Permit ELECTRICAL PERMIT
CITY OF TIGAR®
PERMIT #: 10 5/2 ELC2007-00691
COMMUNITY DEVELOPMENT
DATE ISSUED: 10/5/2007
TIGARD' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 113AB -00600
SITE ADDRESS: 16160 SW UPPER BOONES FERRY RD BLD.0 ZONING: I -
SUBDIVISION: PACTRUST BUSINESS CENTER LOT : JURISDICTION: TIG
PROJECT: EXELIXIS
Project Description: TI - install service feeders and branch circuits.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 2 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: 80 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: 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: Contact #: PRI 503 - 698 - 3417
FAX 503 - 698 -2486
FEES
Description Date Amount Reg #: ELE 3 -243C
IELPRMTI ELC Permit 10/5/2007 $692.60 LIC 51539
["TAXI 8% State Surcharge 10/5/2007 $55.41 SUP 2053S
Total $748.01 REQUIRED ITEMS AND REPORTS
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 l / /ill// / 1 7 Permittee Signature: I _ j # / • / •/I
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 503.639.4175 by 7:00 a.m. for an inspection that 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.
Electrical Permit Applicati i i ^ l ; �' x u k lr' � *,� 1 I r� ,, ..
zl.. - uE3; /. r. �, ia... _...21'∎,: hIS;�'i ,rFx : �.. C. f..
`, : > C of Tigard 0 C T 5 2 00 7 to 5 .� Permit No Err c2ta0 - 00!091 •
! - ° 13125 SW Hall Blvd., Tigard, OR 9'&.,,
' IE ® Phone: 503.639.4171 Fax 50359 DY �� UI6I RD P Review Other Permit:
-. 5 7 "" Inspection 503.639.4175 � UBL ®EtV� ®tU,
»� c :1i K,` spec G NGdfie lMctho Ian 6- 63 Supplemental In ternet www.tigad- or.gov q �� ®� Notified/Method
SuppJcmeat� Information
r!t• Nl
tai �;1' '4°t{oy� ,eah -. x atee,3 . •�narl .1U9.: -�t,I. ,.� _
Yt i 1 ' } ; ,l 1'llk,� i U . : yI� r fili qni 1 r• :� it x ; 4 t� ti - '.:J1C,11 .77 :1 1�a ..{.i} t. t �r
•�.1it,,i calLu,.- ::d4 1. �,�{` �1( U .J1 ,11 s1 1 v , , ,,,,,. lr.sVAil 1 v`., . {�� f ,i y - u !1 . i _ , <r:n � } .
� llw.,`'�,�"t1i :l;l! y sell - I); f� r1110LLIt_,: 1•} i�1� ::.,ll.,tl9.i�i��'!ja..�.'^Zfr� � 7 [61�3�d1� ^... : : ".1.2r+..1���� i "'Si�l�.�,., �I.a. :ra�la� ��illlE.. t� .[�.:��� :�'��I�.i�Sd�i.n�t�i�
❑ New construction ® Addition/alteration/replacement Please check an that apply (submit Jana of plans w/iterns checked below):
❑ thro
Scrvice er feeder 400 amps or mere ❑ Building over e stories.
ID Demolition 1:3 Other:
where the available fault current ❑ Marinas and boatyards.
g �� I 'I�"ii (( ^^ � i � tlitg FiN 51 y clgr T - r k t , I �(" exceeds 10000
i , at 150 volts or ❑ Floating .... 'it11u as:5Il rcli s;: iill L i.:f. . al!tifr iriti itr lr lr.i i t ? l1.4i∎iie,,i A ilia-W ,v,I. 114 l i ta 't E 1 ;1 r d :Se Iwl amps S Lute buildings.
El 1- and 2- family dwelling _1 Commercial/industrial ❑ Accessory building Imo to for other exexde ons. p Comi -�,ae agricultural
far all other installations. btdldings.
❑ Multi- family ❑ Master builder ❑ Other. ❑ Ftro pump. ❑ tnataltation KVA or
!a'i Mt{ ;;! M g { ,p;sr n > aattu[tia . �usi t!ti 1 irsfllEt 3{ amt y¢ft! .t I ` a,r{Sc, ❑ Emergency system larger separately derived syste,n.
0 iiiiic:kC :♦ :s4 lliitalle1 i�' , �_+ :bits.•, ,us, :.fire L:714l <a J..,. i •wt , t }I' i 5 i1 ;. ❑ Additionofncw moterloadof ❑ "A ", .•g••, -1 -2 «t.3••.
Job no.: Job site address: ' (, �IJ a l vet 6 / Acre) fi m more. occupancy. U� l G[ 0 Six or or more residential twits Recreational vehicle parks.
City/State/ZIP: ❑ Health -care & alines. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal
e.
Suite/bldgJapt. no.: I Project nazne: ', if yi S 2E ❑ Service or feeder 600 or more
'tv �g�"F S r i J� 'f ltf 7�p� - rp y ,..s. .. , xnllltl 'i s ,J(tl?^ i 91:
:fit' k 1 � R Jsi.I: w �?;i e , '3 ni Liff ll14lltl,: 1
Cross street'directions to job site: `s l l �
QN. Fee. Total •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1.000 sq. ft. or less 145.15 4
Tax map /parcel no. Ea. add? 500 sq. ft. or portion 33.40 1
. y q s I 4 I t 1 �a,e.l r . �r Nwe u.• Limited energy. residential
I( 75.U6 2
I li i " rl 11�jI, roI i{ tl 1 I h 4 i a 1 t` ivI t' ' a+' i t`I'I�II s f : � t
�c`�tiabe �.Kaekial ... � 1:11.......i, ls4'dei_u .. alums+:'3 i •r, +lalli Stni. ' :._ .1141,1 14116411.1=: 1Y611 _ : ,A l xi, ... (with abWa sq. ll.)
Limited energy, muhi- family
TUl LU fl 1 Yl') ' pnvtrran / residential (with above sq. fl.) 75.00 2
,Services or feeders installadon,alteration, and/or relocation
i' l i xEl a,e.. � k p5 t l It I tw t o t o t > 1
200 amps or less 1.. 80.30 1(o. (p0 2
Ia . it; it i '' .ate. , rt tti . i ' 4t? c„ i i n r; 7 i+� i m i ; t'' 106.85 2
. W, ltd, r la, aLra f , s„ , y � ( t�_,. ■
2 01 amps to 400 amps
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or Tess 66.85 1
Owner instailatiion: This installation is being made on property that I own which is not _ 201 amps to 400 amps 100.30 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75
1 2
Owner si lure Branch circuits - new alteration, or extension, per panel
! Date A. Fee for branch circuits with
i ,3' ( !1:!t-�+1 a �1 sr a{ H��i`s� .'I f 4t 1; .P ts�,�tatrt rauc, ;. »' tyhFr er € : above service or feeder fee,
a511�, i��rli4iL. f{ Itmb,ut_ .r:y:r�r.� �'4�ltk a�iat�L,..l( :. ��� .I,� =' ° :,�-.. �<> �,�; s .7,0 6.65 b32 2
Business name: Johansen Electric Inc. each branch circuit
B. Fee for branch circuits
Contact name: Charlynn Leifsen witlrout service or feeder fee, 46.85 2
fast branch circuit
Address: 10948 SE Valley View Terr. Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Clackamas, OR 97086 Each manufactured or modular 90.90 2
Phone: (50E3) 698 -3417 I Fax: : (503) 698 -2486 dwelling, service and/or feeder
Reconnect only 66.85 2
E -mail: jotl�tansenelect@nssn.com gt Pump or irrigation circle 53.40 2
!il i s 9l u 1 }RI ...4O Cs# t�ta il,;:` / M j f(' !t i I a. ` :lIR
� ,e,�I .a.,. '� , „a;_�.�a ; l�l Sign or outlitte lighting 53.40 2
Business name: Johansen Electric Ina Signal circuit(s) or limited -
energy panel, alteration, or
Address: 10948 SE Valley View Terr. extension. Describe: Page 2 2
City/StateJZIP: Clackamas, OR 97086 Each additional inspection over allowable in a . • of the above
Phone: (503) 698417 Per inspection 62.50
Fax: (503) 698 -2486 Investigation per hour (1 brume) 62.50
CCB Lic.: 51539 I Electrical Lic.: 3-243C I Suprv. Lic.: 2053S [ndustria! • Iant • r hour 73.75
-
-a la 'l lm i a lt 5 t . 1 ° trill ' 't 11 r i pl f at sx rt M1+..
Suprv, Electrician signature, required: /.✓ �€ u' 4 z- u,l,.. ua ;�. S u of t , .iSi 4 �it� ¢u;
4r ,, Subtotal: i
Print name: Carl Johansen Date: 1 0 6 07 Plan review (255"0 afperrnit.fee):
State surcharge (8% of permit fee): 5S, y/
Authorized signature: TOTAL PERMIT 1'EE: 7 y $ ,e)/
Print name: Charlynn Leifsen Date: /0/6/0-7 permit application expires if a permit is not obtained within 150
days after It has beast accepted as complete.
I: 1BuildiaettYmits tELC- PermitApsdoc 05123 ;o6 440.4615T(1 VD5(COM/W® + Number of inspections allowed per pemtil.
T ' d Xdd 13C213S1J1 dH Wd66:2 LOOZ SO 400
n `(Zg r `i A t p-cr j f G C6 r r.eLf, or , . s c,1) 1 / le /c� 7
LE L PERMIT
. r } cam ®F ����►
COMMUNITY DEVELOPMENT PERMIT #: ELC2007 -00691
y DATE ISSUED: 10/5/2007
TIGARD' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
m = PARCEL: 2S113AB -00600
SITE ADDRESS: 16160 SW UPPER BOONES FERRY RD BLD.0 ZONING: I -L
SUBDIVISION: PACTRUST BUSINESS CENTER LOT : JURISDICTION: TIG
PROJECT: EXELIXIS
Project Description: TI - install service feeders and branch circuits.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 0 PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HMI SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: (2 W /SERVICE OR FEEDER: 80 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: 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: Contact #: PRI 503 - 698 -3417
FAX 503 - 698 -2486
FEES
Description Date Amount Reg #: ELE 3 -243C
[ELPRMT] ELC Permit 10/5/2007 $692.60 LIC 51539
[TAX] 8% State Surcharge 10/5/2007 $55.41 SUP 2053S
Total $748.01 REQUIRED ITEMS AND REPORTS
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 - 001.8640 through OAR 952 - 001 - 100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issue• :y: t i M 61 /1 Permittee Signature: p ,e, fiff li(Q,
•
-. 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 503.639.4175 by 7:00 a.m. for an inspection that 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.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: El_.C2007.00691
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/E!:2t107
Phone: (503) 639 - 4171 „ ' '” ,ii��l;
Inspection Requests (24 Hrs.): (503) 639 - 4175±+ •
INSPECTION WORKSHEET FOR DATE: 1/30/2008 TIME: 7:02AM PAGE: 19
SITE ADDRESS: 16160 SW UPPER BOOKIES FERRY RD I3LD.c.r CLASS OF WORK:
SUBDIVISION: F ?ACTRUST BUSINESS CENTER LOT #: TYPE OF USE:
PROJECT NAME: EXELIXIS
DESCRIPTION: 1'I - install service feeders and branch circuits..
OWNER: 1 REALTY ASSOCIATES, PHONE #:
CONTRACTOR: JOHANSEN ELECTRIC INC PHONE #: 503 -69B -3417
Inspection Request Scheduled For: Date: 1/30/2008 Pour Time:
Code # Inspection Description CCmfirrn- Contact # Message
199 Electric al final 0&1210 -01 503. 704 -153 N
Corrections/Comments/Instructions:
qt/
PAS PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: " Uv 60 Date: t • 30` 01 Phone #: (503) 718- 1- •
CITY OF TIGARD iiii `
BUILDING DIVISION PERMIT #: ELC2007.0[691
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: / j 007
Phone: (503) 639 - 4171 isie °' <;Ii i.
Inspection Requests (24 Hrs.): (503) 639 -4175 . '_ '1 J .
INSPECTION WORKSHEET FOR DATE: 1129/2008 TIME: 7:02AM PAGE: 19
SITE ADDRESS: 16160 SW UPPER BOONES FERRY RD BLD.0 CLASS OF WORK:
SUBDIVISION: PACTRUST BUSINESS CENTER LOT #: TYPE OF USE:
PROJECT NAME: E 'LIXIS
DESCRIPTION: TI - install service feeders and branch circuits.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 1
CONTRACTOR: JOHANSEN ELECTRIC INC PHONE #: 503696.3417
Inspection Request Scheduled For: Date: 1/29/2008 Pour Time:
Code # Inspection Description (Cpnfirm -# Contact # Message
199 Electiical final 064123-04 503 - 098 -3417 N
Corrections /Comments /Instructions:
.1t.ov11m A (ic S F • .)-gi�ty ✓ * INS 1 I'
M
I
I
N
I
I
n PASS n PARTIAL APPROVAL ❑ CANCEL ' NO ACCESS
,FAIL X CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G - 1 1 V v t 3 1 Date: 1 ' v , . 1 Phone #: (503) 718 - l Y f' L
CITY �����7���������
�*mn m OF mm��m������ ' ' . •
BUILDING DIVISION ' '
��~°,~~~°,,"~° ~,,°,~,,~~,~ PERMIT #: ELC2007-0U691
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/512007
Phone: (503) 639-4171
Inspection Roqueo�(24Hnsj:(6U3)63Q4�175 . '"��.
INSPECTION WORKSHEET FOR DATE: 1313/2007 TIME: 7:O0AN PAGE: 33
SITE ADDRESS: 18160EW UPPER 8{){)NES FERRY RDBLD.0 CLASS OF WORK:
SUBDIVISION: PACTRUSTEU8|NE9OCENTER LOT #: TYPE OF USE:
PROJECT NAME: [xa.|XIs
DESCRIPTION: T|' install service feeders and branch circuits.
OWNER: PACIFIC REALTY ASSOC]ATES. PHONE #:
CONTRACTOR: JOHANSEN ELECTRIC NC PHONE #: 503-598-3417
Inspection Request Scheduled For: Date: 12/3/2007 Pour Time:
Code # Inspection Description Contact # Message
1:Ki Wall cover 503-969-5717 N
/
Corrections/Comments/Instructions: /
�'
''
.
.
PARTIAL APPROVAL El CANCEL 7 N ACCESS
� �-_
��
| | FA|L CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: G.-- ` o �� e / E - Date: 1 143101 Phone #: (503) 718- • •
.: .r'`% L E 4 Permit Alic � f 2t 4 - w LlIl^; p l ,. ;��
( l Y ( i l - (1151 1(ti) l \I tl \IM1'e en r I
F: �. .x w'cy �a ` 43...iu3a 410.1- L01:• i - -•� 4. Diu.cy' ..tsix�tipi.,�4 .1ti4mageg
OF of Tigard C) ( T -� Received I, s 6 c2oo - OOlo9 i
13125 SW Hall Blvd., Tigard, OR 972 zoo? i ` �teB �� �7 s Permit No.:
® �,
4 6; , P hone: 503.639.4171 Fax 503.598� Plan Review
� C� p - � Other Permit:
f, ,iI inspection Line: 503.639.4175
"K i{ Internet www hgatd -or gov 8 U , 0 � " 0$WS O - N ofie M Supplemental h n brit y � ! ®8 2 In
Information
r,d � _ � t � V ln
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I6''i� 'a 1Q1 ty na ,ra, , .mlr , lt �•l� � ` I 1`I^�.
....n�ir �... " t) ':lt{ ull)& I o II'� 4, ,fi i Ii:, 1 !na 1I 1 IRONI(� �� iiiiFp"h (Oitc' ag I�rr r'�,'{ T Igl +N P Y01� . < 7 �iFi rp ,.41:!iM I
. - ,.3T39.`;,11!i:. h.l�i't.✓3' 3 ik 1 �'rJd..s.i. .::,.iii.. s tuts ai 1:11 Y. :Ii,.i.+Y
❑ New construction ® Addition/alteration/re lacement Please check all thu
Addition/alteration/replacement apply (submit 1 seta of plans wtiteiru checked below):
❑ Demolition ❑ O ❑ Service or feeder 400 amps «more ❑ Building over three stories.
l ? °±lap r ( iii f 1w'3tr van whore die available fault currant ❑ Marinas and boatyards.
��?�� ii:...li ' !{"3 It L! , pwr 1 r/ 1 y,'; F,nt_ v I ra »,��Ingl, ,.il 1 i
i{ 5 �,N : 1 11. 0 . :� .al dm i rLi a t sr t .11 ii l t,;± °. AIHr li'. 1 ,i l l : � r � exceeds 10,000 amps at 150 volts or ❑ Floating building&
Ices to o g�
❑ 1- and 2- family dwelling ® Commercial/ ❑ Accessory building ' s ons. Qc«atnctc;al - o„ agricultural
sups for all other installations. buildings_
❑ Multi- family ❑ Master builder ❑ Other. ❑ Fire pump. ❑ lastalistion of7$ KVA or
r• :�. y 1 x
!irk i t Ia :9liad m wu u j q s ". { tr"Ilra r ~ f ❑ Emergency rystem
1 1 n'� 1 { ?• t . t1 ,, I "1 7 ; 7 ,1a N �p h m's larger xpa,stely derived system
11JIThJ1 I411' 1I 111 1811 tl 'Almw, ,U!IAWI i1 ilol,e.uJ,nen �4:u..tlxt 1 1tM 1� ijF`I. .. ❑ Additionofnew am mr load of ❑ "A °,rE ", "1 -2 ", 93 ",
I 'l l I �_ 100HP or more. occupancy. no.: Job site address: i i
oi � � ❑ Six or more residential =its. ❑ Recreational vehicle parks.
City / State/ZIP: ❑ Health - cane facilities. ❑ Supply voltage for mare than
❑ Hazardous location& 600 volts nominal.
Suite/bldgJapt. no.: Project name • • ! , / S i r ❑ Scmce or feeds 600 or more
i ���II H I I) 5p 1 +,f-4 J�] ?� 1
lifl fiif/ `a.4itit... j I + '�� .1;41TiTt, fllLitn.:1 -:
Cross street'directions to job site:
Description
Od. : Fee. Total •
New residential single- or mold- randy dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft or Tess 145.15 4
Tax map /parcel no.: Ea. add? 500 sq. R. or portion 33.40 1
! Irl t f'!i t s �i,s l + l : :.rr t ..,, Limited energy. residential
rr16..urLa�J° i) 1 ! �k4 R(1' - A f , Z 1 ' 4. i+ 1 t d a �{�ry 7. + r T .
w>�... �� 1..ri � a , ® ul.) rt 1u� , ..:IITtt'ti�,.�i''r�i���+iti l !�� (with a sq. R 7500
) 2
Limited energy, multi-family 75.00 2
4 / 111 II • 1 - IL! .1 residential (with above sq. ft.)
Services or feeders installatio alteration, and/or relocation
/ lo
it If , •� ^a . !Il,ny -,,� , Fnl+iF'�- ^4! (i�1 t yp }�u »ate } 200 amps or less I. 80.30 (v'ro•(06 2
`: it ril'': IC,�:� - .i;s 4ir Nrilii@si r18. y 4 1... l `£f! 201 amps to400a s
b.•.si� ..bL nf 4 �i p 106.85 2
Name: 401 amps to 600 amps 160.60 2
Address: 601 amps to 1,000 amps 240.60 2
Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 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 stops 100.30 2
I intended for sale, lease, rent,. or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: Due: Branch circuits - new, alteration, or es nsion, Rer panel
ttq{i Is i "" n s n° MIN g t lnuiralt w.c ,assn ,:• ::.. A. Fee for branch circuits with
Vtlp,u ( .1:di41t. '_...1Ge+ut ..:alk$ 14'4Nh lei L,. I {. Cx is } a t' above service or feeder fee,
. rlrn.,.:«.thlrll: .�14:,iltlfl SO 6.65 63-2_ 2
Business name: Johansen Electric Inc. each branch circuit tJ
B. Fee for branch circuits
Contact name: Charlynn Laken without service or feeder fee, 85 2
first branch circuit
Address: 10948 SE Valley View Terr. Each add'I branch circuit 6.65 2
City/ State/ZIP: Clackamas, OR 97086 Miscellaneous (service or feeder not included)
Each manufactured or modular 90.90 2
Phone: (503) 698 -3417 Fax: : (503) 698 -2486 dwelling, service and/or feeder
Reconnect only 66.85 2
E-mail: johansenelect@msn.com Pump or irrigation circle 53.40 2
21'$.l still 'i:.' Elk `, ll:.afl; ZE ' ' r, a� .?{ ,�'• E 1 ' t
L,.tll.a , . .,•. w . • :�;'��;� Sign or outline li 53.40 2
Business name: Johansen Ekctric Inc Signal circuit(s) or limited -
energy panel, alteration, or
Address: 10948 SE Valley View Terr. extension. Describe: P age 2 2
City / State/ZIP: Clackamas, OR 97086 Each additional inspection over allowable in mixer the above
Phone: (503) 698-3417 Fax: (503) 698 -2486 Per inspection 62.50
Investigation per hour (1 hr min) 62.50
CCB Lic.: 51539 Electrical Lic.: 3-243C Suprv. Lic.: 20S3S Industrial • Iant • r hour 73.75
1' 1 ua,':. ... 1 ::: .ta CIF.}( u :,•
Suprv. Electrician signature, required: ` r ' r y tom' i / , q >w 9
= / • r .�. ...- � subtotal. / q IPn
-
Print nine: Carl Johansen / Date: 10 17 a Plan review (25% of permit fee):
State surcharge (85 of permit fee): 5S. 1/
Authorized signature: if L L TOTAL PERMIT FEE: 71/ g .. dV
Print name: Charlynn Leifsen Date • 02'D7 This permit application expires if a permit is not oblaioed within 180
days after It has been accepted as complete.
t lauildiagPermiLSPLC _Pecmitgppdoe OS/Y1;06 " Number of inspections allowed per parent.
440- 4615T(i 1 /05 /COM/W®
I . of XH 4 I gr> cw a1-1 W.-IPP : a J nn2 cn son
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: FLC2007-0069i
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1016/2007
Phone: (503) 639-4171 i
Inspection Requests (24 Hrs.): (503) 639-4175 L
INSPECTION WORKSHEET FOR DATE: 11/130007 TIME: 7:01AM PAGE: 77
SITE ADDRESS: 16160 SW UPPER BOONE'S FERRY RD BLD.0 CLASS OF WORK:
SUBDIVISION: PACTRUST BUSINESS CENTER LOT #: TYPE OF USE:
PROJECT NAME: EXIELIXIS
DESCRIPTION: TI - install service feeders and branch circuits.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: JOHANSEN ELECTRIC INC PHONE #: 503-698-3417
Inspection Request Scheduled For: Date: 11/13/2007 Pour Time:
Code # Inspection Description ( Confirm_tk , Contact # Message
125 Wall cover - ---059489-01 503-9695717
Corrections/Comments/Instructions:
p iko To ctirst■er Fee. r--4.tekL
Nen •
isPP te)Notil-- ia c.st,qm. PO41 isA be 144-.1, co
PASS
... &21ZIAL APPROVAL 0 CANCEL I 1 NO ACCESS
n FAIL 1 I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
A
Inspector: G" Date: ILO lin Phone #: (503) 718- VILA)