Permit -
CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00685
DEVELOPMENT SERVICES DATE ISSUED: 9/15/2005
i I I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2 S 113A B -00600
SITE ADDRESS: 16165 SW 72ND AVE BLDG D ZONING: I -L
SUBDIVISION: PACTRUST BUSINESS CENTER LOT : JURISDICTION: TIG
Project Description: (10) 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: WISERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 9 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 -WM1 10948 SE VALLEY VIEW TERR
PORTLAND, OR 97224 CLACKAMAS, OR 97015 -000
Phone: Phone: 503 - 698 - 3417
FEES Reg #: LIC 51539
2053S
Description Date Amount SUP 3
ELE 3 -243C
[ELPRMT] ELC Permit 9/15/2005 $106.70
[TAX] 8% State Surcharge 9/15/2005 $8.54 REQUIRED ITEMS AND REPORTS
• Total $115.24
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: "(PX1 C 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 Leifsen 503 - 698 -2486 To: City of Tigard Date: 9/1/2005 Time: 2:47:50 PM Page 2 of 3
•i Electrical Permit Application J r I t , ii ( ) I I I ( 1 1.1 1) \ 1
City of Tigard 3 VC -d J7 n_
7 2 3 ► J /"' d Permit No.: d i t Plan 13125 SW Hall Blvd., Tigard, OR 9:
Phone: 503.639.4171 Fax: 503.598.1960 "'' • p Other Permit:
Inspection Line: 503.639.4175 1, ' r
. 4 'I I. •
, t aro ReedyBy: IMO ® See Page 2 for
Internet www.ci.dgard.or.us Notified/Method:
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❑ New construction ® iA ddlfi'onlalteratioNreplatxment Please check all that apply:
❑ Demolition p Other: ❑Service over 225 amps, comm'I ['Hazardous location
, ' , r ' -, r - , , 3 Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
_ Y _ _ . . > t 7 ,, 1.. ' :..;.: :: ■ 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
❑ Multi- family ❑Master builder El Other: ❑Building over three stories [Weeders, 400 amps or more
1 „ „ r 7 , ['Occupant load over 99 persons ❑Manufac ured structures or
k tl : .. t ❑Eg ess/Iighting Plan RV Park
Job no.: Job site address: 16165 SW 72nd ❑Health facility ['Other:
Submit, sets of plans with any of the above.
City/State/ZIP: The above are not applicable to temporary construction service.
�� apt. no.. Project name: Max-Viz - &° - -- q ;
DuctiPriw, Qty . 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'( 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential 75.00 2
.d .
t ` ,.,� rn i 1 Limited energy, non -
^s residential 75.00 2
+ - _ iii ','.:--77--.--:`,1=C°:..,,, si i� i
1 _ ,.... Ii.',
. ,.: . ..; _: ;i , ;:-.: .1�: !._ ', .. i,, t 4 _ ::.:::..:: Each manufactured or modular
TI dwelling, service and/or feeder 90.90 _ 2
Services or feeders installation, alteration, and/or reloeadon
200 amps or less 80.30 2
, + r r t " ,, ..1 201 amps to 400 amps 106.85 2
,' , , .. ._._ ?..:,:. .. , r , 401 amps to 600 amps 160.60 2
Name: 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: ( ) Fax: ( ) relocetlon
200 amps or less 66.85 I I 1
Owner installation: This installation is being made on property that 1 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 an 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
i Ee , i - :,- `, h ,- 1r11 - . Y i. E 1.+ 1 -, 3-r j 7 E a , :. ` A. Fee for branch circuits with
Business name: Johansen Electric Inc. Brandt circuit er ' each 6.65 2
as Leifsen B. Fee for branch circuits
Contact name: Char(
Y without service or feeder fee,
Address: 10948 SE Valley View Terr. each branch circuit 1 46.85 46.85 2
Each add'( branch circuit 9 6.65 59.85 2
City /State/ZIP: Clackamas, OR 97015 Miscellaneous (service or feeder not Included)
Phone: (503) 698 -3417 Fax: : (503) 698 -2486 Pinup or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: johansenelect@msn.com Signal circuit(s) or limited -
I tlf r 4.•;:,r-:;:-..:-. a t _ t i• ,; x + 'i energy Panel alteration, or
extension. Describe: Page 2 2
Business name: Johansen Electric Inc.
Address: 10948 SE Valley View Terr. Each addiittonal 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 Li 3 -243 S / .rv. Lic.: 2053S Subtotal 106.
Suprv. Electrician signature, required: ���� / i �� , Plan review (25% of permit fee) IIIIIIIIA D 9/1/05 State surcharge (8% of pennit fee) - 8.54
l / M ' TOTAL PERMIT FEE 115.24
: .
Authorized signature: / , . , Tills permh application expires if a permit is net obtained within l80
days after it has been accepted as complete
Print name: : . Date 9/1/05 1 /05 a F e e methodology set by Tri-Cotm y Building Industry Service Board
es Numbs of inspections per pemtit allowed.
i:5uildinePemriti EI.C- PamltApp.doc 12103 440-4615Tp0/02/COM /WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005.00685
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/15/2005
Phone: (503) 639 -4171 ..u11� it
Inspection Requests (24 Hrs.): (503) 639 -4175 - 1
INSPECTION WORKSHEET FOR DATE: 10111/2005 TIME: 7:08AM PAGE: BC
SITE ADDRESS: 16165 SW 72ND AVE BLDG D CLASS OF WORK:
SUBDIVISION: PACTRUST BUSINESS CENTER LOT #: TYPE OF USE:
PROJECT NAME: MAX - VIZ
DESCRIPTION: (10) branch circuits.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: JOHANSEN ELECTRIC INC PHONE #: 503- 698.3417
Inspection Request Scheduled For: Date: 10/11/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 017920 -01 503 - 704 -1534 N
Corrections /Comments /Instructions:
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
___ 47SAJ________
Inspector: Date: /0 ` /1— D-S° Phone #: (503) 718-
. �. ,