Permit CITY OF TIGARD ELECTRICAL PERMIT
° PERMIT #: ELC2009 00016
COMMUNITY DEVELOPMENT DATE ISSUED: 1/13/2009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S112DC 00500
SITE ADDRESS: 15875 SW 72ND AVE BLDG B ZONING: I -P
SUBDIVISION: OREGON BUSINESS PARK III LOT : 040 JURISDICTION: TIG
PROJECT: SPEC SPACE
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: SIGNAUPANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 2 W /SERVICE OR FEEDER: 2 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 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 1/13/2009 $173.90 LIC 51539
[TAX] 12% State 1/13/2009 $20.87 SUP 2053S
Total $194.77 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
503.246.669 r1.8 33 .
Issued B _ Permittee Signature . _, _ ' X✓iQteli
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:
ONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: � " 110 l \ 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 Agplicati
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CJ' GEiV l<Ilit >I 11('1:1 l- \'I 1
City Of Tigard -.-..- 09 20 Received e -w. • t/ Permit - /�
DatWBv « / /`
13125 SW Hall Blvd., Tigard, OR 97223 1 Plan Review
' Phone: 503.639.4171 Fax: 503598 DateBy: other Permit:
® a� D
rl Inspection Line: 503.639.4175 �/ °F . liGli Date Ready/By: luny ' el See Page for
Internet: www.tigard- or.gov Gi ]I i a ` ...tificd/Metttod: Supplemental Iabrmation
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A i ' �y � t� i ks � q ■y a h ' o� r.nR� ++ ' .
u 1 `: in i t y .11' t, i A t t ; . '-'9,. . � Ifl a. ! . i.t.,lt: iti':. }�t2111 .P: 1i. ,:,.
❑ New construction ® Addition /alteration/replaeemeni Please check all that apply (submit l nets of plans wrrteme checked below} /^
❑ Demolition Service or feeder 400 amps or more ❑ Building over three stories.
❑ Other: where the available fault current
..! }t II�f t1 �l =lyyeepeeuerr �. F 7� amps DFloat
'4 7 It' 'I.� `.. ' �r 'm.IMilliAci�>lYia3'ieeaatlk• � 0 4 r a t i . � t " 'lj.. � X�F� x.1 11 t , l'; _ oxcoed9 10,000 at 150 volts or dings.
❑ 1 and 2 family dwelling ® Commercial/industrial ❑ Accessory building am to ground, or exceeds 14,000 ❑ Commercial agricultural
for all other installations buildings.
a a f
❑ Multi- family ❑ Master builder do
❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
}. :1'. '" k + ',l {t ?' :t r?�1wq 1 r "y I N r ,i ❑ �erg cyst ® larger separately derived system.
t P
a d' t rlti. v tr1' a�r�tirck;iiii z.iK 1 u;s� 1uA:S. t 1 }:I1 §4 ' :,i,., .:4, 4. O Additiotofnewmo . torloadof
Job no.: Job site address: 15875 SW 72nd. 100 HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: ❑ Hearth - care facilities. ❑ Supply voltage for more than
• p ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: - base, e, [ Project name: (2431: - P (f e kD Service or fader 600 amps or more.
i "t 11 MlSTt!QS:.IM fi4t( GLYrd:.r. 1, sM a li=nt,
Cross street/directions to job site: neaeMOtion on. roe Tool -
New residential single- or multi - family dwelling unit
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax trap /parcel no.: Ea. Intel 500 sq. It. or portion 33.40 1
rwe It . t • �Hxsaepa:lra e Limited energy, residential
' ' ! t«e r r { O l iY ,. i E: ro' i t a i y i h `P _ r 3 115 ' Ai •0,
�uaw:anll,�l�:Eas:��,���'. `r. ,'� � .� !� Al ( with above s4. fl 75.00 2
Limited energy, multi- family I 75.00 2
Tenant Improvement residential (with above sq. ft.)
Services or feeders itutallation and /or relocatio
,1; ih T �, , 200 amps or less 'Z. 80.30 X60 •(�iO 2
tl.' ri ri d ut;ml.,1 i 7 ° l w ettl l' ; l l ''�'t : , 1 7'' t o hat <I `.; to.i „'!; 201 amps to 400 amps 106.85 2
Nance: . 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
` Address:
Over 1,000 amps or votes 454.65 2
City/StateJZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1 1
Owner installation: This installation is being made on property that 1 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 1 2
Owner signature: Date: Branch eirc - new, alteration, or extension, r panel
1 a ' �. v..y�, rC' . �'h �., A. Fee for branch circuits with -.
i. * �S:3;a, IL `.. 1 3' lliit4i�: fry leio.�c�rairGi 0 I '�;,�wu• �;':E .:1 above serviceorfeederfee,
each branch circuit Z 6.65 (?> -.• 2
Business name: Johansen Electric Inc. B. Fee for branch circuits
Contact name: Charlynn Leifsen
without service or feeder fee, 46.85 2
first branch circuit
Address: 10948 SE Valley View Terrace Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Happy Valley, OR 97086 Each manufactured or modular 2
Phone: (503) 698 -3417 I 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
'';i:: i s ll l .' I�f�I MI :..' 72,,11=§ A? : ille " ',A' ?a rjl Sign err 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: Happy Valley, OR 97086 Eaea additiotael inspection over allowable in an of the above
- Per inspection 62.50
Phone: (503) 698 -3417 I Fax: (503) 698 -2486 Investigation per hour (1 hr min) 62.50
CCB Lic.: 51539 Electrical Lic.: 3 -243C Sup . Lic.: 2053S Industrial .last per hour 73.75
Suprv. Electrician signature, required: / 11 `;,4ki; :41, - a' ;:,.�igni i 1 •,t.�2a c `rte �j
Subtotal: 1 - 75./0
Print name: Carl K. Johansen Date: 1 /12 /09 Plan review (25% of permit fee):
- State surcharge (12% of pemtit fee): 74 • s7
Authorized signature: • TOTAL PERMIT FEE: / ?(f.7/
Print name: J. Leifsen Charlynn T his permit spplication expires if a penult is not obtained within 190
Y Date: 1 / 12 / 0 9 days after it has beta accepted as complete.
• Number of inspections allowed per permit
1: 1Building \PerroitslELC- PemtitApp.doc 05/23106 440.46157(11/05/COMWEB
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BUILDING DIVISION PERMIT #: ELC2009-00016
13125 SW Hall Blvd., Tigar , OR 97223 DATE ISSUED: 1/13/2009
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639'4175 "�QW 1 J.
INSPECTION WORKSHEET FOR DATE: 2V9/2009 TIME: 7:808hH PAGE: 8
SITE ADDRESS: 15B76 SYV724Q AVE BLDG 13 CLASS OF WORK:
SUBDIVISION: 0RFG0N BUSINESS PARK III LOT #: 040 TYPE OF USE:
PROJECT NAME: SPEC SPACE .
DESCRIPTION: U
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: JOMANSEN ELECTRIC INC PHONE #: 603-698-3417
Inspection Request Scheduled For: Date: 2y9V2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
. 199 E|ect/iva|fmo| � 0130417-03 503'969-6262 N
Corrections/Comments/Instructions:
4v\'‘ .
l�� PAS- �� PARTIAL El �� NOACCESS
��� �� �� . .
[ 1 FAIL E1 CALL FOR INSPECTION [- ADDITIONAL FEES ASSESSED
�-�� ^� ~�����
Inspector: v��--` ��«��� �~ Date: �--� � Phone #: (503) 718'
�
''
CITY OF TIGARD'
BU4LDING DIVISION PERMIT #: c: LC2009 -0OO16
13125 SW Hall Blvd., Tigard, OR 97223 ./ DATE ISSUED: 1/13/2009
Phone: (503) 639 -4171 u�
Inspection Requests (24 Hrs.): (503) 639 -4175 ...' ' L.
INSPECTION WORKSHEET FOR DATE: 1/29/2009 TIME: 7:01AM PAGE: 11
SITE ADDRESS: 1E076 SW 72ND AVE BLDG D CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK III LOT #: 0,40 TYPE OF USE:
. PROJECT NAME: SPEC SPACE
DESCRIPTION: Ti
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: JOHANSEN ELECTRIC INC PHONE #: 50. - 8913
Inspection Request Scheduled For: Date: 1/291:09 Pour Time:
Code # Inspection Description Confirm # Contact # Message
130 Ceiling cover 08012401 503 - 969.5262 N
Corrections /Comments / Instructions:
a ' ° SS ❑ PARTIAL APPROVAL n CANCEL n NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: '4k/N-IV ' Date: 1 —Z/9 9 Phone #: (503) 718-