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Permit
CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2005 -00170 1 111 1 DEVELOPMENT SERVICES DATE ISSUED: 3/21/2005 '' 13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171 PARCEL: 2S113AD SITE ADDRESS: 16752 SW 72ND AVE B14 ZONING: I -L SUBDIVISION: OREGON BUSINESS PARK I LOT: 011 JURISDICTION: TIG Project Description: T.I. 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: 1 W /SERVICE OR FEEDER: 10 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 FEES Reg #: LIC 51539 Description Date Amount SUP 2053S ELE 3 -243C [ELPRMT] ELC Permit 3/21/2005 $140.95 [TAX] 8% State Surcharge 3/21/2005 $11.28 REQUIRED ITEMS AND REPORTS Total $152.23 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: Permittee 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: DATE: LICENSE NO: Call 503 - 639 -4175 by 7:00 a.m. for an inspection that 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: Chartynn J. Leifsen To: City of Tigard Date: 3/21/2005 lime: 1:36:30 PM Page 2 of 4 Electrical Permit Application 97223 rt t( t r i e s l l. l, City of Tigard R E E I V 11 " P amir No. 6,c,, 7 d ' d 0 7 13125 SW Hall Blvd., Tigard, OR E Plan Re n ew _ Phone: 503.639.4171 Fax: 503.598.1960 D :I - : Other Permit: Inspection Line: 503.639.4175 MAR `` I. ! ! D ate R 10 See Page 2 for Internet: www.ci.tigatd.or.us 1 Z r Notified/Method: Supplemental Information . �. >: t :ICrt „p�i ,. ----n-2,',.',-• t A- � _ :[t .... ..l r , rd,, . t ,tr•I is 2. ❑ New construction 3t i :.' t' cement Please check all that apply: El Demolition ❑ Other ON ❑Service over 225 amps, Comm') ['Hazardous location = u , 1 . , ,r it ; t ❑Service over 320 amps - rating QBwldng o v e r 10,000 sq. ft , uii # : *. ;._a n ,.; , - r.:.: , -. . -- - - . - r - . _ '��;;, , ,_,Y ' 41 of 1- and 2-family dwellings 4 or more new residential ❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure El Multi-family El Master builder ❑Other: ❑Building over three stones OFeeders, 400 amps or more t ,1 0 .... 'i 1F:1 rl ' , � .. :. '' , . --• e t t • ' 4 ['Egress/lighting plan persons RV park ed structures or Cf3 Job no.: Job site address: 167VSW 72nd ['Health facility ['Other: Submit. sets of plans with any of the above. City/ State/ZIP: Portland, OR 97224 The above are not applicable to temporary construction service. Suite/bldg. /apt no.:' -/ c( Project name: , i 4 .40:41 '-'1..,.'',..'.;:3".-, '.'")1'..';',."'-, .., ,.. e e n Description Qty. Fen Tend 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'1500 sq. ft or portion 33.40 1 Limited energy, residential 75.00 2 Tax map/parcel no.: Limited energy, non - residential 75.00 2 V : r q jj `.=..":::t'.:.:',.:' iw. {......, ; .. ..s: U s ti .. , i I,,1., , . ,_ ..... t . : -.. i . 1 '' W ,, ,i, 4 IV, ,. . ..... ... ... ... . r 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 1 80.30 80.30 2 n'g +,! ; r .. .'.t<+ t , s, -, '.. "iI*'r'f +4t" ,r �r, 201 amps to 400 amps 106.85 2 P- ..,_ : _ a. :: _ . ., .',,c'',;:,:"•""•-.1.;',',". .i, W.;,.. �r = -. y 2 ..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 66.85 1 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 amps to 600 amps 133.75 2 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel t ''''''"7-7,-7.1,r ' i "� ih : sir n- . A. Fcc for branch circuits with < ; ,.., : -. ��- ..,,.._... ... _: <_ ...... .:... ... ,.. , ,.. >. . ......., service or feeder fee, each Business name: Johansen Electric Inc. branch circuit 10 6.65 60.65 2 B. Fee for branch circuits Contact name: Charl n Leifsen wiihour service or feeder fee, 46.85 2 each branch c Address: 10948 SE Valley View Terr. Each add'I branch circuit 6.65 2 City /State/ZIP: Clackamas, OR 97015 Miscellaneous (service or feeder not included) Purnp or irrigation circle 53.40 2 Phone: ( 503 ) 698 - 3417 Fax: : ( 503 ) 698 - 2486 Sign or outline fighting 53.40 2 E -mail: johansenelectamsn.com Signal circuit(s) or limited - 1 a 4 : j t * s -.-,. f 1 'Ir�'t rfn' 5 . energy panel, alteration, or .. J . , �... 1 , ..... _. I...,.... extension. Describe: Page 2 2 Business name: Johansen Electric Inc. t 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 hr min) 62.50 Phone: (503) 698 -3417 Fax: (503) 698 -24136 Industrial plant 1,,, , - . p er w ', .. _ ....T 5 CCB Lic.: 51539 Electrical Lic.: 3 -243C Suprv. Lic.: 2053S Subtotal 1 40 .9 5 Suprv. Electrician signature, required: / / ... � _ ' ` 4-..:-... Plan review (25% of pern it fee) Print name: Carl K. Johansen / Date: 3/21 /05 State surcharge (8% ofpermit fee) 1 1.28 TOTAL PERMIT FEE 1 1 52.23 Authorized signature: I . , This p ermit application expires if a permit is not obtained within 180 . r - - � , days after It her been accepted epted as complete Date: 3/21 /05 • Fee methodology set by Tri-County Building Industry Service Board •• Number of inspections per permit allowed. is18ui1diaguwmiu\E1.0 Permiupp.doe 12/03 440.4615T(10a2/COMIWPB CITY OF TIGARD BUILDING DIVISION PERMIT #: ELC2005-00170 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/21/2005 Phone: (503) 639 -4171 ` Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 8110/2006 TIME: 7:04AM PAGE: 61 SITE ADDRESS: 16752 SW 72ND AVE B14 CLASS OF WORK: SUBDIVISION: OREGON BUSINESS PARK I LOT #: 011 TYPE OF USE: PROJECT NAME: MCKENZIE ATHLETICS DESCRIPTION: T.I. OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: CONTRACTOR: JOHANSEN ELECTRIC INC PHONE #: 503.698 - 3417 Inspection Request Scheduled For: Date: 8/10/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 034726 -01 503 -704 -1534 N Corrections /Comments /Instructions: ❑ PASS ❑PARTIAL APPROVAL C ANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION DDITIONAL FEES ASSESSED Inspector: N 06 Date: Qb i 0/ CA") Phone #: (503) 718- 2#P0 CITY OF TIGARD BUILDING DIVISION #: ELC2005•0017() 13125 SW Hall Blvd., Tigard, OR 97223 �I t� DATE ISSUED: 3/2112(}05 Phone: (503) 639 -4171 , Inspection Requests (24 Hrs.): (503) 639 - 4175 , ' W `'! I INSPECTION WORKSHEET FOR DATE: 8/11/2006 TIME: 7:06AM PAGE: 75 SITE ADDRESS: 16752 SW 72ND AVE B14 CLASS OF WORK: SUBDIVISION: OREGON BUSINESS PARK i LOT #: 011 TYPE OF USE: PROJECT NAME: MCKENZIE ATHLETICS DESCRIPTION: T.I. OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: CONTRACTOR: JOHANSEN ELECTRIC INC PHONE #: 503 - 698.3417 Inspection Request Scheduled For: Date: 8/11/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 034793 -01 503 -704 -1534 N Corrections/C;• - ructions: *.---> ;Al PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: G-Attla Vat Date: A 11 O Phone #: (503) 718- 2.346 . i CITY OF TIGARDy ,. . BUILDING .DIVISION Y i - t - - PERMIT #: ELC2Q0i 4X l7L) 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 301/2005 Phone: (503) 639-4171 , u , e'o „ �1 .A\ Inspection Requests (24 Hrs.): (503) 639 -4175 �+�- ` -_.. INSPECTION WORKSHEET FOR DATE: 4/41200' - TIME: 7:11AMM3 PAGE: S;9 SITE ADDRESS: . 16752 SW ;•'2N0 AVE T3.4 CLASS OF.. SUBDIVISION: OREGON BUSINESS PARK I LOT #: 011 TYPE OF USE: PROJECT NAME: MCKENZ IE ATHLETICS . . DESCRIPTION: T.i OWNER: PACIFf C REALTY ASSOCIATES, PHONE #: CONTRACTOR: .JOH ANSC°N ELECTRIC INC PHONE #: 60;1 698 -:117 • Inspection Request Scheduled Fo'r: Date: 4/412006 Pour Time: Code # Inspection Description Confirm # Contact # Message 1,99 EIes tricai final 003629-01 01 60 - 04- I614 N Corrections /Comments /Instructions: (2) S ' g l,,i-'�..G,..1• h Q 1 9rNo v, 1 0 6,, 6fr- (7 C r 1 S 0 AA 0 )C C- l \ The electrical installati defectkn on this report shall be corrected ands an inspection request made withtn.20 . • calendar days per OAR 918 -271- 00'3 ©� \ ' o ..- ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS -FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: ' /O i /I AA Date: Y` O 0 C Phone #: (503) 718 -