Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2009 -00023
COMMUNITY DEVELOPMENT DATE ISSUED: 1/16/2009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S112DA -01400
SITE ADDRESS: 15350 SW SEQUOIA PKWY 190 ZONING: I -
SUBDIVISION: PACIFIC CORPORATE CENTER LOT : 002 JURISDICTION: TIG
PROJECT: DIANA HARRISON CPA
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 HAPPY VALLEY, OR 97086
Phone: Contact #: PRI 503 - 698 - 3417
FAX 503 - 698 -2486
FEES
Description Date Amount Reg #: ELE 3 -243C
[ELPRMT] ELC Permit 1/16/2009 $46.85 LIC 51539
[TAX] 12% State Surchar 1/16/2009 $6.65 SUP 2053S
Total $53.50 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: / ? fl.Qjjf\j X/ Permittee Signature: ( CO ' . • 1' a I
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.
w i,
Electrical Permit Applies AP OII ECEIVED
1 01-1 1( 1. I tin: t 00.1
ilt City of Tigard JAN 1 C • Permit No.: £ C0i_ooa 3
n 13125 SW Hall Blvd., Tigard, O Plan Review A 2oog
I phone: 503.639.4171 Fax 50 F m Other Permit t P 20 0 -
T i ; , Inspection Line: 503.639
www.ti -or. ov UILDING D�VI�I ®DIVISION Date Ready/By: See Page tor .,
Internet: NotiNotified/Method: Notified/Method: Sup ... '...talInformation
E .,r t
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 2 mu of plans w/items checked blow):
❑ Demolition CI Other ❑ Service or feeder 400 amps or more ❑ Building over three stories.
what die available fault current CI Marinas and boatyards.
• ir, ' 1t ',-.1.1;i'-. � �n " _ ` I M tt,l , 32811 + •.r ;3...;,.', exceeds 10,000 mops at 130 volts or ❑ Floating buildings.
I - and 2 - famil dwelling 1 less to ground, or exceeds 14.000 ❑ Cormnencial -nse agricultural
Y g ® Commercial/industrial ❑ Accessory building
El Multi M aster builder Fire pump. other installations. Ins allatio
❑ ❑Othe ❑ pump. ❑ Installation of7S KVA or
r itu en tins u r<a .a u
:''':,:.1% '1. , �� z I� � * . iv ❑ Additionofnewmotorload of ❑
.. .. -
Job no.: Job site address: 15350 SW Sequoia 100HP or more. ouarpaacy.
❑ Six or more retideotiel units. ❑ Recreational vehicle parks.
City/State/ZIP: ❑ Health - care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldgJapt. no.: 1 9 0 I Project name: Diana Harrison ❑ Service or feeder 600 am.. or more. .
fillEIMEZIEWhirlialll .l
Cross street directions to job site. site: MENMTM
Danipdon Qtr. Fee. Total •
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. it or less 145.15 4
Tax map /parcel no.:
Es. add'l 500 sq. ft. or portion 33.40 I
� Limited energy, residential
ltlti 5llgl I IFySEZ ',p uPiFq yl HCUer4 M Tft��tW}t fl`0_L�l� . t .
ivh w, i.~ i. �u, n.:. �i:6, w�NYCiaitl�fai� :�wi�%�liiflliHL��all[I , I (with above 9q. @.) 7500 2
Limited energy, multi - family .
75 2
Adds to tenant improvement residential (with above se. 11.) _
Services or feeders installation, alteration, and/or relocation
rs r ttnsa �s Rte, y r r,. 200 amps or less 80.30 2
fi_ IF.I s ,• i .. K a`` k' ^� �, ' tea ` tar ,'1a 1� ,�� : � 4,r� .p "' l,i.a) �.. 201 amps to 400 amps 106.85 2
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 less 66.85 I 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 i 2
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: Date: Branch circuits - new, alteration, or extension, per panel
" A. Fee for branch circuits with
r. - t I o-y"'F1K ZNfslif� 1 a �. uRs4� u ,r uw4otsat9•r{: r p d0�i
*L'i t nt`.�t.. �C� , � , iI811J1p. ° li` ';;. �.�t:, above service or feeder fee, 6.65 2
each branch circuit
Business name: Johansen Electric Ise. B. Fee for branch circuits
Contact name: Charlynn Lelfsen without service or feeder fee, 1 46.85 4 6 • 85 2
first branch circuit
Address: 10948 SE Valley View Terrace Each add'I branch circuit 1 6.65 6 - 65 2
_ Miscellaneous (service or feeder not Included)
City /State/ZIP: Happy Valley, OR 97086 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (503) 698 -3417 I Fax: : (503) 698 -2486 Reconnect only 66.85 2
E -mail: johanseneleet@msn.com Pump or irrigation circle 53.40 2
` r l r ll I YAML� iS L';li'» iIMIANgs l 1I,' µla, i r1„',t. " , Sign or lighting 53.40 2
- outline li tin
Business name: Johansen Electric Inc. Signal circuit(s) or limited -
energy panel, alteration, or
Address: 10948 SE Valley View Terrace extension. Describe: Page 2 2
City/State/ZIP: Happy Valley, OR 97086 Each additional inspection over allowable in an of the above
Per inspection 62.50
Phone: (503) 698 - 3417 I Fax: (503) 698 - 2486 Investigation per hour (I hr min) 62.50
CCB Lie.: 51539 I Electrical Lie.: 3 -243C I Suprv. Lie.: 2053S Industrial plant .er hour 73.75
la
Suprv. Electrician signature, I lkI iTiM.'l'1`R. s!!r '. 4 d f �t rtht 0.0
P gnature, required: " +"'" itt�(x
Subtotal:
��!/ J .� ,�',,...
Print name: Carl K. Johansen P� Lj3'9 Plan review (25% of permit fee):
/r State surcharge (12% of penny fee): 6 . 42
Authorized signature: v TOTAL PERMIT FEE: 59 . 9 2
Print name: Charlynn J. Leifsen / 16 / 0 9 This permit application expires IPA permit a not obtained w'itIda 160
days after it has been accepted as complete
• Number ofinepections allowed per perms
I :taaitding\PermitaLC- PermitApp doe 05/2906 440- 4615T(I 1/05/COM/WEB
T'd Xdd 13Cd3S131 dH WU2E :6 6002 91 Uer
CITY OF TIGARD
BUILDING DIVISION PERMIT #: +._t cs009 f1f1023
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 1/16/2008
Phone: (503) 639 -4171 ICI
Inspection Requests (24 Hrs.): (503) 639 -4175 ...=__-
INSPECTION WORKSHEET FOR DATE: 1/211:X009 TIME: 7:00Am PAGE: 15
SITE ADDRESS: 1 SI'1P SEQUOIA PKWY 190 CLASS OF WORK:
SUBDIVISION: PACIFIC CORPORATE CENTER LOT #: 002 TYPE OF USE:
PROJECT NAME: DIANA HARRISON CPA
DESCRIPTION: (2) branch circuits.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: JOHANSEN ELECTRIC INC.: PHONE #: 603.691.3417
Inspection Request Scheduled For: Date: 1/21/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 El ec:t . ri cal final ill/9881-01 503.969 -5262 N
Corrections /Comments /Instructions: 1 f
r
Vl
%7A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
i — L ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G ' Y" be, W-,
� Date: I 1 Phone #: (503) 718 - AA_