Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00283
**44111?' DEVELOPMENT SERVICES DATE ISSUED: 5/19/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 112 D D -00400
SITE ADDRESS: 15946 SW 72ND AVE PRV17
SUBDIVISION: OREGON BUSINESS PARK 1 ZONING: I -L
BLOCK: LOT : 017 JURISDICTION: TIG
Project Description: Installation of (2) branch circuits. Job No. 8206.
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: 1 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, LOT11E 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
Reg #: LLC 51539
SUP 2053S
FEES ELE 3 -243C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/19/03 $53.50
[TAX] 8% State Tax 5/19/03 $4 Rough -
Elect'I Final
Total $57.78
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.
Issued By: � - Permit Signature: 11lAr /°G / (1-770
/J
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 639 - 4175 by 7:OOpm for an inspection the next business day
From: Charlynn J. Leifsen To: City of Tigard Date: 5/16/2003 Time: 2:05:10 PM Page 2 of 3
-
Electrical Permit Application 4 ,1 , 1\i 1
Date received /0 D 3 Permit nom, - /I e7S03
�, . : I City of Tigard Ptoject/appt. no.: Expire dale:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: Gb'r/ ,
Phone: (503) 639 -4171 ����
Fax: (503) 598- 1963 Y ED tine no.: Payment :
Land use approv 1: 77G
0 1 & 2 family dwelling or accessory .' ;,,.� stria! O Multi - family O Tenant improvement
O New construction GI ��„ replacement
al t11Oli1' O Other: O Partial
.iOIt til 11 I \I t1101 \ 11O\
Job address: 15946 SW 72nd Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: Snow Brand Seed I Description and location of work on premises: Tenant Improvement
Estimated date of completion/inspection: 5/23/03
( (►\ I? \( Itll( \I'I'I. l( 11111\ 1 11. '( 111 - 111 I1
Job no: 8206 Fee Max
Business name: Johansen Electric Inc. Description Qty. (es.) . Total DO•Irp
NewrealdeaAal -stogle or. 6.Yy per
Address: 10948 SE Valley View Terr. _ dwelliegank.ineledesattathedgarage.
City: Clackamas I State: OR I ZIP: 97015 Servleehrcaded:
Phone: 503 -698 -3417 I Fax: 503- 698 -24861 E -mail: Johansenelect@aol.com 1000 sq. 0• or less 4
CCB no.: 51539 1 Elec. bus. lic. no: 3 -243C Each additional 500 sq. 0. or portion thereof
Limited energy, residential 2
e kno.: 4896 Limited energy, nen- residential - 2
5/16/03 Each manufactured home or modular dwelling
Signature of •sing electrician (required) Date Service or feeder 2
Sap. elect. name (print): Carl K. Johansen License no: 2053S Strrvinaorkeden— hwelinatleo'
alteration or reJocatbx
200 amps or less 2
Name (print):
201 amps to 400 amps 2 2
Mailing address: 601 amps m tr00 2
amps to 1000 amps
City: 'State: I ZIP: Over 1000 amps or volts 2
Phone: Fax: 1E- mail: Reconnect only 1
Owner installation: The installation is being made on property 1 own Temporary eerriar or feeders -
eloca
which is not intended for sale, lease, rent, or exchange according to InatelhdO1
200 amps or less 2
ORS 447, 455, 479, 670, 701,
201 amps m 400 amps 2
Owner's signature: Date: 401 to boo s 2
Brandt ehtdte- new, alteration,
or waterloo per pearl:
Name: A. Fee car branch chants with purchase of
Address: service or feeder fee. each branch circuit 2
City: 1 State: I ZIP: B. Fee fur branch circuits without purchase
of service or feeder fee, tint branch circuit: 1 46.85 46.55 2
Phone: Fax: E-mail:
Each additional branch circuit: 1 6.65 6.65
I ' I \ \ It I N 1 1 VI (I' Ir A.r t 1R r 1. All dish :wit l% ) 1NIsc (Service or feeder aotlneladed):
O Savior over 225 amps oommacial 0 Healthcare faaldy Each pump or irrigation circle 2
O Bounce over 320 amps -eating of I&2 U Hazardous location hach sign or outline lighting _ 2
family dwellings O Building over 10000 square fed four or Signal circuit(s) et a limited energy panel,
O System ova 600 volts 'samba] more residential units in one Oriente alteration. or extension' 2
0 Building ova three stories 0 Feeders, 400 amps or more •Description:
O Occupant load over 99 persons U Manufaamed strneams or kV pule Each additional Inspection over the allowable in any oldie above:
0 Egrew/Gling plan U Other: per inspection 1 1 1 1
Sabah sets of plasm with any elide above. Investigation fee
The above are mat applicable to temporary cost tr clioa scribe. Other
rant an jurisdictions swept credit cards, plume cal jurisdiction for more information. Notice: This permit application Permit fee 53.50
U visa U MasterCard expires if a penult is not obtained Plan review (at _ %) S
Credit card number: / / within 180 days after it has been State surcharge (8 %) $ 4.28
Cr
Expires TOTAL $ 57.78
accepted as complete.
Name of cardholder as shown on nimbi card
S
Cardholder signature Ammo 4404615 (6/00/COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received i ll AO /Z Date 6 -/3 AM PM BUP
994'x' r�
Location • / 2U ® Suite MEC
Contact Person ,OV4/ Ph ( �) %� y'5 'V PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 3 OO2 $'3
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
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
PAS PART FAIL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before nextinspection. Pay at City Hall, 13125 SW Hall Blvd.
ASS )PART FAIL
SITE ❑ Please call for reinspection RE: / Unable spect — no access
Fire Supply Line .
ADA
Approach/Sidewalk Date �j /∎V r!Q3 Inspector Mr` � 7si� Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL