Permit CITY.OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00580
, DEVELOPMENT SERVICES DATE ISSUED: 9/17/03
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 - 4171 PARCEL: 2S113AA - 01000
SITE ADDRESS: 16562 SW 72ND AVE B -09
SUBDIVISION: OREGON BUSINESS PARK 1 ZONING. I -L
BLOCK: LOT : OOC JURISDICTION: TIG
Project Description: Installation of (10) branch circuits for tenant improvement. Job No. 8924
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: 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 -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 9/17/03 $106.70
[TAX] 8% State Tax 9/17/03 $8.54 Rough -
Elect'I Final
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 da . ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth in 52 -00 -s : 0 through OAR '52- 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1 -80 32 -2344.
, its ,A
Is ued By: _�' : % !� i Permit Signature: X/ 2 •
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: td t DATE:
LICENSE NO: 36
Call 639 -4175 by 7:OOpm for an inspection the next business day
Fr : Charlynn J. Leifsen To: City of Tigard Date: 9/15/2003 Time: 4:12:08 PM Page 2 of 3
...fr
Electrical Permit Application
R eceivEG � `1~1GCtr;cah ��++ Q �"�
Date/By: 9 /S v : :' : FsrrnitNO,:: G L:L' - ( a S
City RECEIVED 11�E p Onto/ By: Approval • P e r
Ci Of Tigard Planning Permit Na.:
13 125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 ccCC�� DatelBy: Pem»tNo.:
Phone: 503- 639 -4171 Fax :SE6 - 5/8511003 Post - Review Land Use
4,' .' DatrlB Case No.:
Internet: www.ci.tigard.or.us re' i I Contact J + :l ; See Page. Z for
13ameA4cthod: / Supplemental Information.
24 Inspection Request :Cy���y9- ft1��5RD --- ��
BUILDING DIVISION
.. , .,......r n-- �•- .T.� � „. . ( �� .'.:. r. :. f.A: J - •�.l'A' :. .. ; . r . + � a: 1�Fa _ ..,
. .. - :.: :.,.. .x...- � � � i •..: L.. ...... r:.. y �� � .. �r ..F,..: , .� :. ^..V �': A "'.:}.`Ir :.' %RM•!r�µ N �� }�;... _
• New Demolition ■ Service over 225 amps- • •'l'Heaith -care "facility:
commercial ❑ Hazardous location
• Addition /niteration/rre lacement Other: CI service over 320 amps-rating of ❑ Building over 10000 square feet,
�
�
:: ,';;` :'ti i"' , ': 7 " .. '. ''$ : ,t 63)91:::y ?'� ,;ny: ?A4. :rY '.`•:., 1 & 2 family dwellings four Or note residential units in
NI 1 & I.Family dwelling x Conunercialiindustrial ❑ System over 600 volts norrdnai vile sIrtiCtox
0 Building over three stories 0 Feed 400 amps or tnorr
i • Accessory Building ❑ Multi - Family 0 Occupant toad over 99 persons ; ❑ Manufactured structures or RV park
Building
I • Master Builder .] Other: # Eg essnightnng plat, . • . 0 Outer. ••• :.,. - -- ..
i, Ls o ar x Y `: O f r Ore ll C ' Submit sets of plans with any of the above. �I
;!nd ' 1 '1
' The. above are not as: licableto tern .orar�':conctrtection
Job n° f
h site address: 16562 SW 72nd Ave ^ y xta ins �A, ' .a: e�,. ' r m '-, 1µA^ 2 —
:
Suite #i: Bldg. /Apt.#r: Number of hispectiOns per : permit allowed
Project Name: Spec Space Description Qty fee (ea.) Total i
New residential- single or enultbfamily per
Cross stieet/Tirections to job site: dwelling unit Includes attached garage
1 Service included:
1000 sq. ft or ices 145 .. . 4
Each additional 500 sip tt or portion thereof • . 33.40 - 1
Limited energy. residential 75.00
Subdivision: I Lot it: . —.. ._..__: • Limited energy, non residential
Tax ma 1 • • reel #: Each manufactured home or modular dwelling
x 47∎1 ; ,Itr �SIt ta7. :• , • eyvv serviceundtor feeder 90.90
k , ; ^ jt x` . .6 4 ,- .4. - .� ^ 4 44.1. 1 . , '4,Y. (] : G Hie r ,.. -- - ' (; � :I F YJ L A: . .
^ ., • ' Services or feeders - Installation,
Tenant Improvement alteration orrelocatton: •
249 amps•r ices - 80.30
— • 20 amps to 400 amps 106.85 ' ••
401 amps to 600 amps . 16050 . in
L : r '601 a%ps w 1000 amps 240.60 2
Name: s; 'L 4 . t ' l wl N� . `x+ .,§E ' > t ,• �+... ; ... , ai (h cr MO oar, s or vo ice G �.3 2
I
`� r? MO only
Address: ' Temporary servic or feeders - installation . .. 1`
alteration, or relocation: {
City/State/Zip: 200 amps or lest 66.85 1 ;;
( 20I amps b 400 amps 100.30 Phone: - 1 401 to600amps 133.75 2
w 4 �L�p 1.2•'R++''R'(f :) ": r.A. R '," .,... rr & V,nV r ' k
4 '''''s �..t r
Willi? ka1t't4. ydrRe;r:,.o 1 44 .5,^'l : ;, ; 'r r . : '.t .if: . 71:'- S I u cb circuits- new, alteration, or
Name: Johansen Electric Inc. extension per panel: . : .
A. Fee for braocheircuits with purchase of
V Address: 10948 SE Valley View Terr. service or fee=ler fee, each branch circuit 6•65 2
City /State/Zip: Clackamas, OR 97015 • 11 Fee Mr branch circuits without pureha.6 of 1 l•. 46.8 46
servfee or feeder fee, first branch circuit
•'
ph one: ( 50 698-2486 F.ach ndditinnai branch circuit 9 .4,65 59.85 2
698 -3417 Fa (5 03 )
E- rrlail: Johansenelect @a Misc.(Scrvice or feeder not included).
i �. • v. r E pump or irrigation c 53.40 2
^L. (�t iN'A 'f' ',.......'1:.,:,::41::::'4' i .�.._ µ ....r -._
�f . . ;. f 4 ^ �r{'.•. •l '. li4 t� t� I`�•w�nw>' a r�f _ -� Eectt 91 ou 1 e lighting 53.40 2 • _
Job No: 8294 Signal circuit(i)or a limited energy panel,
t altertfon, or Clctrnsica • Page 2 2
Business Name: Johansen Electric Inc. Description: :
Address: 10948 SE Valley View Terr.
F.ach additional inspection over tbe allowable in an .- oftthe above:
Cif' /State /dip: Clackamas, OR 97015 Per inspection per t,o,rr�in. hour) .62..50
Phone: (503) 698-3417 Fax: (503) 698 -2486 Investigation fee; r
5 1539 Lic. 3 -243 r•--. °a1ef
CCB I ic• #: #: _ . `' ^ alb+ ! '4 4 '41 . 4 �' .1 •K. Il w , +
Supervising electrician Subtotal .8.106:70
signature required: Plan Review (25% of Permit 'Peel: • . $ _. .
State Surohar a 8% of Permit Fee) _ 5 8.54 c
Print Name: Carl K. Johansen 1 Lic. #: 2053S .8 ( ' 1
r TQ� AI. PERMIT lEi _ $ 24 :
•
9 -15 -03 Notice: This permit applicationcapiresif a permit is not obtained within
Authorized , iA j. a ,, e: ISO days after lithos been accepted as complete.
*Fee methodology set by 3'rl- County Building Industry Service Board.
Charlyn • . Leifs - n f
(Please print norm)
i:\DstslPemvl forms\ FloPermitApp.dec 01(03
I
CITY OF TIGARD 24 -Hour
BUILDING - Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested l d — 7 AM PM BUP
Location / % Z '7 `t 40-e • Suite MEC
Contact Person —TO Ii V Ph (9-5
�� SZb2PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 3 - 00 52
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
C
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 RT FAIL
( rECECTRICA
Service
Rough -In
UG/Slab
Low Voltage
rm
'� Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
P. :l PART FAIL
SITE 111 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date I Inspector Z� Ext
Other:
Final DO NOT REMOVE this Inspection record om the jo site.
PASS PART FAIL