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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2004 -00089 �I� DEVELOPMENT SERVICES DATE ISSUED: 2/25/04 � f '` -ma 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 - 4171 PARCEL: 2S 113AC -00101 SITE ADDRESS: 16655 SW 72ND AVE 500 SUBDIVISION: COUNCIL VIEW ACRES NO. 2 ZONING: I -P BLOCK: LOT : 029 JURISDICTION: TIG Project Description: Electrical TI, (2) services 200 amps or less & (12) branch circuits. Job No. 8407 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: 2 W /SERVICE OR FEEDER: 12 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 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 2/25/04 $240.40 [TAX] 8% State Surcharge 2/25/04 $19.23 Elect'I Service Rough -in Total $259.63 Elect'I Final This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246-6699 or 1- 800 -332 -2 ••. • • Issue. By: _ P`/ � /% Permit Signature: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: `' 4W DATE: LICENSE NO: X535 Call 639 -4175 by 7:OOpm for an inspection the next business day From: Charlynn 1. Leifsen To: City of Tigard Date: 2/23/2004 Time 1:28:26 PM Page 2 of 3 Ekterical licatllo '0i Uarm .n 4 irVil ���1' i4L 11 Ji nQ1s L d ' Received :•Bleetneal p ,p PlanningA proval Sign City Tigard Ell V �D Datc/I3J: ✓� Permit No.: -- __________ 125 ;SW Hall Blvd. . Plan Review Other Tigard, Oregon 97223 ftb .0 Date/By: .. Permit .No.: ' Post- ilesieiv Land Use • Phone: 503-639-4171 Fax: 503-598-1960 >@ � rt, t>am y Case tv�a.: _ — -- — T _ _.. • Internet: WWt .cL l and 01'.US CIT (1 drr 1L:� ,+t hi" Contact Jtrris.: See Page Z for - � .�lrm 24 -hour Inspection Request: 503 -639 DiN. • j � -- 1. Name7Motltod. Supplemental Information. 1 • ' -- r -+' i '.�.�"_ -' �-r- - - ; � :S . A ..� : . y ... '.� - - /i,. c Mr•. ( ^��r r2 ?}� : . r.: ,... r - . �.,..n... i, r .�.. - IT.., Q � ;•: .W.. .. raia ..'A "F4' :'J�i+4r l ^! 'yi:' �V: 'f., 11 Ilayl$t ; tt . New construction _ Demolition erviu over225 'H:ealth -care .facility: . __ •- commercial ❑ Hazardouslocation © r�+dditlollltilteratitaxl!T .lacctnent Other. CI Service over 320 amps-rating of ❑ Building over ;,0,090s,guwe feet, r i ` iI5A fgr m residetrtia.I units in r ,r ,: �., .:..5% -��' ;.;....�t��:..t ����� I3Y��I�d� � .' �'...'. s, ., i & 2 family dwcllin� { �7 1 & 2 •Family dwelling © Commercial/Industrial mercial/Industrial ©`r'y:tena over 600 polls nominal I a ne sl n,ct ore —. -_. - - — - -- . ❑ Building over three stories r 0 Feed 400 .attps or [tore { Accessory Bu ilding Mtl1 e1 -t amity t ❑Occupant toad over 99 persons Mnmtfactursci structures or k�' park • t f Master Builder Other: 0 f=gresvll ;ghurrg.ielan 0 outer �,, �.- + '+rd Submit sets of plans with any of the above. AL .717 -li `.5`X x : 4 l i►' iadilf µadit£ 'C -04 r x a The above are not a llcable to tern orarti n service Job site address 16655 SW 72nd , m.. - - -- . ._ gfigo: +� M�hot , ke _ ;r µ Yry� ?� Suite i #: 5 00 Hld.. /Apt. #i: - Number of•inspeclibns per permit allowed r_.. Description Pro'cct Name: Arlenco { Qty $es(ca.) Trite —••— New residentla &single or multi- family per Tr Cross s rect'T)irections to lob Site: dwelling unit. includes attached garage. 1 Service included: , 1000s._ tt en less '145.15 ... 4 Eat% additional 500 sr fr. or neon tt rwf 33.40' _- _ -- - - -- —. -. _....."...r- -- - - -- -- Limited ene v. resident :al 1 75.00 1 2 + Subd ,vision: 1 L fr _.. . l , imiiedenema nonresidential 75.00 . _ .. - 2 Tax mil / }arccJ #: Each ni ufac ured home or modular dwelling 4G Rfl z . VimW A4' JJ' 'T ,r�: servico andkw 'r' - lhng � _.....__ ° „'"'`..: � ---- --•.__ ' • Services en feeders - lnstalfadua, alteration' or relocation: 'Tenant Improvement 106.85 1 2 I •- __ -- -�. .-- 201 atttPs to 400 neaps r : yz ' 4 crops to 1000 amps -.. 140. .''60 _ 2 y+ � _ 240 2 �g i r ...._ _ Over 1000 amps or 12,4_ 654.65 Name: - _ -._ Reconnect only (4.85 1 2 , � • - -. 200 amps or tservi e i or feeders - installation, Address: Cit '!StEIteiZip• • - - -r - - 3 ! —_ 3 k - 14ti: 0 t 2 A Phone „ * 401 t 00 amps 1.3. S 4 ; , 1E.'i i ¢ ~ < k; . , ,. % n `e `'' ,,1 , I3f1rneh circuits - new, alteration, yr z Name: Johansen Electric Inc. 1 extension {ter panel: .... . . , —.._ __ _ - - A fee ce o r feede rrc fee, with r a n ch ci r ai' 1 12 0 1 Address: 10948 SE Valley View Teri. ._- service tar. feeder fee, pacer branch circuit _ G.t 79.8 j 2 ' Clackamas, OR 97015 13 p Fee, for branch circuits without urchase of • 1 j City /StatelZip: - -- servi'ec or feeder fee, first branch circuit _ I 4G: 85 1_2 i Phone: ( : g : (503 698 -2486 Eac additional branch circuit - -I- _ 6 .6 5 1 ' > email Johansenelect@aol.com Misc (Service or feeder not included). w a.A Ma Fac_ h 4?t°” °r rrratsua_cirote 53.40 — -- 2 •-- 'wr'i-, ,.; ' ,G; � +:5::, , , , • a , t, . , .+a`, _ ` 2 -- b� 1V-E .F . Each sit n o outline tip inn&_ 53.4:0 , - 2 i .,u ' y 8407 _ - � ___� Sign -al c o' a lirnited energy panel, loll No: P I . �.... -- - °— alteration, or extension _ ___ Pay e 2 I _....�.. 2 Business Name: Johansen Electric Inc. 1 7eseriptian: — - - -- Address: 10948 SE Valley View Terr. Fach additional iris Mien over the allowable in anv of the ohove: Li Citv!State /Zip: Clackamas, OR 97015 Perinspection. 1 hour) 62 i__.._._ 503 698 -3417 Fax: (503) 698 -2486 tm�cdgaltonfex - j ... 515 Lic • i. 3-243 C " C. C;1Lit). //: - _." ;* +n � Y ' r r 1, a : x ' ".. ' ; " i Supervising electrician . (25% of Permit $ .240.40 signature required: Plan Review rmit ['ec1 :_ . ... St ate Surcharge 8 4 of I Permit Fee'i $ 19.2 Print Name: Carl K. Johansen Lic. #�: 2053S -___ ( .. -.- I'GI I'AL PERMIT PEE Gl (� I' PR _ P 1 _ __� Authorized 1 t ` (. / , 2/23/04 Notice: This a rmit.a licatioo. cx Tres if fl permit is not obtained within' Signature: ! ; --- a i D., c: .... _ - 180 days after ithas been accepted as complete., *Fee methodology set by I rI- C.ouaty Building Industry Service Board. Charlyn . Leifs n - / (Plc omit name) . .. . • i :Oats \Permit I=ormsVfloPermitAnp -doe 9 1'03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST �33) BUP Received 4 / 1 ' El Date Requested .3' U c� AM PM BUP //w �� q Zed Location ! (6�� Suite MEC Contact Person 91)14 Ph ( 353) 96 5 4 _ PLM Contractor Ph ( ) SWR BUILDING • • •wner T- 4 V-0 29 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 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 F'_: • - m PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. tara. ❑ Please call for reinspection RE: Unable to inspect — no access Fire Supply Line / ADA " Approach/Sidewalk Da 0 .- 6 Inspect° . O Ext Other: Final DO NOT REMOVE this Inspection record fr m the Job te. PASS PART FAIL