' t CCB Lic.: 51539 Electrical Lic.: 3 -243C Suprv. Lic.: 2053S Subtotal 213.30 Suprv. Electrician signature, required: / / / - J Plan review (25% of permit fee) Print name: Carl K. Johansen Date: 9/17/04 State surcharge (8% of permit fee) 17.07 TOTAL PERMIT FEE 230.37 Authorized signature: • / i 1 - 0 �� a , This permit applicadoo expires if • penult is not obtained within 180 - days after k has been accepted as complete Date: 9/17/04 ' Fee methodology set by Tri-County Building Industry Service Board •• Number of inspections per permit allowed i lBuilding\PUmiu\ELC -PermitApp doe 12/03 440.461 ST(IONLCOM/WED CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested /_6�' 2 -1 1 2 -1 1 AM PM BUP Location f 5 ' ' 5 7a 42 � Suite 6— MEC Contact Person j4 4 Ph ( ) C� PLM _ Contractor � 1Pu ' � _U� Ph ( ) c:7 9 /� SWR ,L BUILDING Tenant/Owner ELC 60 S9� Footing ELC Foundation Ftg Drain Access: 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 PLUMBING 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 PASS PART FAIL ELECTRICAL C 4 - c, 3 15' Service Rough -In Qa - o 6 6 G f , UG/Slab Low Voltage Fire Alarm Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. ASS PART FAIL Please call for reinspection RE: Unable to inspect - no access Fire Supply Line ADA Approach/Sidewalk Date �► Inspecto / Ext Other: Final DO NOT REMOVE this Inspection record rom the ob site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspectjon Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested AM PM BUP - Location ) .S Suite MEC Contact Person 0 I fl YL, Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner 2.-4n (,(> ELC oD D _DDS J� Footing Foundation ELC Access: - Ftg Drain _. _ ELR Crawl Drain Slab Inspection Notes_ _ _ _ SIT Post & Beam Shear Anchors - Ext Sheath/Shear — r Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler A Fire Alarm Susp'd Ceiling -Roof Other: Final PASS PART FAIL PLUMBING 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 PASS PART FAIL ELECTRICAL t�Servic ugh -In UG/Slab Low Voltage Tiro Alarm nal fl Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL $ Please call for reinspection RE: Unable to inspect – no access Fire Supply Line ADA / / Approach/Sidewalk Date o Inspector / _ Ext Other: Final ' 0 NOT REMOVE this inspection record from t job site. PASS PART FAIL