Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -10046
. ' • DEVELOPMENT SERVICES DATE ISSUED: 3/14/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S113AA - 00400
SITE ADDRESS: 16200 SW 72ND AVE B2 ZONING: I -L
SUBDIVISION: OREGON BUSINESS PARK I LOT : 018 JURISDICTION: TIG
Project Description: Repair of service.
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/ SVCI FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 2 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1 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: SVCIFDR >= 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: Contact #: PRI 503 - 698 -3417
FAX 503 - 698 -2486
FEES
Description Date Amount Reg #: ELE 3 -243C
[ELPRMT] ELC Permit 4/3/2006 $267.45 LIC 51539
[TAX] 8% State Surcharge 4/3/2006 $21.40 SUP 20535
Total $288,85 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.
Issued By: Permittee Signature:
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.
From: Charlynn Leifsen 503 - 698 -2486 To: City of Tigard Date: 3/13/2006 lime: 2:12:52 PM Page 2 of 3
l R . - 1VE A Electrical PermitA [ J_! '' ., e,rr►e ►. ► •►: ,,\I
City . of Tigard Dat Received* �, 6,_ PJ -7460 ` C
t B : " ' , Permit No.
13125 SW Hall Blvd., Tigard, OR 97223 20 Re"0n"
60 M AR 13 : : 'b• Other Permit:
Phone: 503.639.4171 Fax: 503.598.19 p ''ii ` pB • ;
Inspection Line: 503.639.4175 i a _ _ T Ate Re edy/By. !il See Page 2 [or
Internet: www.ci.tigard.or.us CITY OF Ti Notifted/Method: Supplemental t°tormatioe
4", .:... :I _- .�;_.. ';`
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❑ New construction ® Addition/alteration/replacement Please check all that apply:
❑ Demolition El Other: ❑Service over 225 amps, comm'I ❑Hazardous location
r ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft,
t 1- t J ?:;,;,,,.., - , ,.,, : of I- 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
❑ Multi family ❑Master builder ❑ (der: ❑Building over three stories ❑Feeders, 400 amps or more
Occupant load over 99 persons DManufactured structures or
f - ! .1 . .... i_ : .. :. ;, I' ' ,: " ❑ plan RV Dark
Job no.: Job site address: 16200 SW 72nd ❑Health -care facility ❑met
Submit 2,. sets of plans with any of the above.
City/State/ ZIP: The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: Tufcoat
Dim:APS= Q4. Rt. Tad ..
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
Limited energy ' residential 75.00 2
Tax map/parcel no
`. I :' L's '. 7- # �n'' , f Limited energy, non-residential 75.00 2
i .._ :; ... _, : f , ,,.q N . , . . :. ,. ,.x .G ..: i ;_ Each manufactured or modular
Repair of service 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
t < r� f , 201 amps to 400 amps 1 106.85 106.85 2
i:7 . .. a 9 .. , _ .._ . t o J' - . _ . .'.a c: :.: ?`, , €.t
. _ - 2 r
- 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
Reconnect only 66.85 2
City/State/ZIP: Temporary serviette or feeders installation, alteration, and/or
Phone: ( ) Fax: ( ) relocation
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 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 circuits - new, alteration, or extension, per panel
i iz r - -. ,� 1: ` ,f A Fee for branch circuits with
...._... A. service or fender fee, each
Business name: Johansen Electric Inc. branch circuit 6.65 2
B. Fee for branch circuits
Contact name: Charlynn Leifsen without service or feeder fee,
each branch circuit 46.85 2
Address: 10948 SE Valley View Terr. Each addl 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.com Signal circuit(s) or limited-
, &> ∎ . - ' r ' f , 1 ' - ..L - 1 - ...., - ....t - , @ i -.Y ',,,, On Fin on, or
extensi 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 (1 br min) 62.50
Phone: (503) 698 -3417 Fax: (503) 698 -2486 Industrial plant per hour 73.75
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CCB Lic.: 51539 Electrical Lie, 3-243 S . . Lic.: 2053S Subtotal 267.45
Suprv. Electrician signature, required: �e, 1 it , ' Plan review (25% of permit fee)
Date:
�� j , / r State surcharge (8%ofpermit fee). 21.40
3 3/ 13/06 TOTAL PERMIT FEE 288.85
Authorized signature: i , _ /.� This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
/ Date: 3/13/06 • Fee methodology set by Tri .County Building Industry Service Board
•• Number of inspections per permit allowed.
isl nuiIdioswernib \EI.C- PaodtApp.doc INO3 440.461 sTootozicommteB
CITY OF TIGARD s - L2G
BUILDING DIVISION PERMIT #: 2-e0 I ! — 100 9
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 s u�� u 41� I1I1
Inspection Requests (24 Hrs.): (503) 639 -4175 ! '__-.
INSPECTION WORKSHEET FOR DATE: 3 /2_„10 / TIME: PAGE:
SITE ADDRESS: / 6 2- '7 ? / :7 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #: /
CONTRACTOR: PHONE #: Q / ' f c756
Inspection Request Scheduled For: Date: Pour Time: .
Code # Inspection Description Confirm # Contact # Message
Corrr /Co I :tructions:
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]. . Pe Nt L. (A l 8} L1 t) Vi Q__. 4 1)166440J RKIV o
Cc
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED .
Inspector: v Aa NO6 Date: 311- oh Phone #: (503) 718- _ZWL____