Permit A CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00142
,1 I n DEVELOPMENT SERVICES DATE ISSUED: 3/9/2005
13125 SW Hall Blvd., Tioard, OR 97223 (503) 639 -4171
PARCEL: 2S112DD -00500
SITE ADDRESS: 15870 SW UPPER BOONES FERRY RD Fj(j
SUBDIVISION: 61TE GON BUSINESS PARK I ZONING: I -L
BLOCK: LOT : JURISDICTION: TIG
Project Description: Electrical reconnect due to meter explosion.
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: 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: 1 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
PACIFIC REALTY ASSOCIATES JOHANSEN ELECTRIC INC
15350 SW SEQUOIA PKWY #300 10948 SE VALLEY VIEW TERR
PORTLAND, OR 97224 CLACKAMAS, OR 97015 -000
Phone: 503 - 624 -6300 Phone: 503 - 698 -3417
FEES Reg #: LIC 51539
tion Date Amount SUP 3
Description ELE 3 - 243C
[ELPRMT] ELC Permit 3/9/2005 $66.85
[TAX] 8% State Surcharge 3/9/2005 $5.35 REQUIRED ITEMS AND REPORTS
Total $72.20
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 �s
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 0-93 -23
Issue By: /p Permittee Signatur
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 I STALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: " DATE:
LICENSE NO: o.?. 53 5
Call 639 -4175 by 7:00pm for an inspection the next business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
From Charlynn J. Leifsen To: City of Tigard Date: 3/9/2005 Time: 2 35:12 PM Page 2 of 4
Electrical Permit Application I.( )1« t►I Flt I 1 ' F . 1► \I.1•
City of Tigard Domed �D Ain Permit No.. A O /
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review r -
Phone 503.639.4171 Fax: 503.598.1960 ° •,, ' v�•' I Dm : : Other Permit:
Inspection Line: 503.639.4175 x.1 ' i Date Ready/By Ell See Page 1 for
Internet: www.ci.tigard.or.us Notified/Metbod. Supplemental Information
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,.. g, 1 x F i1 I I . i - ` -a ,, .._ ... ' ._, . ;,; ..1,� E:iI lio { 1 7.: #5 •i,
x:a �.fivf: _. _ i ..; -. . ,a,, .. _ if.L �J ... ...... .. ..... ; _. . ; _ : + t . r�=y ` . ", -•` , .._6: -LL-r -� , 0 al r .��:.�d,,hm@,..,�ais.,.
❑ New construction ® Addition/alteration/replacement Please check all that apply:
(1 Demolition ❑Other ['Service over 225 amps, comm'I ['Hazardous location
et , ,tir i .iii M ldra - ,,, ,r r, i FORIUSI ❑Service over 320 amps - rating QBuildng over 10,000 sq. ft ,
ii pkrai, `,,.! 1 " i;0 ..• , ,... ,., a of 1- and 2 -famil dwellings 4 or morn new residential
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi- family 12 Master builder ❑Other: ❑Building over three stories :Weeders, 400 amps or more
- 4 il , f � e �� 5 ,�, r Other: I i ; ❑Occupant load over 99 persons ['Manufactured structures or
k, h�2: F . ": r . ) , . � .,,� t _ _ . ., ` 1' ❑E gre ss/Ilghtingp la n RV park
_ , ,�_, „•.r_� -.� ,_ . t..:_: . _ _ _._. ❑Other•
Job no.: Job site address: 15860 SW Upper Boones ❑Health - care facility
Submit _7, sets of plans with any of the above.
City/State/ZIP: Portland, O R 97224 The above are not applicable to temporary construction service.
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t . ,.., - g .:,_ :- .:. -, _ ....... fwd, ' C ' :1.:1 : .,
ri s � r 1
Suite/bldg./apt. no.: Project name: Harver Company o
ercrlptlaa Qry. Fee. rod
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'I 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 2
Tax map/parcel no.: c1 111 ' Y Y } 1
7 �!.��
����, 7,- .,� r� tc,it , ,,:ar,,..,.�,.,a.n w �q ,, � fJ ..,. _ j, 1{ ■t �, •.. Limited energy, non - residential 75.00 2
" s�,.�"rk'' .)if4N t 3 q• ;- � #zr . 1 Li. ,fi ,:: -. . ..3. ,i._ ns¢.. (,.cS.., >. , 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
-. if:. -a t' •;: v 'r =�s; .,,' -, ron>or.;�= a:r :. ;; h v ,` - Ps^
, 'e,. „ s_' 201 ampst0400amps 106.85 2
i�,:C -. . ..._ _. _... r_., e. -.t. ; .:. , .;_a., .;iwa"Ifr. _r ,. ,.:. 1--C:-`",, .. ' .,.t�l 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 1 66.85 66.85 2
City/State /ZIP: Portland, OR 97224 Temporary services 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 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
.Y " l yin :,a . , ,u l iy.. q ., T u 1
5 , ttt 't , � � „ k F , t i, s 1 l iii , , t , AA A ' a Fee for branch circuits with
..:�� _�, T�:,,.. ..,_ . �, ,� ,,.. .._:.. > '"
�a m i..k.r.a? _ .__- ... , :.tt;..�t ... nit ., u; 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
each branch circuit 46.85 2
Address: 10948 SE Valley View Terr. Each add'I branch circuit 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: johansenelectamsn.com Signal circuit(s) or limited -
li iii iii- a 4 . 7 ,�. -.-- !. * ' 'r1 - : t D 41 a <W," , energy panel, alteration, or
" ..� r:3 ... g n
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 nun) 62.50
Phone: (503) 698 - 3417 Fax: (503) 698 Industrial plant per hour 73.75
CCB Lie.: 51539 Electrical Lic.: 3 -243C Suprv. Lic.: 2053S Subtotal 66.85
Suprv. Electrician signature, required: / f __ / Plan review (25% of permit fee)
IAA...-. State surcharge (8% of permit fee) 5.35 4.
Print name: Carl K. Johansen / Date: 3/9/05
TOTAL PERMIT FEE 72.20
Authorized signature: /. 1 , ra This permit application expires if a permit is not obtained within 180
- , days after it has been accepted as complete
Date: 3/9/05 • Fee methodology sd by TriCo,mty Building Industry Service Board
•• Number of mspedions per permit allowed.
1 1BuildmgWamiu\ELC- PermitAppdoe 12/03 440.4613T(10/02/COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 -00142 1
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/9/2005
Phone: (503) 639 - 4171 Vit
Inspection Requests (24 Hrs.): (503) 639 -4175 ...
INSPECTION WORKSHEET FOR DATE: 3/15/2005 TIME: 7:13AM PAGE: 30
SITE ADDRESS: 15870 SW UPPER BOONES FERRY RD B15 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK I LOT #: TYPE OF USE:
PROJECT NAME: HARVER COMPANY
DESCRIPTION: Electrical reconnect due to meter explosion.
OWNER: PACIFIC REALTY ASSOCIATES. PHONE #: 503-624 -6300
CONTRACTOR. JOHANSEN ELECTRIC INC PHONE #: 503- 698 -3417
Inspection Request Scheduled For: Date: 3/15/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
115 Electrical service/reconnect 001752 -01 503-704 -1534 Y
Corrections /Comments/ Instructions:
/ dip .
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V, 5
I
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Gu. / 7 Date: 3 - f c � -- Phone #: (503) 718-