Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT # : ELC2009 -00014
° COMMUNITY DEVELOPMENT DATE ISSUED 1/12/2009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 112DC -00500
SITE ADDRESS: 15895 SW 72ND AVE BLDG B 100 ZONING: I -
SUBDIVISION: OREGON BUSINESS PARK III LOT : 040 JURISDICTION: TIG
PROJECT: T MOBILE
Project Description: TI. (8) 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: 7 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 1/12/2009 $93.40 LIC 51539
[TAX] 12% State Surchar 1/12/2009 $11.21 SUP 2053S
Total $104.61 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&I. OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: 461
�� - V/14 Permittee Signature: Q 1 \ OlI On
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.
.: _ e RECEIVED
Electrical Permit Application JAN 1 2 200y 1111: Ul fl( 1: 1 st. ()NIA
City of Tigard Received
b-- I , 12- •03c Permit No.: ESC
20M - �01
; :,- 13125 SW Hall Bh'd., Tigard, OR 9 i22 OF '' an Review
� �
Phone: 503.639 4171 Fax 503.598.1 , By. Other Pant:
i ,, ;,, ; Inspection Line: 503.639.4175 3UILDING DIVISI $ Read @1 six Pagel for
w.
Internet: wwtigard- or.gov Notified/Method. 11:
Supplemental Informadoo
f n�g , D+ i i[ j,. f. •G 'rXi� W 11'i`aTtia ! �: , 3 t,( } - .l',t , 'xh + f,I��ik. mil T' ;: ..4t i'1 .0� 1..1.'�r 1�1, hi$t,1 + +'-'� i11 `�'t�a�a,a.-lu,nu?y{ 1114E9i i
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit it set' of plans w/itarm checked below):
❑ Demolition ❑ Other: O Service cc feeder 400 amps or more ❑ Building over three amnia.
1 ' " 4 ? a. l ma a: �aWr:s,7a A where the available fault current ❑ Marinas and boatyards.
ii I;!) i'.v; i jili: $'ii; a c ; r t s 9ta n l!;'- : -., iii ice .1 ...,t'. T - ; ` i exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
❑ 1 - and 2 - family dwelling ® Commercial/industrial ❑ Accesso buildi lass to ground, o e exceeds 14,000 ❑ commercial -use agricultural rY building amps for all other installations. buildings.
❑ Multi family ❑ + Master builder • ❑ Other: ❑ Fire pump. ID of 75 KVA
� U): }�1yta d• r*j:6'!•1! nl'• +I t`.til {f'i" fi " jli� ❑Gmergem gmaeparatalyeriveday°em.
ro smc +Is , :, .- , . t (' i'�:'I'; n; ;.�„ . ❑ Addition ofnoha• motor load of ❑ "lerA" '•E" "1-2" -d1.3"
Job no.: Job site address: 15895 SW 72nd 10OHP or more. eccupamy.
❑ Six or mere residential units. 0 Recreational vehicle parks.
City /State/Z IP: 0 Health-care facilities. ❑ Supply voltage for more than
❑ Harardous locations. 600 volts nominal.
Suite/bldgJapt. no.: Jal I Project name: T Mobile ❑Service or feeder 600 amps or more. in
Cross street/directions to job site: Description oty. Fee. Total •
New residential single- or multi- fandly dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 4
Ea add'I 500 sq. R or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
�p���p e 1 r ta ,"� I , i i • i^ 75.00 2
tt lglEi. { : , ��M12'rCir6ti:051 r 13ds Z, t it ( '.fii7:1 : r w . Ji: i (with above K. R.)
Limited energy, multi- family 75.00 2
Tenant Improvement residential (withabove aq. s.)
Services or feeders installatio Alteration, and/or relocatio
c 200 amps or less 80.30 2
MI Y#Iairi , , .cif' �4.41ii • • n � u,�„i'� '
B ! .1 1;iii lei .i 'ii: 201 amps to 400 amps 106.115 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: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being rnadc 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 599 amps 133.75 - 2
Owner signature: Date:
Branch circuits - new, alteration, or extension, per panel
, „+;I ;;: �ar,asa�� i M � ;.1.4,,,, A.Fecforbra�hclrcuits
` .� y.:>. � la . , .• •: :t$ro aril'' �. �i ' ' ' ' a;,,t+.. 'i Lars � above service or feeder fee, 6.65 2
W each branch circuit
Business name: Johansen Electric Inc. B. Fee for branch circuits
without service or feeder fee,
Contact name: Charlynn Leifseo first branch circuit 1 46.85 4 5 - 8 5 2
Address: 10948 SE Valley View Terrace Each add'I branch circuit 7 6.65 46.552
Miscellaneous (service or feeder not included)
City /State/7,1P: Happy Valley, OR 97086 Each manufactured or modular 2
dwelling, service and/or feeder
Phone: (503) 698 -3417 I Fax: : (503) 698 -2486 Reconnect only 66.85 2
E -mail: johansenelect@a msn.com Pump or irrigation circle 53.40 2
`? *.. { ItngEmi2.3' wri;t�r�I 7 Sign or outline lighting 53.40 2
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: Rappy Valley, OR 97086 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 698 -3477 I Fax: (503) 698 -2486 Investigation per hour (1 hr min) 62.50
CCB Lic.: 51539 Electrical Lie.: 3 -243C Suprv. Lic.: 2053S Industrial .lant hour 73.75
Suprv. Electrician signature, e _ 7 L/ ., o-1 ^3 %'Y ,l;s°.. Y,r t > 1 ,, , , Z 9 t. = 11 ii •�i' 1 •
p gnattue, required l�(,T/CL' /t �Q�-.�
Subtotal: . • s
Print name: Carl K. Johansen ate: 1/12/09 Plan review (25% of permit fee):
State surcharge (12% of permit fee): 11.21
Authorized signature(
if TOTAL PERMIT FEE: 104.61
Print name: Charlynn J. Leifsen Date: 1/12/09 p ermit a e l m Ua permit is not obtained within 180
days after It has been accepted as complete.
Lu9mldrnghPotmit iELC PemitApp.doc 03/23146 440.4 (t
613T1 /05/COM/WEB • Number uf inspections allowed per permit.
T . Cl XIdH 13C213SI33 dH W1J0E e T T 6002 2T Ue f
CITY OF TIGARD
BUILDING DIVI PERMIT #: ELC2009-00014
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/17J2009
Phone: (503) 639 -4171 "4
Inspection Requests (24 Hrs.): (503) 639 -4175 "'I �..
INSPECTION WORKSHEET FOR DATE: 1113/2009 TIME: 7:00AM PAGE: 5
SITE ADDRESS: 15095 SW 72ND AVE BLDG 8100 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK III LOT #: 040 TYPE OF USE:
PROJECT NAME: T MOBILE
DESCRIPTION: Ti, (8) b ranc h circuits. 1
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: JOHANSEN ELECTRIC INC PHONE #: O3- 698.3417
Inspection Request Scheduled For: Date: 1/13/2008 Pour Time:
Code # Inspection Description Confirm'# Contact # Message
183 Electrical final - 679640.04 503.968-5262 N
Corrections /Comments /Instructions:
• \
\ \
l'
Il '
1
A PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
1° 13-15i
Inspector: CYM Ki(S6 Le '''.
Date Phone #: (503) 718- 241L •
CITY OF TIGARD
,• -
BUILDING DIVISION
AO PERMIT #: Ft..c2o09.00014
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 111212009
Phone: (503) 639-4171 :ZIA t
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 1/13/2009 TIME: 1 PAGE: 6
SITE ADDRESS: 15996 SW 72ND AVE BLDG 13 100 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK III LOT #: No TYPE OF USE:
• PROJECT NAME: T MOBILE:
DESCRIPTION: '11. (8) branch circuits.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
• CONTRACTOR: JOHANSEN ELECTRIC INC- PHONE #: 503-699-3417
Inspection Request Scheduled For: Date: 1/13/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
130 Ceiling cover 079640-03 603-969-5262 N
Corrections/Comments/Instructions:
I
"‘ PASS fl PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS
0 FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
G--.146LL
Inspector: Date: 1 ' 1 3 -I Phone #: (503) 718- MA
, .