Permit -CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00594
DEVELOPMENT SERVICES DATE ISSUED: 9/17/2004
111? 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 112 DA -01400
SITE ADDRESS: 06650 SW REDWOOD LN 105
SUBDIVISION: PP1996 -048 ZONING: I -P
BLOCK: LOT : 002 JURISDICTION: TIG
Project Description: T.I. (4) 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: SIGNAUPANEL:
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: 3 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 9/17/2004 $66.80
[TAX] 8% State Surcharge 9/17/2004 $5.34 Rough -in
Elect'I Final
Total $72.14
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spedalty 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: � � Permit Signature: . S P�P pS �p \ (�
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 639 -4175 by 7:00pm for an inspection the next business day
From: Charlynn J. Leifsen To: City of Tigard Date: 9/17/2004 Time: 10:39:58 AM Page 2 of 4
Electrical P ermit Application � i �1 , , , l(, l i ,• i ( , i , I . u, I .,
City of Tigard eN vV :-.Z i - -a q / ` tr'�_ _/ _r�_'r' y
13125 SW Hall Blvd., Tigard, O Plaw - - - -
Phone: 503.639.4171 Fax 50 � 1 %\ 4 .::+ J • Der - : : Other Permn:
Inspection Line: 503.639.4175 Q -x _ _ Date ReadyBy. 0 See Page 2 for
Internet: www.ci.tigard.or.us S , • r Notified/Method: Supplemental Information
r
it R. ...._. > _ ,;• i ,,.!_• ,. Z ' ... � ..: ` _ . „i:55,-. ... , ._- _. .. ,= �... ,rty,, �.i i', ,. �., ..a'
ID New construction El : ' : t�71: t : Ion/replacement Please check all that apply:
El Demolition El er []Service over 225 amps, comm'I ['Hazardous location
°Service over 320 amps - rating DBuildng over 10,000 sq. ft,
1 f,
'� �� t ` A �' I , t n r, 3 ' r of 1 - and 2 -famil dwellin 4 or more new residential
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi - family ❑ Master builder CI taller; ['Building over three stories ['Feeders, 400 amps or more
. r,c Occupant load over 99 persons Manufactured structures or
�t l Jii> ,, ;t: ; t , , :, e ll }k,,:: r, ❑E gress/lightingplan R V put
Job no.: 8762 Job site address: 6650 SW Redwood Ln ❑Health - Care facility Dom:
Submit 3. sets of plans with any of the above.
City/State/ZIP: Portland, O R 97224 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: 105 I Project name: Coaxis ' : ` r �: I, ii ' . . � ,
DexrlpHoe Qty. Fm TeW '
Cross street/directions to job site: New residential single- or muiti-family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea add') 500 sq. ft. or portion 33.40 I
Tax map/pareel no Limited energy, residential 75.00 2
r F i , , ,t, Y Limited energy, non - residential 75.00 2
. _ ..i ...�c__ j: , ....E , 5 - c i' . Y :'' I, , t, , .' - i _ . K ,e � ', 1, .,. . � ;..' 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 80.30 2
201 amps to 400 amps 106.85 2
i .. :: , " a 1,. _ 401 amps to 600 amps 160.60 2
Name: Pacific Realty Associates 601
amps to 1,00o amps zao.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 , O R 97224 Temporary services or feeders Installation, alteration, and/or
Phone: ( 503)624 -6300 I Fax: ( 503 ) 624 -7755 " relocation
200 amps or lesss 66.85 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
..
,: r{ :: . ' r p ' L ' I ., 1'I I -T n ii(iil, I rk " ° i ' "'' , I I 1: i A. Fee for branch circuits with
G„ s r .. ,i f _,. , ...;5 ::,. r, ,ti.,t ? % _ .ti. , a,. .,! :. `. service or feeder fee, each
Business name: Johansen Electric Inc. branch circuit 6.65 2
n Leifsen B ou branch o r fe e
Contact name: Charl d
y without service or feeder fee,
Address: 10948 SE Valley View Terr. oath branch circuit 1 46.85 46.85 2
Each add'I branch circuit 3 6.65 19.95 2
City/State/ZIP: Cl ackamas, O R 97015 Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( 503 ) 698 - 3417 I Fax:: ( 503 ) 698 - 2486
Sign or outline lighting 53.40 2
E -mail: johansenelectQmsn.com Signal circuit(s) or limited -
IR ) K 1, < ,: ;. F llrli ,I l p ' f - energy panel, alteration, or
I :u. " . I extension. Describe: Page 2 2
Business name: Johansen Electric Inc.
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 (1 hr min) 62.50
Phone: (503) 698 -3417 i Fax: (503) 69& Industrial plant per hour 73 75
2486 li' h ;'1 al ( S
CCB Lic.: 51539 `Electrical Lic.: 3 -243C I Suprv. Lie.: 20538 Subtotal 66.80
Suprv. Electrician signature, required:ae /, Plan review (25% of permit fee)
State surcharge (8% of permit fee) 5.34
Print name: Carl K. Johansen Date:9 /17/04
TOTAL PERMIT FEE 72.14
Authorized signature: ��� This rmit a ex
I Pe PP ucadon P ires if • permit b txlt oot o6tafned within 180
days after it Ins been accepted as complete
Print name: Charlynn J. Leifs I Date: 9/17/04 • Fee methodology set byTriCountyBuildingindustryServiceBoard
•• Number of inspections per permit allowed.
i:lBuildinePamiu 161.0- PamitApp.doe 12103 MG•4615Tpa/02/COM/Wm
CITY OF TIGARD 24 -Hour .
BUILDING Inspectionlin e 4503) 639 -4175 MST
• INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received / R ue ted AM PM BUP
Location Q5V Suite //)5
t MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner C fps ELC
Footing ELC 29v ex,__czy
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 P JS0 F-04- F f J/41.
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
larm
ice Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hail Blvd.
PART FAIL
❑ Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
Q-
ADA Date 1 Inspector ' fir-gNaLy
Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL