Permit CITY OF • TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00395
i DEVELOPMENT SERVICES DATE ISSUED: 6/29/2004
hL` '�� �� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 2S113AA-00200
SITE ADDRESS: 16364 SW 72ND AVE B -08
SUBDIVISION: OREGON BUSINESS PARK I ZONING: 1 L
BLOCK: LOT : 002 JURISDICTION: TIG
Project Description: 2 branch circuits to check tenant wiring.
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: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 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: Phone: 503 - 698 - 3417
Reg #: LIC 51539
SUP 2053S
FEES ELE 3 -243C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/29/2004 $53.50
[TAX] 8% State Surcharge 6/29/2004 $4.28 Rough -in
Elect'I Final
Total $57.78
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: Permit Signature: f>'-
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 639 -4175 by 7:OOpm for an inspection the next business day
From: Charlynn J. Leifsen To: City of Tigard Date: 6/25/2004 Time: 10:47:32 AM Page 2 of 4
Electrical Permit �t�l�` / D 1 1 i I< I I I l 11 1 1,1 11\ I. l
City of Tigard �/ Al, - Dat :: � 1 r i ia� ,r - (� Ai
13125 SW Hall Blvd., Tigard, OR 97223 2004 Phone: 503.639.4171 Fax: 503.598.1960 !, ;, "', ` ..,, _ ; Other Permit:
Inspection Line: 503.639.4175 ' ' ' ' e : _ pate Ready/By: ® See Page 2 for
Intern CITY OF
et: www.ci.tigard.or.us T I G t N otif ed/Metbo d:
Supplemental
., Information
f t ,
❑ New construction ® Addition /alteration/replacement - Please check all that apply:
❑ Demo1 • ❑ Other ['Service over 225 amps, Comm') []Hazardous location
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
%i r . 11 ''=:', 4 , °" ;` ' ` 'v , � ' I of 1- and 2 "filmilY dwellings 4 or more new residential
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
f=1 Multi - family El Master builder ❑ Ogler; ['Building over three stories [Weeders, 400 amps or more
„ Occupant load over 99 pers ons Manufactured structures or
,, �
,- 'r F.,il S n . r', , f_.: ∎. . . � r_ , 1 + -4:' ;i5t DE P RV park
Job no.: 8671 Job site address: 16364 SW 72nd ❑Health - care facility Il Other
Submit .1. sets of plans with any of above.
City/State/ZIP: Portland, OR 97224 The above are not applicable to -r, r , rary construction service.
Suite/bldg. /apt. no.: Project name: Ron's Restaurant Services " ' "' `
Description Qty. Fen 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'l 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential 75.00 2
' } M y� ` ° 141i } t irif ,. Limited energy, non- residential 75.00 2
;, ,:, .... Each manufactured or modular
Check tenant wiring. dwelling, service and/or feeder 90.90 2 .
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
w; w i r z `a r ' ∎ ∎ r 201 amps to 400 amps 106.85 2
.. f,
r' . t . , a_ V' •.,i t. l - ; . ' 7.z-----1 '' '' 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 1 66.85 1 1
Owner installation: This installation is being made on property that I own which is not 201 an 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
u z,xt! ,r ' , , }� ,
., :,::,.0 1 ",i' ,
, - zi ' c ,1 fly ; Fee for branch circuits with
A
..r r,l s _. , ..,.aa„�, 7. . :� :;: A. _.,ht.i., ..1
... .., . • � . , .._ . _.. `' service or feeder fee, each
Business name: Johansen Electric Inc. branch circuit
6.65 2
B. Foe for branch circuits
Contact name: Charlynn Leifsen without service or feeder fee, 1 46,85 46.85 2
each branch circuit
Address: 10948 SE Valley View Terr. Each add•[ branch circuit 1 6.65 6.65 2
City /State/ZIP: Clackamas, 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: johansenelectamsn.com Signal circuit(s) or limited-
[ .` kc._ it _. _ t`. •ty ...• `. a. . .:. ` Y s < .F o A 11 ',4-,:-::::5-='''-'• ', -, . r-n.,s ''1). +r llf.,. - �=1 1 . energy panel, alteration, or
. ,., , ..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 7335 2-,',2.1---,s2.0,,,,,.;
CCB Lic.: 51539 Electrical Lic.: 3 - 243C Suprv. Lic.: 20533 Subtotal 53.50
Suprv. Electrician signature, required: .. / _ / / Plan review (25% of permit fee)
Print name: Carl K. Johansen / / / Date: 6 /25/04 State surcharge (8% of permit fa) 4.28
TOTAL PERMIT FEE 57.78
Authorized signature: i " " irI R . This permit application expires if • permit is not obtained within 180
days after it has been aaepted a complete
Date: 6/25/04 • Fee methodology sa by Tri-County Building Industry Servia Board
•• Number of inspections pa permit allowed.
is Building \Permiu\ELC- PermitApp.doe 12/03 4464613T(10/02/COM/WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection. L'ne (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested g — a 7 AM PM BUP
Location / (o 7) £ 4.4.2.-e_ _i Suite MEC
Contact Person Ph ( ) 7e 4- /S3 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner C./,44 ELC c200 DO. � 35
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation M PQ /� ( F1 ��fl 1
Drywall Nailing T) f u ► v v
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
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
�� E Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SI Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line �f I / , A
ADA Dated — 27 J Inspector ( (,, Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL