Permit 'CITY O F T I GA R D ELECTRICAL PERMIT
,;�.;I DEVELOPMENT SERVICES PERMIT #: ELC2004 -00621
DATE ISSUED: 9/28/2004
�' II 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S112DD -01600
SITE ADDRESS: 15575 SW SEQUOIA PKWY
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: (2) Branch circuits in south corridor of office bldg.
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+ ampNolt: > =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
FEES SUP 2053S
ELE 3 -243C
Description Date Amount
[ELPRMT] ELC Permit 9/28/2004 $53.50 Required Inspections
[TAX] 8% State Surcharge 9/28/2004 $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- 332 -2344.
Issued By: . i , ztp- Permit Signature:,.
? e
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: 9/27/2004 Time: 10:49:50 AM Page 2 of 4
•
Elet trit 1 permit App • eE`v ED ri 11< t 1 l 1 l t l I ,1. 4).1 .l
0. City of Tigard '"ad ♦ - "�
13125 SW Hall Blvd., Tigard, OR 97223 c 2'7 20 � ' Plan Review
Phone: 503.639.4171 Fax 503.598.1960 SCP ' ' ' '`e,+ ' I Dm : • Other Permit:
Inspection Line: 503.639.4175 c Ti _I: t 1-- '_ Date ReadyBy la See Page 1 for
Internet: www.ci.tigard.or.us Ca 1 0 T , S - 1 Notified/Method: Supplemental Information
,. l jr,, ji - 41 - 4' t . ' � 1
. es „l _._ _ .,- " t _17:-. ,,. ,,,,,I { ' I "' . ri ,
❑ New construction ® Addition /alteration/replacement Please check all that apply:
1.:1 Demolition El Other: ['Service over 225 amps, comm'I ['Hazardous location
t r r s t{i ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. R,
44 =. - :. 1 . 1 .. . i ', of 1- and 2-fami1y dwellings 4 or more new residential
El 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
El Multi family ❑ Master builder ❑Other ['Building over three stories [Weeders, 400 amps or more
r 1, , , r a , .. Occupant load over 99 persons ❑Manufactured structures or
_�
"1 r '' '.'-',..1.,-;.'.:, . ,, ., . r:, x � _ „ . . : F r � f �.; �
. :,+; E ❑ Egresa/lightic►g plan RV park
Job no.: 8732 Job site address: 15575 SW Sequoia ❑Health - care facility ❑Other:
Submit $, sets of plans with any of the above.
City/State/Z1P: Portland, OR 97224 The above are not applicable to temporary construction service.
5
Suite/bldg. /apt no.: Project name: Building Corridor, South w` � '
Description 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: Lot no.: Ea. add', 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: ' Limited energy, residential 75.00 2
Y y 3 x 'lint energy, non-residential 75.00 2
.
." a .1 ...... .. .. . .. :z;, ' .1 1, +r r, ,r:,:, ,_ i , < i ii ' { 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
;` %+ ', S ` r r t ( ,, �; t ; , > r ti 201 amps to 400 antes 106.85 2
_ r. lj{� .... - .. _ , _ . 1, . ,. f=:' .t l.ifi
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
City/State/ZIP: Portland, OR 97224
Reconnect m Temporary 66 2
Ci
ty Temporary servlees 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 turps to 600 amps 1133.'7 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
•. p r '.; ! U y i . t � ; er rst r
•` } tF- t h �� ' - r y ' > , t i � { t 's �j ?F r U le � 1 v 7 � a i , rt I ,( p' i - : A. FCC for branch circuits with
-... ,,.... -t 43- .. -_ ..: ,a,�, . , ,..a t •. . - ,! r .. i_ : :..: ; yr . ,,..,... - .. service or feeder fee, each
Business name: Johansen Electric Inc. branch circuit 6.65 2
B. Foe for branch circuits
Contact name: Charlynn Leifsen without service or feeder fee, 1 85 46.85 2
Address: 10948 SE Valley View Terr. each branch branch it
Each add'I bch circuit 1 6.65 6.65 2
City/State/ZIP: Clackamas, OR 97015 Miscellaneous (service or feeder not included)
Phone: ( 503 ) 698 - 3417 Fax:: ( 503 ) 698 - 2486 Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: johansenelect(CDmsn.com Signal circuit(s) or limited -
.12` > �- iw .... � _ ._" 6 < :":":: l', _ ti,! 1 �c ; _ energy panel, alteration, or
r „r ,..: _ ., ... ; .. .. „ ,.
_., t ..,.._ ..._ . _ extension. Describe: Paget 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 Fax: (503) 698 -2486 4
Industn plant per hoar 73.75
_F..- i'll �.11II1rE., i,x„ Y.'r'S r d,, ..,.- 1 ,% i y ;
CCB Lic.: 51539 Electrical Lic.: 3 -243C Suprv. Lic.: 2053S Subtotal 53.50
Suprv. Electrician signature, required: / / Plan review (25% of permit fee)
- I'm � _ J ` 4Y
Print name: Carl K. Johansen Date: 9/27/04 State surcharge (8% of permit fee) 4.28
TOTAL PERMIT FEE 57.78
Authorized signature: .11r_ �. This permit application expires if a permit Is not obtained within 180
days after it has been accepted as complete
Print name: Charlynn J. Lefts V �/ , Date: 9/27/04 • B u i l d i n g
•• Number of inspections per permit allowed.
i :WBuildingUWmiu\ELC-PamfApp.doe 11/03 440.4615Tp0/02/COM/WFa
CITY OF TIGARD 24 -Hour
BUILDING Inspection gene: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requ ted I AM PM BUP
Location f 5 S 75 Suite lo o N e MEC
Contact Person 1_ / - A Ph ( ) ` Z g - 34./17 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner clp a DC q - Od (p a- 4
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof •
Other:
Final
PASS PART FAIL
PLUMBING
C-
Post & Beam
Under Slab
Rough -In ,??1/
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
S pAART FAIL
Service
Rough -In
UG/Slab � }
Low Voltage 4- ' \ ' — -)z) �° i L �V .
Fire Alarm
y Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date /6 .2 ,j
, K Inspector � '� - Ext
Other:
Final DO NOT REMOVE this inspection record from the J ' . site.
PASS PART FAIL