Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00702
DEVELOPMENT SERVICES DATE ISSUED: 11/2/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S113AB - 00101
SITE ADDRESS: 16101 SW 72ND AVE BLDG A -200
SUBDIVISION: ZONING: IP
BLOCK: LOT : JURISDICTION: TIG
Project Description: Electrical tenant improvement, (12) branch circuits. Work is on 1st & 2nd floors. Job No. 8801
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: 11 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
Reg #: LIC 51539
SUP 2053S
FEES ELE 3 -243C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 11/2/2004 $120.00
[TAX] 8% State Surcharge 11/2/2004 $9.60 Rough -
Elect'I Final
Total $129.60
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 a set forth im0AR 952 - 001 -0010 through OAR 952- 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246-6 99 or 1 -800-33 344.
Issu By: / lam. 0 Permit Signatu to-L....-
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: a/Ds35
Call 639 -4175 by 7:OOpm for an inspection the next business day
From: Charlynn J. Leifsen To: City of Tigard Date: 11/2/2004 Time: 12:30:50 PM Page 2 of 7
Electrical Permit Application 1 • t 1 I Z ( 0 1 I I r 1• i. 1/N1 1
City of Tigard o f f �Q Al y Permit No.: g� , ,e, c _ 70 ')—
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 .r{ ' I ' Date/B
Inspection Line: 503.639.4175 !,. ' f :
Date Ready/sy: 1a++y IV See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: . ) t CO. Supplemental Information
.,,..r .. #,, , {,I #'I r . , y t ��. _ , . --,, , � : l+sec ea r ,{ t T7 ',.,',1...7./. 4 : a i l
❑ New construction ® Addition /alteration/replacement Please check all that apply:
❑ Demolition CI Other: ['Service over 225 amps, comm'1 ['Hazardous location
n , k t ['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
.ii:" ` ' ' "` ,itt ,1 0( 1. and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling ® Commerciaiindustrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
12 Multi - family ❑M aster builder ❑Other; ❑Building over three stories [Weeders, 400 amps or more
� � � �� Other:
,a p red structures or
['Occupant load ova 99 persons Manufadu
, - '# r' ' : , r 4
1 ' ` . •. s .. ! _ :.,. ' .. ; . '' ! : fl 4I{. ❑E i plan park :., .. 7i ,,. . , `' :.. , .._.r .. �n ['Egress/lighting ghtingP V p
R
Job no.: 8801 Job site address: 16101 SW 72nd ['Health 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.
`. ''''•,i ' ;' ' ° ; 2
Suite/bldg. /apt no.: Project name: Qualcom, 1st Floor
nesvlptlsa Qty, Fur Tad
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'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map/parcel no.:
:� 3 t Limited energy, non- residential 75.00 2
;
_r ,,, 0. rt , r ,, i :,, ,. E a c h m anufactured or modular
Tenant Improvement on 1st floor 4 A 6 /%490/l. dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
3 • : ,Ht, , r n" 1 oi t , a,rr rT 201 ampsto400amps 106.85 2
. -�„ t .. .... r_ .: ',,,.".
., _,.. :,.: .. , _,:., q�,- , :.,,t , x'.r f -. 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 Ova 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 I 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
r z , , ,r �{
'; � t F ! . < { � t ) � I tllyl, � rr�{ , , t � i4 {t t — :: A. Fee for branch circuits with
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,
A each branch circuit 1 46.85 46,85 2
Address: 10948 SE Valley View Terr.
Each add'I branch circuit / /. 6.65 N -/ El
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: johansenelectamsn,com Signal circuit(s) or limited -
1,',;,-,,','f4',.:::' ✓ W T r a g } 11 r u h , y _ +- iTi r K u ^--�- energy alteration, or
.1,. ,., iJ ._ ... :,. !!l., :, - ,x 5 a„ .. 1 : ;u 1! Hr.. r, _ :'?' 4 , ...r. ,._' extension Describe Page 2 2
rgYP ane
P e
Business name: Johansen Electric Inc.
Address: 10948 SE Valley View Terr. Each additional inspection over allowable is any of the above
Per inspection 62.50
City/State/ZIP: Clackamas, OR 97015 Investigation per hour (1 br min) 62.50
Phone: (503) 698 -3417 Fax: (503) 698 -2486 Industrial plant per hour 73.75
. ' •' . F Veia t, r ; 4,y *-! t t 4 i . 1. . T:
CCB Lic.: 51539 Electrical Lic.: 3 -243C Suprv. Lic.: 2053S Subtotal /60 ■°
Suprv. Electrician signature, required: / , Plan review (25% of permit fee) 1
Print name: Carl K. Johansen / Date: 11 /2/04 State surcharge (8% of permit fee) D
TOTAL PERMIT FEE I / Ay, t
Authorized signature: ! 1, This permit application expires If a permit is not obtained within 180
days after it has been accepted u complete
Print name: Charlynn J. Leifse, Date: 11/2/04 • Fee methodology set by TriCounty Building Industry Service Board
•• Number of inspections pa permit allowed.
i :WuiidingWermiu\ELC- PamitApp.doe 12/03 440-4615T(10/02/COM/WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION • ' Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / � AM PM BUP
Location Ao / � � � � - Suite /4 — aOO MEC
Contact Person Ph ( ) - 0 9 — PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner Q ELC Ro6q Dd 7 & —
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: c9 ,/ SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof J
Other:
Final
PASS PART FAIL
PLUMBING i
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
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
SS PART FAIL
El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line [,1
ADA Date) " _ Q � Inspector V 5 ` 'Aid G Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL