Permit v w CITY OF TIGARD ELECTRICAL PERMIT
• PERMIT #: ELC2004 -00368
1 /1t DEVELOPMENT SERVICES DATE ISSUED: 6/22/2004
^� man 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 112 D D -01600
SITE ADDRESS: 15575 SW SEQUOIA PKWY
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: (2) 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: 1 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: 503 - 624 -6300 Phone: 503 - 698 -3417
Reg #: LIC 51539
SUP 2053S
FEES ELE 3 -243C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/22/2004 $53.50
[TAX] 8% State Surcharge 6/22/2004 $4 Rough -in
Elect'I Final
Total $57.78
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 -800-3 ' 44.
Issued By: / _ / _ y ; 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: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
m: Charlynn J. Leifsen To: City of Tigard
Fi ja
. ,
Date: 6/17/2004 lime: 10:30:00 AM
. .. . Page 2 of 3
Elaitrical Permit Application , ..:::: ,.,, ,,, ,, FOR OFFICE' USE °NEN" '. : - , •:'.-..... :::.
.:lal'i•';fiie:Sil:•.:' l .._'• • - :, • -4 :1.: 9 , •
PtfaBy: - - 0 . ' : • - - • • ' f!erthitisio, . .Tu • co i
City of Tigard
EAV ED Planning • ,proval
DateiB : Sign
Pcmit No.:
13125 SW Hall Blvd. clEC _ man kteview Other --
Tigard, Oregon 97223 Date./B : .. .. Pennit No.: . . .. • . .
%5
Phone: 503-639-4171 FaxkUit3 -V8- 1_ 1 _ t.. .1':= ' e.. l'ost-Ftciiev . " Land tl
•
Internet: www.ci.tigarcLoruf riisy j1 .. Date/13 Case No.:
Contact • at Seel'age. 2 •for. .
24-hour Inspection Request 503-(13 `-'-' ' """ . . NarnaMetItod: Su lenaental Information.
CI L) DIVISION
BUILDING ..
:'.I' 1 540003.• 5 0.01W L ...M.P. r .g 4 FigFg:'.4`...a:•.,:r•t:g?; : n-I''....;;•Vg::n '•:: atEnrjog:#.7aVillftriiiiIiiri'''...'::::::!:g.:,:!:::::
F I New construction U , Demolition ii Service over 225 amps- • • • X Realth-eare -facility ..
II
— commercial 0 Hazardousiocatn
CI io Addition/alteration/r ilaccrnent • Other:
..,_ . 0 seivice ovcr 320 umps-rating of 0 Building Over 10,0(gi square feet.
t7, 'ibriEMarAttri O - 644;1:13:Walit4 i & 2 family dwellings our or more residential units in
• I & .2-Family dwelling • Commercial/Industrial D System over 600 volts nominal one structure
0 Building over three stories 0 Feeders, 400 amp or frOle-
0 Accessory Building 0 Multi-Family . co Ocklupant toad over 99 persons 0 Manufactured structures or ltY -park
11• Master Builder Other: 0 1c in plan - : • • . - 0 other,,,
T,.... - Submit sets of plan.s with arty of the above. . . .
:;:•:',..:,c, 1'; I . 5 i 1, The a be ve are not atecable to terimo z rary oonstruction service.
job site address 15575 SW Sequoia P
- equoia kwy___
• ,----,..- . ... ..... ..... .. . „ . -.,;:ZgaLiqttife,, t•_ ..
Suite #: .C.01r144koul Bldg./Apt.#: Nuniber of lifs, ectiODS IT. ermit atlowed
_
_
Proj ect Name: c iziz. ist,,,,__A_________ - DC4cliPtion Qty Fee (eu.) . 'OW 1
- New residontialLsingle or multi-famlly per
cross street/Directions to job site: dwelling unit. Includes attaehed garage.. . . .
Service included; . • • • •
• •
' - 1 - 000 sq. ft ot less • 145.15 •
Each addit ionat 300 sq. ft. orportion thereof • .. • • JOAO . • I
Lim_ite, resident ral gm 'moo 2
Subdiyision: I Lot #-:
Li enezu ncm residential
Tax ma areel #: Each manufactured home or -modular cbgellin -
,kLi4' 5-5 STO.:-.INIOM----W-C7-00,17'Allitiki<:::::.:;!::::'.7.Aing:. ,Z. 7.7,,ta service and/or feeder . . . .. '. 90.90 • a
Services or feeders - Installation, . .
' - • • alteration or relocation; • •
Work at building corridor shell . .200 amps less • •• • - -- - • - • • " 80.3-0 2
. . . „.
. . 2011 amps to 400 amps 10655 2
-
401 aroys to 600 ento "..: " • 160..60 : 2
7 N M"' orfiWi'clicnvratE:'14:0VPIRITT y-Rzs F60) amps io 1000 snips . 240.60 2
. . Over 1001) amps or vohs " - • •-• - .....:.: : :: . 454.65 : ;-- i
Name; . .Beconnect only (
- . .
Address: • Temporary servtew or feeders - Installation, • • : • • •• . • .
1 alteration, or relocation: t
City/State/Zip: 1 200 amps or less 66;85 1 1
l L22Lan09. amps —......_i
10030
. - 2
Phone: Fax: —
WeeP1M" ggiVIVIDW
0 ,.,,.., . ,. - 401 io 600 amps
MraI9? 11-1 7 -- MATT 7 i.:7 1: 7•_ ' L _:',...,•• ._ ...„..:',.' -.. .... . . 3 :.• Branch circuits- new, alteiation, or , 133.75 2
Name: Johansen Electric Inc. i extension per panel: :
-
A. fee fel btanch•cirtuits with tchase of •
I 2
Address: 10948 SE Valley View Terr. service or feeder fee, each branch circt_ j
Cit iState/Zi : Clackamas., OR 97015 • ••••• - h. Fee for brand circuits wltholit purctiatAfifir • • • • • • • I •
-• --- service or fe01:1GT fee, first branch circuit 1 i 46 46.85 • 2
Phone: 698-3417 Fax: (503) Bach additioral branch circuit -- I i .4,65 6 • .f
E- Johansenelect@msn.com mi60.(Service or feeder nolistcludea: .
Eaciation PiTCle .. 53.40 2
, 614 , ifkiONTre..44...arrTE4 ,* - t' 0 nr;,:q:will NESVIN:: • . •
si outh.„ lighting 53.40 2
Job No: 8657 Signal etrcuit(s)or a limited energy panel,
— alteration. Of • • Pooe 2 -
Business Name: Johansen Electric Inc. eKtrosigo 2
Description:
Address: 10948 SE Valley View Terr. .. .. . . . . .
— Each additional Inspection uver the allowable in an ' of the above: .....
City/State/Zip: Clackamas, OR 97015 Per inspection per homintin. I hour) 6230
Phone: ( 698-3417 F (503) 698-2486 1nm:stip/inn fee: . , • OM
Other l*-
i
CC13 Lie. #;. 51539 Lic. #: 3-243
0.02,11401a11 f Negm
Supervising electrician .
signature required: / . . Plan Review (25% of Permit :... $ .. _ _ • ,
_
_Print Name: Carl K. Johansen Lic, 4,t: 2053S State gurehafgek8% of Permit Fee) s 4.28
. ...
.
.--- TOTAL PERMIT. PEE 1
.
Authorized V. , 6/17/04 Notice: This permit.application eipirealrf a permit is not obtained within'
Signature: i i 1_ ' ...( \ ,.,,,,,,_, +te: 180 days after Ittes been accepted as complete.
. *fee methodology set by TrI-Cou My Building Industry Service Board.
Charlyn . Leifs n i
(Please print rinrne) . . .
. . .
. —
• -
i;TistsWerrnit Font \ EliaPermitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING . • Inspection, Line* (503) 639 -4175 MST
INSPECTION DIVISION Business Like: (503) 639 -4171
BUP
Received _ Date Request V � 7. AM PM BUP
S
Location / S 7S
Suite ( r ) MEC
Contact Person C- 1/(- t Ph ( ) PLM
Contractor Ph ( ) SWR �y
BUILDING Tenant/Owner ELC P r/ 6o 7 -06
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors OEM
Sheath/Shear
Int Sheath/Shear
Framing
Insulation �.QO p JV � L& F �
Drywall Nailing + t r 1 �`�V w l+ v
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling 1
Roof f
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
e Alarm
PART FAIL 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
❑ Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line �j r / D
App v 1 L ( Inspector (l.} h'` ��t��• — Ext
PP roach/Sidewalk Date
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL