Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2002 -00603
DEVELOPMENT SERVICES DATE ISSUED: 11/15r02
^~^ 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S113AA -00700
SITE ADDRESS: 16444 SW 72ND AVE B -05 ZONING: I -L
SUBDIVISION:
BLOCK: LOT : OOD JURISDICTION: TIG
Project Description: Install 1 200amp and 6 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: SIGNALJPANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: 6 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: 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 TERRACE
PORTLAND, OR 97224 CLACKAMAS, OR 97015 -000
Phone: Phone: 503 - 698 - 3417
Reg #: ELE 3 - 243C
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 11/15/02 $120.20
[TAX] 8% State Tax 11/15/02 $9 Elect'I Service
Rough -in
Total $129.82 Elect'l Final
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 -800-3 -2344.
Issued By: (r r /� - .mac a— Permit Signature: e)-
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: (U 6 - 3 S
Call 639 -4175 by 7:OOpm for an inspection the next business day
From: Charlynn J. Leifsen To: City of Tigard Date: 11/12/2002 Time: 9:56:06 AM Page 2 of 3
A
• Electrical Permit Application ' i l l ,,1 1
Date raccived //-6 -o a Permit no.: ' 2 2 19060 '
City of Tig • ev ED
- i . Project/appl. no.: Expire dare:
City of Tigard Address: 13125 SW "k11 tgatd, OR 97223 Date issued: IMEM Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 lei 1 F c�
. 212 Case fie no.: Payment type:
Land use approval: ABO
0 1 & 2 family dwelling or accessory ID Commercial/industrial l] Multi- family O Tenant improvement
O New construction 0 Additimegferation�placement ❑ Other. O Partial
Job address: 16444 SW 72nd '3 .05 Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: !Block: I Subdivision:
Project name: NW Industrial Plastics Description and location ofwork on pxmises: Work to move tenant in
Estimated date of completion/inspection: ASAP
4 (l \I It \( Il)I( \I'I'1.1( \11(1\ I I.I. . \( 111 1)1 1.I
Job no: 8013 Fee Max
Business name: Johansen Electric Inc. Dernipreini Qty. (°') Total ao'inm
Wewreafdeadal -deer yper
Address: 10948 SE Valley View Terr. . dwelliagualtindladesatteelted garage,
City: Clackamas 1 State: OR 1 ZIP: 97015 Servireb`weea:
' Phone: 503 -698 -3417 1 Fax: 503-698-24861E-mail: .ionansenesact@aoicom 1000 sq. R. or less 4
CCB no.: 51539 1 Elec. bus. lic. no: 3 -243C Each i 6OO7t son s0,. a t>r potion thereof
Limited energy, residential 2
e lis�no.: 4896 • Limited energy, nonresidential 2
11/12/02 Earl mauufacttaed horse or modular dwelling
Signature of bring electrician (required) Date Service and/or feeder 2
Sap. elect. name (print): Carl K. Johansen i.iocase so: 2053S 8e'd`erortmed®.- Iarauatyom'
alteration orrdocanow
200 amps or less 1 80.30 80.30 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: 'State: 1 ZIP: Over 1000 amps or volts 2
Phone: 'Fax: 1E-mail: Ktasrmmt only 1
Owner installation: The installation is being made on property I own Tempara*y.enims or feeders -
which is not intended for sale, lease, rent, or exchange according to 1°'c.m`tf°°'`ue"dm''°srelocation:
200 amps or less 2
20
ORS 447, 455, 479, 670, 701. 201 1 amps to 400 amps 2 ,
Owner's si tare: Date: 401 to 600 s 2
Iran& `tr`dt. - new, alteration,
or extearloa per pearl:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6 6.65 39.90 2
City: 1 State: 1 ZIP: B. Fee for branch circuits wianut purchase
Phone' Fax: E-mail: of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
Mb- (Servvt a or feeder mot Indaded):
0 Service over 225 ampseom' vial 0 Health-care balky t+acb pump or irrigation circle 2
O Service ova 320 amps - rating of I&.2 O Haraudous Iocatisn Bach sign or outline lighting 2
family dwellings O Building over 10,000 square fad four rR Signal circuit(s) or a limited energy panel,
0 System ova 600 volts nominal more residential units in tine structure alteration, or extension• 2
0 Building ova three stories 0 Feeders, 400 amps or mac • Description:
0 Occupant bad over 99 persons U Manubamed sanctums or KV park Each Makes! Inspeetion over the allowable d aay of the above:
0 hgtea-a/lighting plan U Other: Per inspection f 1 I 1
Submit sets of plane witty nay of tie above. 1mestigation fee
Mee above are mot applicable to temporary eoudrudion service. Other
Permit fee . $ 120.20
Nut all jurisdictions accept credit cads, Naas call jurisdiction for mare information. Notice: This permit application
u visa U MasterCard expires if a permit is not obtained Plan review (at T %) $
edu card member: .. . _ / / within 1 SO days after it has been State surcharge (8 %) $ 9.62
cr
pQ° accepted as complete. TOTAL $ 129.82
Name of cardholder as shovm on credit card
s
Caialder signature Amount 440-4615 (6/00/COM)
CITY OF TIGARD 24 -Hour
;,BUILDING Inspection Line: (503) 639 -4175 MST
.INSPECTION DIVISION Business Line: (503) 639 -4171
!) BUP
Received Date Requested ) / — i ll AM PM BUP
Location / 1 y 7 Z .-✓ lls-/ Suite MEC
Contact Person r ( Ph ( ) 7 0 V -/)-141 PLM
Contractor S� l �,�lc? �Fc,'c Ph ( ) SWR
BUILDING Tenant/Owner ELC _ L 9O3
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
Drywall Nailing •
Firewall "— • c t
Fire Sprinkler — - — " A s rpnIS
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
cAI.
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
r iMp PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA �
Approach/Sidewalk Date f/ '' 0g Inspector Ext
Other: v r7'
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL