Permit ' r
•
ELECTRICAL PERMIT
CITY aF TIGARD
PERMIT #: ELC2003- 00385 .
YI VELOPMENT SERVICES DATE ISSUED: 6/25/03
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 1S136CC-00100
SITE ADDRESS: 11765 SW PACIFIC HWY
SUBDIVISION: ZONING: C P
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install 30 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: 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: 29 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:
WORLDWIDE REAL ESTATE JOHANSEN ELECTRIC INC
GENERAL MOTORS CORP. 10948 SE VALLEY VIEW TERR
DETROIT, MI 48202 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 6/25/03 ' $239.70
[TAX] 8% State Tax 6/25/03 $19.18 Rough -in
Elect') Final
Total $258.88
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 1-800-332-4.
Issued By: Permit Signature: da /
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: ` 5 3 "3
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Call 639 -4175 by 7:00pm for an inspection the next business day
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From: Charlynn J. Leifsen To: City of Tigard Date: 6/25/2003 lime: 9:00:20 AM Page 2 of 3
Y
i K
i.: Electrical Permit pplica io _ •
r.r t r •tr ' d:/,....5_, r V t... a Date rcecive 0 3 Permit no. G /j3 -ift) 3 5
l j' ii City of Tigard - ,� Project/appl. no.: Expire date:
City ojl`ylu d Address: 13125 SW Hall Blvd, igazd, ' 2>103 late issued: By ) I Receipt no.:
Phone: (503) 639 -4171 if � 1[Jrr
Fax: (503) 598 -1960 Go OFTIG1\BD Case file no.: Payment type:
Land use approval:
8U1LDINC4 ^ ".'1S1C�1'
I 1 1'1 (II I'1 II "Ill
U 1 & 2 family dwelling or accessory TB Commercial/industrial ❑ Multi- family 0 Tenant improvement
0 New construction CI Addition/alteration/replacement ❑ Other. 0 Partial
Job address: 11765 SW Pacific Hwy Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: IB1ock (Subdivision:
Project name: Old GM Building (Description and location of work on premises: Tenant Improvement
Estimated date of completion/inspection: 7/20/03
( ( ) N i l t l ( I l i l t \ I ' I ' t . s ( 1 1 1 1 ) \ I • 1 . 1 . .1( 1111)111
Job no: 8248 lee Max
Business name: Johansen Electric Inc. Description Qty- (`a) Total no.Iam
Address: 10948 SE Valley View Terr. r�ldr ld
.ade aleo aestNeaesched prate. a
City: Clackamas I State: OR (ZIP: 97015 ��ed
Phone: 503 -698 -3417 I Fax: 503- 698 -24861 E -mail: Johansenelect @aolcom 1000 sq. It or less 4
CCB no.: 51539 I Elec. bus. lic. no: -243C Each additional 500 sq. R er portion thereof
Limited energy, residential 2
&alllis._no.: 4896 • Limited energy, non-residential 2
6/23/03 Each manufactured home or modular dwelling
Signature of ising electrician (required) Date Ser+'ice and/or feeder 2
Sop. slug. name (print): Carl K. Johansen License no: 2053S Services or feeders —I dallatloo,
alteratlor orreJocadoa
200 amps or less 2
Name (print): 201 amps to 400 amps 2
.. amps m 600 maps 2
Mailing address: 601 amps to 1000 amps 2
City: !State: ( ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only I
Owner installation: The installation is being made on property I own Temporary services or feedere -
which is not intended for sale, lease, rent, or exchange according to Instillation, `bOi'Orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 • s 2
1 MO NI 1. It Branch circuits - new, alteration,
or =tendon per patrol:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each brace circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E - mail: of service err feeder fee, first branch davit: 1 46.85 46.85 2
Each additional brands circuit: 29 6.65 192.85
Iii \ \ itl \ 11 \1 I I'Iua.r chi e 1, all tliot apple ) Anse - (Service or feeder sot leaded):
O Service over 225 amps- commercial O Health-cart facility Each pump or irrigation circle 2
O Service over 320 amps -rating of 18x2 Cl Hazardous location Each sign or outline lighting 2
family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited many panel,
O System over 600 volts nominal more residential omits in one structure alteration. or extension' 2
O Building over three stories O Feeders, 400 amps or mane 'Description:
U Occupant load over 99 persons U Manufac* umd structures ur kV park Each rdWonal boa over the allowable in say adder: above:
O Erma/lighting plan U Other: per inspection L I I I
Submit _ sets of piss with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Na cards, an jtaisdimions accept credit !dare call jurisdiction for more i°fmmmtiaa. Notice: This permit application
Permit fee • $ 239.70
Plan review (at _ %) $
U visa U MasterCard expires if a pemnit is not obtained 19.18
Credit card numtar. .. . _ / I within 180 days after it has been State surcharge ( 8% ) $
c pII° accepted as complete. TOTAL $ 258.88
Name of ardhdda as shown on credit card
S
etrdbo1der signature Amount 440 - 4615 (6/00/COM)
CITY OF TIGARD 24 -Hour
BUILDING.,. Inspection Line: (503) 9-4175 MST
INSPECTION DIVISION Business Line: (5 - 4171
BUP
Received Date Re uested — 2 AM PM BUP
/ (es
� 7
Location Suite MEC •
Contact Person n Ph ( ) G S 717 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 3 - 00 3 S5
Footing
ELC
Foundation
Ftg Drain Access: ELR 3 - DU .R a 7
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear (/
Framing
I nsulation
Drywall Nailing � r�L'f '�!�'�� /1Z�
Firewall i A9 /
Fire Sprinkler SP al/0Y)
Fire Alarm PO `n F L e<..) Susp'd Ceiling
Roof
Other: /y
Final j `mo C -z 1r a
PASS PART FAIL l �`
PLUMBING 44 L_. 1tha
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain /
Shower Pan /‘,2 /
Other: (((
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Final
PASS PART FAIL \\
MECHANICAL ;`' • / -
Post & Beam .+ N.
k Rough -In
Gas Line
I Smoke Dampers
/ � �
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
• UG/Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
il2MPI. PART FAIL
Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 7S f - 02, 623 Inspector ['� � Ext
Other: ��JJ
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL