Permit CITY OF TIGARD ELECTRICAL PERMIT
." PERMIT #: ELC2005 -00319
�
111 DEVELOPMENT SERVICES DATE ISSUED: 5/13/2005
' --� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S112DC -00500
SITE ADDRESS: 15895 SW 72ND AVE BLDG B 100 ZONING: I -P
SUBDIVISION: FANNO CREEK ACRE TRACTS LOT : 040 JURISDICTION: TIG
Project Description: (4) 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/ SVC/ 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: 3 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 - 6300 Phone: 503 - 698 - 3417
FEES Reg #: LIC 51539
Description Date Amount SUP 2053S
ELE 3 -243C
[ELPRMT] ELC Permit 5/13/2005 $66.80
[TAX] 8% State Surcharge 5/13/2005 $5.34 REQUIRED ITEMS AND REPORTS
Total $72.14
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: Y ,v Permittee 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:
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 J. Leifsen To: City of Tigard Date: 5/12/2005 Time: 11:38:46 AM Page 2 of 4
- EIe trical Permit Appligton l u i< mil( l I I � r. t ► \ I ,
City of Tigard C.EIVE4
Dat ` i` : °° ' - 45'. c PetmitNo. , 4 603/
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 501639.4171 Fax: 503.598.1960 MAY 1 ' ` ' ' D e /B : Other Permit:
Inspection Line: 503.639.4175 2 2 i1, : :,.. . ` + f L Date Ready/By: la See Page 2 for
HH Internet: www.ci.tigard.or.us Notified/Metbod: EMI Sappkmental information
.,,k.:7,..„.„4::, ^'l i fll j 1 . 1. T ,
{c r c.. t - 1 '', ,' � { I f '� .. . _L z . :y . ,. . . t .. . r n .._ , ,,, 'Ty' , •` 1'
❑ New construction ® Additro . ' i ?rP' 7 ttltent Please check all that apply:
['Service over 225 amps, comm'l ['Hazardous location
❑ Demolition El Other:
A> it; + n ' t < a 1 ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
,: t - t r i ' . , , w; , { i of 1 - and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ® Conunerciallindustrial ❑ 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
❑ Oceu
7 ;r persons ['Manufactured structures or
p ant load oval 99
le ,- '` .• - ,r I 'Vii ; _.. _ E - � t,.rx ; l'' ❑Egress/lighting plan park
Job no.: Job site address: 15895 SW 72nd, 100 ❑Health -care facility ['Other:
Submit.L 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: T Mobile 1 '
Damption Qty. Fee. Teta ••
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 I
Limited energy, residential 75.00 2
Tax map /parcel no Limited energy, non-residential 75.00
.' Ir i f ,
t :4,..!:>- ' Y s -- - , x' _ f y 7, . - t Itv.
? '=-1--,.
' �- ` . i ,. - ..._. � a .:` � . ' ,, '! .,.9 1 .+.. hl L .r.._....., x Each manufactured or modular
Tenant improvement dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 ' 2
f d,t*i -i.A r" r5 r a I r , r x Ii ,ara ,r , i - .;g 201 amps to 400 amps 106.85 2 •V -, ".r. ,...!l.'1 •", L - :. :i`..Ith!,. • ,: z ,..;; -,.>G ,...,.r.l' ¢. ,:'!, 3 ' -VI ?,9
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 instalatlon, alteration, and/or
Phone: 503)624 -6300 Fax: ( 503 ) 624 -7755 relocation ( 2000 amps mps or Icss 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
• -'11:1.P.' 3 - ti r Y P I I w ' f ,ir. a1 i tl r r lliyr i ,, (. I r 7 a : � 1 FG a i c A Fee for branch circuits with
_c, .: - ..G,, .,.. . ... .. _.:. r.ar..'!1 ,:.�:. �., ,t..,._ :.. . ..... '' rS ,,�, service or feeder fee, each
Business name: Johansen Electric Inc. branch circuit 6.65 2
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 3 6.65 _ 19.95 2
City/State/ZIP: Cl ackamas, 0 R 97015 Miscellaneous (service or feeder not included)
Phone: ( 503 ) 698 - 3417 Fax: : ( 503 ) 698 - 2486 Pump or irrigation circle 5140 2
Sign or outline lighting 53.40 2
E -mail: lohansenetect(CDmsn.com Signal circuit(s) or limited -
a ,,c.+ y jx r rte n ."',, ,? y .i: ' 11g17 rj,.'' '4 " `s' ' l It - energy panel, alteration, or
t nr..s . _ ,.. .....r. ;.._: extension. Describe: Page 2 2
Business name: Johansen Electric Inc,
Address: 10948 SE Valley View Terr. Each additional 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 how 73.75
S` . S
fH 1 lti'Efi � ..bib 1 t i � � t I 3.
CCB Lic.: 51539 Electrical Lic.: 3 -243C Suprv. Lic.: 2053S Subtotal 66.80
Suprv. Electrician signature, required: / / �`� _ _ ` Plan review (25% fee)
-
Print name: Carl K. Johansen / Date: 5/12/05 State surcharge (8% of pettnit fee) 5.34
TOTAL PERMIT FEE 72.14
Authorized signature: ! i• This p ermit application expires if • permit is not obtained within 180
days after it has been accepted as complete
Print name: Charlynn J. Leifs -, Date: 5/12/05 • Fee methodology set by Tri -County Building Industry Service Board
•• Number of inspections per permit allowed.
i Buitdiag ■Permiu\ELC -PermitApp 12/03 440.4615T(10N2/COM/WF8
CITY OF TIGARD _;
1
BUILDING DIVISION PERMIT #: ELC200300319
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 5/13/2005
Phone: (503) 639 - 4171 77,40,011,;1\
Inspection Requests (24 Hrs.): (503) 639 -4175 `__..
INSPECTION WORKSHEET FOR DATE: 6/13/2005 TIME: 7:08AM PAGE: 89
SITE ADDRESS: 15895 SW 72ND AVE BLDG B 100 CLASS OF WORK:
SUBDIVISION: FANNO CREEK ACRE TRACTS LOT #: 040 TYPE OF USE:
PROJECT NAME: T- MOBILE
DESCRIPTION: (4) branch circuits.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503- 624 -6300
CONTRACTOR: JOHANSEN ELECTRIC INC PHONE #: 503 - 698 -3417
Inspection Request Scheduled For: Date: 6/13/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 009003-01 503698.3417 N
Corrections /Comments /Instructions:
I
XLIDASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
1
❑ FAIL ❑ CALL FOR INSPECTION , ❑ ADDITIONAL FEES ASSESSED
R Inspector: / , -' — '7 Date: +� - 93 — Phone #: (503) 718-
.