Permit - CITY OF TIGARD ELECTRICAL PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELC2008 -00352
DATE ISSUED: 6/19/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25101 AD -03200
SITE ADDRESS: 12909 SW 68TH PKWY 410 ZONING: MUE
SUBDIVISION: TIGARD TRIANGLE CENTER LOT : JURISDICTION: TIG
PROJECT: TOMPKINS BENEFIT GROUP INC
Project Description: TI.
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: 5 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 6/19/2008 $80.10 LIC 51539
[TAX] 12% State Surchar 6/19/2008 $9.61 SUP 2053S
Total $89.71 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.
AIM Issued By: / Yom/ Permittee Signature: rh
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.
•
1
Electrical Permit Application 1 i) It (;I 11( 1. 1 , I : O.l .l
City of Tigard ) Received � �� Date/13 ��j l i rap Perrot No.: C /:. : b
Ili - ii 13125 Phone: S W 503 Hall Bl 417 vd 1 ., Tigard , 503 OR *' jj, . c
• •_ s Plan Review
. Dato/g Other Permit:
, I ,. , u. f Inspection Line: 503.63 9.4175 ,l Date Ready/By: % See Page 2 for
Internet: www.tigard - or.gov Notified/Method: A/ r Supplemental !abrogation
1'% (4 .' :. 1( Fa s . 1-i � ' !�I iCraaY,(stt -I yam: I(( �� Phi"!,;,''.;
Sri: ::� :7. � �. �:b:f ,.y 7 { i .. i
. 'til , �l' � �'» t!
++ w..w�t�lY '�.•. �.:!a.�b �� .,,' i'It �37 ; t1.�. .17.7 ,: 1 ...�A�•' P.'f;5rf..��1 �
❑ New construction ® Addition/ahem ) t ! i.. 40 _ - - Please check all that apply (sobunit a seta of plans w /items checked below):
l ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: • i \VI uil where the available fault current ❑ Marinas and boatyards.
H r F: 41 Y Lf , f- 'lllr)Aa I, f lu i '� exceeds 10,000
"; OA L : L..+4. � :. i,1V c s � r - Z 4 , 1, ;,. b t A , t i ? y at 150 volts or
,. .la.,, s6 t. r 1 �:. F less to ✓>mDa ❑FlaetirtgbuiWmgs.
❑ 1- and 2- family dwelling ® CommercialJindustrial ❑ Accessory building o r allot or eaweeds 14.000 ❑ Commercial use agricultural
amps for all other installmooa buildings.
❑ Multi-family • ❑ Master builder ❑ Other: ❑ Fire pump. ❑ installation of 75 KVA or
. ;'
.' a . ,. ❑ E e e er separately erived system.
7 'i +v .,.i4 el cf.' 416 l� n , i q°' ;"!f1. ! 1,T "i. -.. i „ i ❑ Addition new motor load of ❑ larger .. 2 . ..
Job no.: Job site address: 12909 SW 68th Pkwy 100HP or more. occupeacy.
❑ Six or more residential units. ❑ Recreational vehicle parka
City/State2EP: fa Healthcare facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldgJapt. no.: 410 I Project name: Torok i ns Benef ❑ Service or feeder 600 amps or more.
is li t , ;1'1 :4 :>_= M1 l {t 41tiNi;
Cross street directions to job site: arerbrer, (Pn'. Ye: Toe •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add') 500 sq. ft. or portion 33.40 1
Taxmaplparcel no.: s l Limited energy, residential
`. ■ 1 11 i t � Oil m e `a e . a+la rini;l r 4.. 17 .Iii , 11 ;41 ' (with above so. ft.) 75.00 2
Limited energy, multi-family 75.00 2
Tenant Improvement residential (with above so. ft)
Services or feeders installatio alteration, and/or relocation
m„ a7) in'lad 200 amps or less 80.30 2
�
ti ��a? 1 1 ILil[iis �:. :1. *R ii',t.. 1.. :i :, "� ,�iiirf {�;, 4lii% 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
I relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 I 2
intended for sale, lease, tent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with -
:,!. qli :1 ct1,1:1',• t •.., t • , •', '!�°• "�,��1[tg�a ��� I 4 _I 11t dialgilLMCM rZilai above service or feeder fee,
each branch circuit 6.65 2
Business name: Johansen Electric Inc. B. Fee for branch circuits
Contact name: Charlynn Leifsen without service or feeder fee. 14 B5 2
first branch circuit
Address: 10948 SE Valley View Terrace Each adds branch circuit 5 6.65 133 . 2 -5s. 2
Miscellaneous (service or feeder not !Deluded)
City/State/ZIP: Happy Valley, OR 97086
Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (503) 698 -3417 Fax: : (503) 698 - 2486 Reconnect only 66.85 2
E -mail: johansenekct@msn.com Pump or irrigation circle 53.40 2
• .t ' s.1 1 f1 ; l i:K,° Zi i s =su rf ; ` 11 t ; , Sign er outline lighting 53.40 2
Business name: Johansen Electric Inc. Signal circuit(s) or limited-
energy panel, alteration, or
Address: 19948 SE Valley View Terrace extension. Describe: Page 2 2
City/State/ZIP: Happy Valley, OR 97086 • _Each additional Inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 6903417 1 Fax: (503) 698 -2486
Investigation per hour (t hr min) 62.50
CCB Lic.: 51539 I Electrical Li � Su . Lic.: 2053S Industrial , : t r hour 73.75
e. :q
Suprv. Electrician signature, required: Subtotal: : • • f Subtotal:
Print name: Carl K. Johansen Date: 6 / 19 / 0 8 Plan review (25% of permit fee):
State surcharge (12% of permit fee): 9 . 6 1
Authorized signature: .l& 1".... - _ TOTAL PERMIT FEE: 8 9. 71
Print name: Charlynn J. Leifsen I Date: 6/19/08 Thh pariah a pp le app if permit is not obtained within 180
drys after it has been accepted as complete.
t U3aildinglPertriulELG l4mucAyp doe 05/21/O6
• Number of inspections allowed per perm it.
140.4615T(11/05AOOM'WEa
•
Ed XEid 13C?J3SEJ1 dH WEJBE : L 8002 6T unC
CITY OF TIGARD = =
BUILDING DIVISION PERMIT #: F_l_C2Q0 &003.5'2
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/1912008
Phone: (503) 639 -4171 1 r °b11 i(l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/31/2008 TIME: 7:QOANI PAGE: 17
SITE ADDRESS: CLASS OF WORK:
SUBDIVISION:
12909 SW 68TH PKWY 410 LOT #: TYPE OF USE: I
PROJECT NAME: TIGARD TRIANGLE CENTER
TOMPKINS BENEFIT GROUP INC
DESCRIPTION: TI.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: JOHANSEN ELECTRIC INC PHONE #: 503 -69B -3417
Inspection Request Scheduled For: Date: 7/31/2008 Pour Time:
Code # Inspection Description Confirm- Contact # Message
199 Electrical final 073540.01 503 - 969.5262 N
Corrections/Comments/Instructions:
I
n( I
v\ 1\j
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: • N v 08 Le' Date: - 11 11 CT% Phone #: (503) 718-