Permit /1114A ELECTRICAL PERMIT
CITY OF TIGARD
PERMIT #: ELC2005 -00655
DEVELOPMENT SERVICES DATE ISSUED: 9/8/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 2 S 112 D D -004 00
SITE ADDRESS: 15912 SW 72ND AVE B17 ZONING: I -L
SUBDIVISION: OREGON BUSINESS PARK I LOT : 017 JURISDICTION: TIG
Project Description: Services
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: 2 W /SERVICE OR FEEDER: 40 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:
KAUFMAN, LOTTIE L + JOHANSEN ELECTRIC INC
SUBOTNICK, RUTH ET AL 10948 SE VALLEY VIEW TERR
BY PACIFIC REALTY ASSOCIATES CLACKAMAS, OR 97015-000
PORTLAND, OR 97224
Phone: Phone: 503 - 698 - 3417
FEES Reg #: LIC 51539
SUP 2053S
Description Date Amount ELE 3 - 243C
[ELPRMT] ELC Permit 9/8/2005 $426.60
[TAX] 8% State Surcharge 9/8/2005 $34.13 REQUIRED ITEMS AND REPORTS
Total $460.73
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 2
Issued By: _ G jj., Permittee Signature: Sy? 6?...-7c2 ' e _I _-!/y L
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.
•: Charlynn Leifsen 503 -698 -2486 To: City of Tigard Date: 9/7/2005. lime: 12:56:16 PM Page 2 of 3
Electrical Permit A lie '011 4 -= . I UIl 111 I it 1. 1 ■r t 1.1.1
City of Tigard 9474, Permit No C - _ Gtr - . .
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 0 I 1� ' - 'R
� : i _, ._ �• � � Dummy; Other Permit:
Inspection Line: 503.639.4175 - AAA- '-- I f - Date Ready/By: r • • • S a
Sp Z for
Internet: www.ci.tigard.or.us Notified/Method:
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,1, : t. _.... f t , t , .',.,..,`, f, - t,'-"- 1 , � : , $ F P! .- -, . v r f' I ` r : .. :. �' .: , } i t ` ,a •
❑ New construction ® Addition /alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ['Service over 225 amps, comm'l ['Hazardous location
' , a r 7r . ,, i ❑Service over 320 amps - rating ❑Bulldog over 10,000 sq. ft.,
"" i ;'- '' .. t,. f _ . 4 ..J ' ` ' of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
[3 Mani- family ❑Master builder ❑Other: ❑Building over three stories ['Feeders, 400 amps or more
, ['Occupant load over " 3: 4 ,.. : _f t ; ;;a- i t l ,t n e Y .+ to - t ? " '... ai ❑Egress/lrghting Plan persons ['Manufactured park WICd structures or
faC
lob no.: Job site address: 15912 SW 72nd Elleahlt -care facility ['Other
Submit I_ sets of plans with any of the above.
City/State./ZIP: The above are not applicable to temporary construction service.
-, t i ll I , Y
Suite/bldg. /apt. no.: Project name: Cookie Lee r
Description Qty. Fee. Total
Cross street/directions to job site: New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1 _
Tax map/parcel no Limited energy, residential 75.00 2
1 tY f > rn w� > ... { )7 ,i { ' P ` .. _'?'t fr I'I,'*'iK'' Limited en ,non- residential 75.00 2
_ s:.'0 . _ . '.' .. . } .. } ,',.,„:;-;.;.:=,' .....: ... '.,'', 4, 1:. .1N .Cu ,z .t.":. ':? . 't 1s .:::. -.,. _ Each manufactured or modular
TI dwelling, service and/or feeder 90.90 _ 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 2 80.30 160.60 2
- ... v .',"...,,....:.....i. a , e '" I ,. t t , , ,I ,
� i a .`... , r t x : 201 amps to 400 amps 106.85 2
, , ,1.� ..r . , ! F .. .:.6....?' , _ . ; f . 401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
-
City/ State/ZIP: Reconnect only 66.85 _ 2
Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fax: ( ) reloudon
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 1 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: _Branch circaib - new, alteration, or extension, per panel
,T e. _ r: ' .. , f : p s t1 r : , i, rj 15 i i . y S 1 A. Fee for branch circuits with
t? ?
a,l <, „Ck - :;. - =:, - ,t. , q , 1, ,e:,,...., i service or feeder fee, each
Business name: Johansen Electric Inc. branch circuit
40 6.65 266 2
B. Fee for branch circuits
Contact name: Charlynn Leifsen
without service or feeder fee,
Address: 10948 SE Valley View Terr. each branch circuit 46.85 2
Each add'l branch circuit 6.65 2
City/State/ZIP: Clackamas, OR 97015 Miscellaneous (service or feeder not included)
Phone: (503) 698 -3417 Fax: : (503) 698 -2486 Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Johansenelect@msn.eom Signal circuit(s) or limited -
: , t J , >5 .. / T c Q s S i 1 ancl altcratlon, Of
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tr L:.;,,:.
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..... Y .- . ,.l�.,f. } mart ;mind.
extension. Describe: 2 2
Business name: Johansen Electric Ina Page
Address: 10948 SE Valley View Terr. Each additional inspection over allowable In any of the above
Per inspection 62.50
City/ State/ZIP: Clackamas, OR 97015 Investigation per hour (1 hr min) 62.50
Phone: (503) 698 -3417 Fax: (503) 698 -2486 Industrial plant per hour 73.75
rt
CCB Lic.: 51539 Electrical Lic. 3 -243 S .rv. Lic.: 2053S Subtotal 426.60
Suprv. Electrician signature, required: ' i� � Plan review (25% of permit fee)
State surcharge (8% of permit fcc)- 34.13
r=yerW Date: 9/7/05
T TOTAL PERMIT FEE 46 0.7 3
Authorized signature: ,, /, This permit application expires if a permit is not obtained within 180
days titter it has been accepted as complete
• Fee methodology set by Tri�ounty Building Industry Service Board
/ ' - - - " " ",' Date 9/7/05 •• Number of inspeetioas per permit allowed.
iustuidinylPamitsuuc- Permltapp.doc U10) 440.4615T(10ro2/COMAVca
•
CITX DF TIGARD
BUILDING DIVISION PERMIT #: ELC200S-00665
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/8 /2005
Phone: (503) 639- 4171 ,,o 11 dji
Inspection Requests (24 s.): (503) 639 -4175
INSPECTION WORKSHEET F. - DATE: 10/27/2005 TIME: 4:11PM PAGE: 30
SITE ADDRESS: 15912 SW 72\) AVE B17 CLASS OF WORK:
SUBDIVISION: OREGON BUSI ESS PARK! LOT #: 017 TYPE OF USE:
PROJECT NAME: COOKIE LEE
DESCRIPTION: Services/branch cir s.
OWNER: KAUFMAN, LOTTIE L +, PHONE #:
CONTRACTOR: JOHANSEN ELECTRIC I PHONE #: 503- 698 -3417
Inspection Request Scheduled For: Date: 10/28/2005 Pour Time:
Code # Inspection Description Co firm # Contact # Message
199 Electrical final 019:0-01 503-209-0395 N
Cg{ctions /Comments /Instructions: �t
(LOa11 Q � A Nno_ Q_ w l V ISM ►N �� �
F' NAL P' JOi N
76 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ C L FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / L/ /i Date: I 0 Phone #: (503) 718 - 1-64
- OF TIGARD
_ ELCZO0�oos55
BUILDING DIVISION PERMIT #: 91812005
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 A��N I ' � I rl
Inspection Requests (24 Hrs.): (503) 639 -4175 _�_'' "
10/24/2006 7:02AM 54
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
15912 SW 72ND AVE B17
SITE ADDRESS: OREGON BUSINESS PARK I 017 CLASS OF WORK:
SUBDIVISION: COOKIE LEE LOT #: TYPE OF USE:
PROJECT NAME: Services/branch circuits.
DESCRIPTION:
KAUFMAN, LOTTIE L +,
OWNER: JOHANSEN ELECTRIC INC PHONE #: 503- 698 -3417
CONTRACTOR: PHONE #:
10/24/2005
Inspection Request Scheduled For: Date: Pour Time:
Cocj : # eectiocover n Descriptio • U� i 4 01 ,83!564.t395 Memage
ding
1 °x°1
Correc ons /Comments /Instructions:
Q
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Al
Inspector: ` =LI Date: I 0 -Z V' O .� Phone #: (503) 718-
CITY OF TIGARD _ !
BUILDING DIVISION ' PERMIT #: ELC2005`00655
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/8/2005
Phone: (503) 639 -4171 Vit Inspection Requests (24 Hrs.): (503) 639 -4175 _
INSPECTION WORKSHEET FOR DATE: 10/21/2005 TIME: 7:08AM PAGE: 98
SITE ADDRESS: 16912 SW 72ND AVE B17 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK 1 LOT #: 017 TYPE OF USE:
PROJECT NAME: COOKIE LEE
DESCRIPTION: Services/branch circuits.
OWNER: KAUFMAN, LOTTIE L +, PHONE #:
CONTRACTOR: JOHANSEN ELECTRIC INC PHONE #: 503-698-3417
Inspection Request Scheduled For: Date: 10/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
130 Ceding cover 018951 -01 503-209-0395 N
Corrections /Comments /Instructions:
:, '' g� i /k i 140 i 4 b e s u- P
5 e
O. c Psi vl 3 _S a 03 e w l f
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
L WALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 11j r Date: / 0 —2 t' 0 S Phone #: (503) 718-
CITY QF TIGARD r ,
BUILDING DIVISION n�� A PERMIT #: ELG2005 00655
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
W8/2005
Phone: (503) 639 -4171 ' rd I
Inspection Requests (24 Hrs.): (503) 639 -4175 �' "'I I ..
INSPECTION WORKSHEET FOR DATE: 9/27/2005 TIME: 7 :05AM PAGE: 23
SITE ADDRESS: 15912 SW 72ND AVE B17 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK I LOT #: 017 TYPE OF USE:
PROJECT NAME: COOKIE LEE
DESCRIPTION:
Services/branch circuits.
OWNER: KAUFMAN, LOTTIE L +, PHONE #:
CONTRACTOR: JOHANSEN ELECTRIC INC PHONE #: 503-698-3417
Inspection Request Scheduled For: Date: 9/27/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
130 8 cover 016732 -01 503 - 209 -0395 Y
Corrections /Comments / Instructions:
��
V*Ai(P , cr■L'vi A tati LD
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ C LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 27 Otr Phone #: (503) 718 - 8
..CITY OF TIGARD , --
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: ELC2005 00655
Phone: (503) 639 -4171 4 ' lt'� 9I8I2005
Inspection Requests (24 Hrs.): (503) 639 -4175 .�'!i "'I �
INSPECTION WORKSHEET FOR DATE: 9/26/2005 TIME: 7:12AM PAGE: 79
SITE ADDRESS: CLASS OF WORK:
SUBDIVISION: 15912 SW 72ND AVE B17 LOT #: TYPE OF USE:
PROJECT NAME: OREGON BUSINESS PARK I 017
DESCRIPTION: COOKIE LEE
Serviceslbranch circuits.
OWNER: KAUFMAN, LOTTIE L +, PHONE #:
CONTRACTOR: JOHANSEN ELECTRIC INC PHONE #: 503-698-3417
Inspection Request Scheduled For: Date: 9/2612005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
1 25 h Wall cover 016575 -01 503-209 -0395 N
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ,�7 _ . , ; // _ _...,�• Date: Phone #: (503) 718-