Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00141
. a DEVELOPMENT SERVICES DATE ISSUED: 3/9/2005
i4/ J � 13125 SW Hall Blvd., Tioard, OR 97223 (5031 639 -4171
PARCEL: 2S113AA-00300
SITE ADDRESS: 16300 SW 72ND AVE B3
SUBDIVISION: OREGON BUSINESS PARK I ZONING. I -L
BLOCK: LOT : OOA JURISDICTION: TIG
Project Description: Electrical reconnect due to meter explosion.
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: SIGNAUPANEL:
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: 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: 1 SVCIFDR >= 225 AMPS: CLASS AREAISPEC 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
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Phone: 503 - 624 -6300 Phone: 503 - 698 -3417
FEES Reg #: LIC 51539
tion Date Amount SUP 3
Description ELE 3 -243C
[ELPRMT] ELC Permit 3/9/2005 $66.85
[TAX] 8% State Surcharge 3/9/2005 $5.35 REQUIRED ITEMS AND REPORTS
Total $72.20
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 - o in : - 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -66 • or 1-800 -332 -2 • • .
Issue; By: 't 1 - 1 L. Permittee Signatur
OWNER INSTALLATION ONLY
The installation is being made on property 1 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: v
Call 639 -4175 by 7:OOpm for an inspection the next 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: 3/9/2005 Time: 2:23:38 PM Page 2 of 4
ElectricaI_permit Application . ri 1l< i ill ( 1 . 1,1 () N I )
City of Tigard , ff /� • P erm it • No. ' i •. • -4)
13125 SW Hall Blvd., Tigard, OR 97223 Plan Rc Review
Phone: 503.639.4171 Fax: 503.598.1960 . .' Dar- : Omer Permit:
Inspection Line: 503.639.4175 _ t•.4.- ' f� Date Ready/By ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: , Supplemental Information
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:
❑ New construction to Addition/alteration/replacement Please check all that apply:
El Demo • • ❑Other ❑Servioe over 225 amps, comm'l ❑Hazardous location
, s j • ;M -, + � , r a I1, ❑Service over 320 amps - rating QBuildng over 10,000 sq. ft.,
clt`,8:. -. t tv , f 1 ' ", . .. . w ht 'i?lr of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling IS Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
['Building over three stories [Weeders, 400 amps or more
❑ Multi - family ❑Master builder ❑Other:
,.. r z 6.a , m :. 1', . ,, '.''''.4,'-','--;,`-'''71-..-='.1-,--f:',',' ris . s ,- . Y - ',w a f � u ; P CdStrUClufeSOr
[Occupant Toad over 99 persons Manufactur
.5 `� , :ti ., n ,- , s Y ❑ Egress/hghting plan RV park
.. .. �e., ..c . .. s ..., a .. r. _._. .. ::.. ... �k
m b' • (']Health -care facility ❑Other:
Job no.: Job site address: 16300 TH -W-- -- ) 7 Submit .1. sets of plans with any of the above.
City/State/ZIP: Portland, OR 97224 Ai) 4, The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: • 0 ' 1 9 Project name: Tufcoat '.. .:;, : , �� a:
Description Qty. Pm Taut
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
Tax map/parcel no Limited energy, residential 75.00 2
w n , ,
a .'::::1,-;.:41:0`A::::": Limited energy, non residential 75.00 2
.r.. :: t o L , - ... , , °'
..�a!f;�:. 1 . .......: ' 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
i, ,n rf _ .
, ru , , , i1- rr t F c t- r i ; 201 amps to 400 amps 106.85 2
... �_ , ..,...,.. ?w J.. ,e:;:I ., ., :_; 1 • n:f;l; u 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 1 66.85 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 20elocation 0
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 an to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
i t'c� 4i } + 1 " 1 } 1 '1'` M'4 t , r ' ' ,-, ,i tl it k ? A. Fee for branch circuits with
.
: ,;., ..a -.. -, .. t, r.. ?, . ._ (_ , 11 ..!,,,, . _ ,�. .. , 2 a,,. ,r f ■A ° 7.3 t .
service or feeder fee, each 6.65 2
Business name: Johansen Electric Inc. breach circuit
B. Foe for branch circuits
Contact name: Charlynn Leifsen without service or feeder fee,
each branch circuit 46.85 2
Address: 10948 SE Valley View Terr. Each add'I branch circuit 6.65 _ 2
City/State/ZIP: Cl ackamas, OR 97015 Miscellaneous (service or feeder not included) _
Phone: ( 503 ) 698 - 3417 Fax: : ( 503 ) 698 - 2486 P or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: johansenelect(i)msn.com Signal circuit(s) or limited -
i„. " fl i f .k 4'..:17 r f'- :. - s tk . F ft , y3 f- 1 - j11" - v. : enL panel, alteration, Or
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 (I br min) 62.50
Phone: (503) 698 - 3417 Fax: (503) 698 - 2486 Industrial plant per hour 73.75
y : i A. IP .., ' f t z .�'= S 1:
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CCB Lic.: 51539 Electrical Lic.: 3 - 243C Suprv. Lic.: 2053S Subtotal 66.85
Suprv. Electrician signature, required: - . / / � - J ` Plan review QS% of permit fee)
Print name: Carl K. Johansen / Date: 3/9/05 State surcharge (8% of permit fee) 5.35
m
TOTAL PERMIT FEE 72.20
Authorized signature: • i ` V �� a , This p ermit application expires if • permit hi not obtained within 180
• days after it has been accepted as complete
Print name: Charlynn J. Leifs - 0 Date: 3/9/05 • Fee methodology set by TriCooaty Building Industry Service Board
•• Number of inspections per permit allowed
i1Buildintre niu\ELC- PamitApp.doe 12/03 440.4613T(10/02/C0M/WEB
CITY OF TIGARD
BUILDING DIVISION y PERMIT #: ELC2005.00141
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/9/2005
Phone: (503) 639- 4171AP �
t
Inspection Requests (24 Hrs.): (503) 639 -4175 1 ..
INSPECTION WORKSHEET FOR DATE: 3/10/2005 TIME: 7 :30AM PAGE: 42
SITE ADDRESS: 16300 SW 72ND AVE B3 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK I LOT #: 00A TYPE OF USE:
PROJECT NAME: TUFCOAT
DESCRIPTION: Electrical reconnect due to meter explosion.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503-624-6300
CONTRACTOR: JOHANSEN ELECTRIC INC PHONE #: 503-698-3417
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Inspection Request Scheduled For: Date: 3/10/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 001150-01 503- 704 -1534 Y
Corrections/Comments/Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ' ‘ ' Date:5 - / 0 0 ,3 Phone #: (503) 718-
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