Permit s"‘ CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00285
DEVELOPMENT SERVICES DATE ISSUED: 5/21/2004
L I ° 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 - 4171
PARCEL: 25101 AD -03200
SITE ADDRESS: 12909 SW 68TH PKWY 400
SUBDIVISION: TIGARD OFFICE BUILDING ZONING. MUE
BLOCK: LOT : JURISDICTION: TIG
Project Description: 10 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: SIGNAUPANEL:
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: 9 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 9701 5-0 00
Phone: Phone: 503 - 698 - 3417
Reg #: LIC 51539
SUP 2053S
FEES ELE 3 -243C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/21/2004 $106.70
[TAX] 8% State Surcharge 5/21/2004 $8.54 Rough -in
Elect'I Final
Total $115.24
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 -800-33 2344.
Issued By: / / Permit Signature: Qs)—) a- - ' 0-44
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: 0-0 S� S
Cali 639 -4175 by 7:OOpm for an inspection the next business day
Charlynn J. Leifsen To: City of Tigard
11
Date: 5/20/2004 Time: 1:29:10 PM Page 2 of 3
. . to. . '
. •
Electrical P rte 1 '474igAtion ,.......,,... ....,......„,„.,, ,,, .,„,...„. ... .,..,... ...
,.7:,r
.. ...... .. . . • •• .....• .. . . ..„
Received • • • • - ,Jj d.,, ... ....... 1.:EletriCa•11.-(77. •. . .• .• / .-• • •,,,.
_Da_te/ByL 5 PW• - k):f.-?..: : • :
CRY of Tigard MAY 2 '.,,," Planning Appro 1 Sign
20n e.
Date/41y:
Pennit No.: _______
3
3'25 SIN flan Blvd. Pion Review Other
Tigard, Grogan 97223 WV OF IrMiatO pattiluy: Perrin t. No.:
Phon e.: 533-639-417 FQ-14V-61\LTT.5,,WTZVkCX .. ' rtnt Dare/11. -R.twiew ' Land use
Internet: www.ei.tigard.or.uS jA
Lh -
See P tor ...
______,......._ Case No.: _ __...,
•,11•114;-;..11-.74 Contact . • a age 2
24- ho ur Inspec t io a Request: 503-639-4,175 ' I. Narne/Mothod: _ i Supplemental Information. i
.. ..
:; ....... .. iJ• „—._.;—,--Mitt 1 Fia-aA r07477-161, 1 W - iiiA 5 1 1 51•M: 111 •;;;IV
' New construction Demolition I u Service over 225 amps- ,• • Iltralth-cate •facility .• '
- 1 conu-nee.7.lal 1 0 Hazardous location
ri Additionlalteration/replaccment [1] Other: I 0 servitm ov,:t 320 omps-rating nf 1 0 Building owl: 10,000 seuate feet,
T 7161&11101,t PritK1nr.qn:1 . _ ,.,., 1 1 & 2 family dwellin lo en
gs i lour or more TeSidtial :mita
I t 1 & :11
[ 2-Fa.mily dwelling 131 Commercial/Industrial
1
a
Master Builder 0 Systm n
e over 600 volts ominal one sirtictu
. te.
0 Building over three stories 0 Feeders, 400 amps or inoi
Accessory Buildin. e
0 Multi-Famil ___ yL_ _ 0 -Otcupant load over 99 persons 0 Manufactured suuctures or RY park
Other: 0 Egesoightin.B.pirm • - • • . • 0 och._-. • .-._:.
„,:;•:,::: INi7_115A',,,,,,___i4.4WWTIOCM:ilAgial Submit sets of plun.s with arty of the above.
The above are not applicable 'to tememry.,eon ion struct SerciCl.
1 :lob site address: 12909 SW 68th , :::-:f4t.....,, , ,4-:-ng,6-A , ;-,;4,....vo, ,, , , :ifidaiNcsW -, t-4---.-..:. W'''''''''
400 1 Bldg./Apt.#: ,.
ii
--1 Minaret' of Inspect:10ns per-permit 'allowed
Pro•'ect Name: Mortgage Design Group : Descri tion pry f ee (u.) T0t21 1 . i
New residential-singlc or multi-family per
Cross street/Directions to iob site: dwelling unit. includes attached enrage. . • I t l;
Service Included:
. .
...
,-- •1000 so_ ft or kss I • .145.1.5 • .. 4
.
, Each orlditinno1 500 sq. ft orrrtion thereof • , • 11.40. • 1
Limited cusp. residential ; 75.00 1
Subd n: ivisio I Lot #: _ .,,.
• . Limited eneir, eon residential • . •• . ,. . 75.00 .1_ . 2
Tax man, Nireel #: Each manufactured home or modular dwelling
i
'''',--"--,-- • - •-;-; - - -x--` 7,, service ornitor feeder
, ;;;;T::-:qq - 2 - ,:e. - „.7:7,7,TP , •;00'elktgitiON:04 - TORK:': . .. i :::-Pi14::-01„0,,,•;,t,r,o,,,, • . . . .. 1. 90.90 1 2
1 ,412. -,•:,...; • ''''',..•,.. W! e..2 - , - , ' • . " ' ' ' ' '. ' - '''''''. ' ' ' '' "--'. . ' Services or feeders - installation, .
alteration or relocation;
_ __ — ;-•; i
.209 am s less - • •• • • •• • - •• • •• " • 80.30 ; .e. ,
Tenant Improvement _201a/tins to 400 ovips. 106.85 i 1. j
...._____
40 . ,s to 609 amps — -- ' .11 •I 160:•■50 1, • . , . 2 _1
• 240.69 1 2 !
. ,;; • . 0 • ;fif, -;, j R7---c - ,-. 1 1- 6 , :ii amps to ICAO amps
.
Name: 11 ' - - 0_ . 1 _ i .Reconnect oni 60.85 1 ''- 'r
Address: 1 Temporary services or feeders - installation, • • : • - - I • .
— • --- 1 alteration,' or relocation:
City/State/Zip: 1 . 1
209 amps or less — 66,35
1 Phone: 6) - 0 L 1 -4, 5 90 I Fax: 201 amos t 490 arny
= ' 401 io 600 amps 1030
133.75 -11
1 2 1
. W077HAfeil o s -- i
V .:;:i , :.'. 7 •:kf --; ,._ .... ., -, i .• •• • --- •,••••• - ---'• ; 'Branch circuit's new, alteration., or
-i eitension per Panel: . 1
Narne: Johansen Electric Inc.
Te
Address: 10948 SE Valley View
----
...
Citv/State/Z: Clackamas., OR 97015 --- .....
phor_.,..(50. 698-3417 F
.), ___________
......
_ ..... -- ..... -- ax: (503) 698-2486
E.. Johansenelectgaol.com .
1 1 A. Fee foi-branch•circuits with pulchase of • , 1
1 service or feeder f, each branch circuit - 6.65 i
1
'' ft. Pee for branch chrults %sill pureltaae ' • ; 1 ' • ,,,, 2
4
------- 5:2rvice or keder fix, first branch circuit
1
1 Each additional hra:xh -circuit
Misc_(Service or feeder not inzlIttictl)
,-" - -,..: - ,„,12; , F_411 raIMP ot irrigation cliTee 53 40
1 1 4 6 8s ‘io.00 , 2
9 1 • 6.65 59 i,...
r -
iit,,g:- ' ; ' ;94 - 40:• • ;41XT - R7ITi r •r 4401,0:1k4 Sea, siati:or t;;itline. 1 htin&
1 53A0 2
c j o b No: 8626 SigraLeircult(0) tr a limited energy panel, — --
- ' -- - alteration, or corns ion • • I _ Page 2 2
! Business Name: Johansen Electric Inc. ..._ Desc-rintion:
.... .
Address: 10948 SE Valley View Terr. ... . . . . . [
.......____ Flitch additional inspection over the aftewahle in any of the above: • " . ____A
Cit. iiStaleLZip: Clackamas, OR 97015 tcr iris .-,etirinitoto min. 1 !Lauri 6239 1 •
Phone: ( 698-3417 Fax: ( 698-2486 investiration f*:.
illil • 7
— --- other: • • k
CC13 Lic. #: 51539 Lic. #: 3-243 •,,. ig PlitZto. 02' - - - - ' • : ::,.:
/ -
_ ..,
Supervising electrician . . , ... .. . ............... .. .... .. . .... .... al. I S 106 70
— 1.
.signature required: _ / .1
1-- Plan Review. (25% of Permit Fee): • . $... .
Print Name: Carl K. Johansen Li 4,t 2053S Ste S
i atureharge (8% of Permit Fee)
"-- .c... :—
'1
...---
(. percnitap . i no uthorized fit , 1 5/20/04
._
A -A. ; c.
g:nature: kiLl., ._ Ja xikaft • 180 days after Wino been accepted as complete. t5ob.2tal
A ocd witriin
Si
*Fee methodology set by Trl-County Building Industry Service Board.
Charlynki. Leifs n kJ/
(•Please print mule)
• .
inDstsTemlit Forinsi(11oPermitApp.doe 01103
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested --/D AM PM BUP
Location id 9 9 F Suite ( 7 1 0 MEC
Contact Person Ph ( ) 9 03 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC Z 7 O d 9 3
Footing
Foundation ELC
Ftg Drain Access: ELR 4
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Ext Shear Sheath/Shear
Anchors < /
Ext ea/h �"�
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm PIPPIZ6N5J0
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
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
PASS PART FAIL
ELECTRICAL
Service •
Rough -In
UG/Slab
Low Voltage
Fire Alarm
410 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
$ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line /, , � 1, 4a ADA
Approach/Sidewalk D a t e !(J ✓ V Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL