Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00454
Ik DEVELOPMENT SERVICES DATE ISSUED: 7/23/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 112 DA -01400
SITE ADDRESS: 1.5350 SW SEQUOIA PKWY 200
SUBDIVISION: PP1996 -048 ZONING: I -P
BLOCK: LOT : 002 JURISDICTION: TIG
Project Description: T.I., (1) branch circuit.
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: 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-MI 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 7/23/2004 $46.85
[TAX] 8% State Surcharge 7/23/2004 $3.75 Elect'I Final
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty 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 a re 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 -23
Issued By' Permit Signature: -L
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: 7/22/2004 Time: 3:17:24 PM Page 2 of 3
4 ®
E!eetllical Permit'Appli i u i< u u i I• i t I 1,1 t►\ i .1
City of Tigard 1�� RZZL _ I / ' /- ' /
g ® A. ,, ' a % I Pemlit No.L 08, 9 07 131SW Hall BlvdTigard, OR � P
Phone: 503.639.4171 F 503. 60 ! " Dat- :: Other Permit:
Inspection Line: 503.639.4175 ��� ®` � ®74 !„ ' 1 Date Ready/By ® See Page 2 for
Internet: www.ci.tigard.or.us � Notified/Metbod: Supplemental Information
' s -n Z44!: s ki t � i b4 iii �:} t 1 ti. i ' t ' d y --t . - � x' A ,sf r r S?: •
El New construction ® Additio „ ration/replacement Please check all that apply:
El Demolition El Other: ❑Service over 225 amps, comm'l ❑Hazardous location
s +lr r I m o *� ., lea r ❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
j
i fi ; ;1 r ,I ,,,, l .t of 1- and 2- family dwellings 4 or more new residential
❑ 1 - and 2- family dwelling E Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi- family ID Master builder ❑Other: ❑Building over three stories ❑Faders, 400 amps or more
„9 # T A x�£ r Y¢ , ; i . ❑Occupant load over 99 persons :Manufactured structures or
i i Jt_...IrS n t. :,= :::.:',11...,,.". ` „,,,;•,',,.4.4....-_,:;_,,..-..‘,. : ., :._ t1 . ... = �'tI: asi5t ❑ Egress/lighting plan RV park
Job no.: 8695 Job site address: 15350 SW Sequoia Pkwy ❑Health - care 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.: 200 I Project name: Management Group " :ktw,EL.� ... ::I” t;A,r, nIa ...... ... ... ;
oewlptloa Qty. Fee- Total ••
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: I Lot no.: Ea. add'1500 sq. ft. or portion 33.40 I
Tax map/parcel no • Limited energy, residential 75.00 2
.' l F r ` ' t �Ri" i� : - 7,11 if 1 1 ;(fiit„ -j ' , I�
Limited energy, non - residential 75.00 2
.,� .,..�. _ ..........� . , X .. a e.� , I . Ir i.:;,., �,_ _ - � : I r � :,�_9,,,,.�,_.,,i a - - _:. - . : :; 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 r 2 • d 1 ' � : ,: ? Y %. 5 : , 4 .t t ; '.. :. t :li 2 01 amps to 400 amps 106.85 2
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 I Fax: ( 503 ) 624 - 7755 relocation
200 amps or less 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
Fee for branch circuits with
v 11 1 I.n l rn� 1r ':=7:&-.:713f.:':-:,0110:i
}i er � r r 5 y r 3;;t :}1 R ^., ..T r r - :4044
r � � I � ) i �,.I�l�n r�l� ft r, ? . A.
Lau l,_.,....'.... ,. � trl,lt� � - t. ,..a service or feeder fee, each
Business name: Johansen Electric Inc. branch circuit 6.65 2
B. Fee for branch circuits
Contact name: Charlynn Leifsen without service or feeder fee, 1 46.85 46.85 2
Address: 10948 SE Valley View Terr. each branch circuit
Each add'I branch circuit 6.65 2
City/State/ZIP: Cl ackamas, OR 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: johansenelectamsn.com Signal circuit(s) or limited -
M :� r " w.-.. _ F
F 1 L " `` i N1°I' I 1w i` energy Panel alteration F, >,.. :.. .__..�.. � a _�,sa1 �;;, _f' ... , ..�[�. ta...,�,._. �J,�,:1. ;: gYP or
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 (I hr min) 62.50
Phone: (503) 698 - 3417 I Fax: (503) 698 - 2486 Industrial plant per hour 73.75
CCB Lic.: 51539 Electrical Lic.: 3 -243C I Suprv. Lic.: 2053S Subtotal 46.85
Suprv. Electrician signature, required:C /� Plan review (25% of permit fee)
State surcharge (8% of permit fee) 3.75
Print name: Carl K. Johansen Date: 7/22/04
TOTAL PERMIT FEE 50.60
Authorized signature: CIA This permit application expires if s permit is not obtained within 180
days after it has been accepted as complete
Print name: Charlynn J. Lelfse t I Date: 7 /22/04 • Fee methodology set by Tri-Comtty Building Industry Service Board
•• Number of inspections per permit allowed.
is lBuilding1 Permiu1ELC- Aum OAK, .doe I2/03 440.461 ST(1aNLCOM/W®
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line:. (503) 639 -4175
INSPECTION DIVISION Business Line: `(503) 639 -4171 MST
BUP
Received Date Requested o —11 AM PM BUP
Location /5 3 5 D . ,te l.c , .a i Suite -200 MEC
Contact Person Q -.ro, Ph ( ) C g- 34 1 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC q -DO qs(E
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam WLV'
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation MP 124\i F74/4e—
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING I f 1
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
Fire Alarm
� • • PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Please call for reinspection RE: ❑ Unable to inspect – no access
Fire Supply Line
ADA
Approach/Sidewalk Date --( f v c7 U( Inspector ` � _ • • � _we. :I
Other: \ \ \l
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL