Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00612
i, i DEVELOPMENT SERVICES DATE ISSUED: 9/24/2004
�` � �-' 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 - 4171
PARCEL: 2 S 113AA -00500
SITE ADDRESS: 16100 SW 72ND AVE B -18
SUBDIVISION: OREGON BUSINESS PARK I ZONING. I -L
BLOCK: LOT : OOA JURISDICTION: TIG
Project Description: T.I. (2) feeders, (20) 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: 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: 20 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 CLACKAMAS, OR 97015-000
Phone: Phone: 503 - 698 - 3417
Reg #: LIC 51539
SUP 2053S
FEES ELE 3 -243C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 9/24/2004 $293.60
[TAX] 8% State Surcharge 9/24/2004 $23.49 Rough -in
Elect'I Final
Total $317.09
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: 4 ✓ /_ . Permit Signature: ,p
OWNER INSTALLATION ONLY V
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: 9/22/2004 Time: 2:39:10 PM Page 2 of 4
► tr, J
Electrical Ap Ica� r i il< i PI ii , 1 i i.i 1
I C 3 v l 25 r SW H Tigard
BlvdTigard, OR 97223 V EP 2 004 - 9 '`!
Wan Review Other Permit:
nspectionLine : 503.639 .41 7503.598.19 sTVOFTIGA "' i r.. '' � I DateRcady,/By ® See Page 2for
Internet: www.ei.tigard.or.us BUILDING DIVIS • 1 Notified/Method: Supplemental Information
`'' '' -a tlr L�iii r - , . ..t- +x1 r a�
, `l_ .. ,-2,.• .1 r ■
❑ New construction 11 1E/Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other Service over 225 amps, cornm' Hazardous location
z tf � '," i ' ',Ir 4 ❑ o a f 1- and 2 -famil dw ell g ❑ 4 or more residential
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building ❑ System over 600 volts nominal units in one structwe
❑ Multi fami ly ❑ Master builder ❑ Other: ['Building over three stories [Weeders, 400 amps or more
J r qT n p ❑ p persons Man [Occupant load ova 9 p ers ufactwed structures or
i"t ` ..., t r 3 :.: � .. } � "w:. �" ❑Egress/Itght plan RV park
Job no.: 8766 Job site address: 16100 SW 72nd ❑Health -care facility ❑Other:
Submit j, sets of plans with any of the above.
City/ State/ZIP: Portland, OR 97224 The above are not applicable to temporary construction service.
Suite /bldg. /apt no.: Project name: Payless Drug Store ? .'.,:. ' �I_ > . ..*
Description Qty. Fes Total
Cross street/directions to job site: New residential single- or mnitt- 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
�, , „y Limited energy, non- residential 75.00 2
:r«
, Via. 1, , i i s # i t , + t,
. '.a • c i144..:: . , ' .. rY 4Y�A ,, ,, i . •, .., < _ --r -.. ., sit x w i ; .- t:. ... Each manufactured or modular
Tenant Improvement 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
:1; - i r •' ...,7; ','J''',-'-'.,''' ; Yom.-
x x i 'r".l ,^ d`'- P. µ - __ }' 201 amps to amps
.i...... .r ..�cW ,:...:I� ` . ! , Vii
106.85 2
' ` � ' at 40l amps to 600 amps
160.60 2
Name: Pacific Realty Associates 601 amps to 1,000 amps 240.60 2
Address: 15350 SW Sequoia Pkwy, 300 Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/ State/ZIP: Portland, OR 97224 Temporary services or feeders installation, alteration, and/or
Phone: ( 503)624 - 6300 Fax: ( 503) 624 - 7755 relocation
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I 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 an to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
' .`, t 1 ,"' if' v, i i r 3 ... i i 1 i r r . u}` y t , , y .,. ` i „ r' 1 4 , ?;' A. Fee for branch circuits with
:.b. rt ,..: - .. _ _ - . , .e .: .N , .,._*. -, . . _ : ..,, ' , . . service or feeder fee, each
Business name: Johansen Electric Inc. brand, circuit 20 6.65 133.00 2
me: Charlynn Leifsen B. Fee ou service or feeder Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address: 10948 SE Valley View Terr. Each addi 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: Iohansenelect(camsn.com Signal circuit(s) or limited -
1 - t- j r P--..::_-;..-, y" ., s ; 7-7.-2: - . ,,,r na`Zi ? .. 2 .!; ,Hf ... extend Panel, ariba. on , or
...
_ Page 2 2
Business name: Johansen Electric Inc.
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 (3 hr min) 62.50
Phone: (503) 698 - 3417 Fax: (503) 698 - 2486 Industrial Plant per how 73 75
CCB Lic.: 51539 Electrical Lic.: 3 -243C Suprv. Lic.: 2053S Subtotal 293.60
Suprv. Electrician signature, required: / / i Plan review (25% of permit fee)
_ A.
Print name: Carl K. Johansen / Date: 9 /22/04 State surcharge (8% of permit fee) 23.49
TOTAL PERMIT FEE 317.09
Authorized signature: i �• ibis permit application expires if s permit is not obtained within 180
days after it has been adapted at Complete
Prim name: Charlynn J. Leifs- Date: 9/22/04 • Fee methodology set by Tri-County Building Industry Service Board
•• Number of inspections per permit allowed.
iiauildinglPau u\ELC- oemitApp. 12/03 4O.4615T(10/02./COMWWFD
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line. (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested /d — c 7 '? AM PM BUP
Location / €v / DO - ra j 44 Suite MEC
Contact Person Ph ( D3 75 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner P/2_ ge ELC e2L - TID w l
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation , '/ / {�
Drywall Nailing ' " 0 �/
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final C -
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 C4-RC')H OO /2-) s l/C^'��' r6
UG/Slab
Fi Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
AS PART FAIL
SITE Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector - / Ext
Other:
Final DO NOT REMOVE this inspection record from t h Job site.
PASS PART FAIL