Permit CLTY OF TIGARD
ELECTRICAL PERMIT
PERMIT #: ELC2005 -00177
DEVELOPMENT SERVICES DATE ISSUED: 3/24/2005
13125 SWIaII Blvd., Tigard, OR 97223 503 - 639 - 4171
63a l PARCEL: 2S113AA-00400
SITE ADDRESS: 11 SW 72ND AVE B3 ZONING: I -L
SUBDIVISION: OREGON BUSINESS PARK I LOT : 018 JURISDICTION: TIG
Project Description: Work on 200amp service.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 0 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: 1 W /SERVICE OR FEEDER: 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
FEES Reg #: LIC 51539
SUP 2053S
Description Date Amount ELE 3 - 243C
[ELPRMT] ELC Permit 3/24/2005 $80.30
[TAX] 8% State Surcharge 3/24/2005 $6.42 REQUIRED ITEMS AND REPORTS
Total $86.72
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- 0- 332 -2344.
Issued By: Permittee Signature: eryi
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: Charlyni To: City of Tigard Date: 3/23/2005 Time: 2:03:40 PM Page 2 of 4
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Electrical Perntiptettle 4 i v ED ,,,,,, 1 i,,1 r i, l. „\,,
City of Tigard : 65 ; '' Pen°u No G__ - 05" 1 77 oat
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review .
Phone: 503.639.4171 Fax 503.59 �t� 2 3 2005 '' A ,, I, ` Dat : • Other Perm
Inspection Line: 503.639.4175 „.. ' i' Date Ready/By: MI NJ See Page 2 for
Internet: www.ci,tigard.or.us Notified/Method: Supplemental Information
•a,l ,,, �, � (,Y u - , f. ,,
El New construction • 1r 1. r' 7( .. 1 ' fix nf ' ,t Please check all that apply:
El Demolition El Other: ❑Serra over 225 amps, comm'I ['Hazardous location
u „ k }� �i� o r i� , r _ fir Fit .
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
; ,C ,ai , .,� -- , . :,- _i i .. .r,1 of 1- and 2-family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ® Coaunercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi - fancily ❑ Master builder ❑Other: ['Building over three stories [Weeders, 400 amps or more
['occupant load over 99 persons ['Manufactured structures or
3. '`�,a :.il 4::`' - ' , :� r , . . i- . , , i,, . ;.; . , , 'i,., <?ii ❑Egress/lighung Plan RV park
Job no.: Job site address: 16290 SW 72nd _ Q 7 :Wealth-care facility ❑Other:
Submit ., sets of plans with any of the above.
ity/State/ ' : • o and, • - • 4 1O D The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: Tufcoat <% - _ F . ' .., , . :
' ' .... ; ` . . .
....... .. :.
Description Qty. Fm 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
V
Subdivision: Lot no.: Ea. addi 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map/parcel no Limited energy, non-residential 75.00 2
Ili it nu. l j�i , . q } , ' , - s :
.: ,. tx
,..« G ' c „ r .. ;..: ..• , e., . ts:,1�..: 1..: v •,:.. �, ._ .u i -- ... , a., � ,t ... ...._ : _ • : :.: Each manufactured or modular
Work on service dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 80.30 80.30 2
E1.1' a +F r ' ' ,, i )i y �"� , .+.1'" i :T 201 amps 10400 amps 106.85 ' 2
> .1(,'..` _.. .. 11' ',1-:, .., -,,� , w,, ' ' --- - . - :=1:4.r. , -i 401 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 2 2000 0 eatlon
amps or Is 1 66.85 1 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 stops to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
° • .r- c; : '` '' ,lids', r z ` c 3i i A. Fee for branch circuits with
service or fader fee, each 6.65 2
Business name: Johansen Electric Inc. branch circuit
B. Foe 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 add'I 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 S ign or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: johansenelectamsn.com Signal circuit(s) or limited-
M a. '` - '::11? F 5 �
t � ,:. . .... _. � , , � ... f : ....._. retron of
_ t1,. . .i: ' energy Pane re
exteusioa. Describe: 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 (I hr min) 62.50
Phone: 503) 698 -3417 Fax: (503) 698 -2486 industrial plant per hour 73.75
CCB Lic.: 51539 Electrical Lic.: 3 -243C Suprv. Lie.: 20533 Subtotal 80.30
Suprv. Electrician signature, required: / / Plan review (25% of permit fee)
- _ 4..
Printname: Carl K. Johansen / Dace: 3/23/05 State surcharge (8 %of permit fee) 6.42
TOTAL PERMIT FEE 86.72
Authorized signature: L 1 . ffjtljIIIIIIIIIIIIIIIIMI This permit appdatfon expires if a permit Is not obtained within 180
flays after it ltas been accepted as complete
Print name: Charlynn J. Leifs Date: 3/23/05 • Fee methodology set byTri -County Building Industry ServioeBoard
•• Number of inspections per permit allowed.
istaeihasstPamiu \ELC- PermitApp 12/03 4104613T(10/02TCOM/WEB
CITY OF TIGARD : •
BUILDING DIVISION PERMIT #: ELC2005-00177
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 3/2412005
Phone: (503) 639 -4171 ii! 1,i,
-_
Inspection Requests (24 Hrs.): (503) 639 -4175 ' `-_
INSPECTION WORKSHEET FOR DATE: 3/25/2005 TIME: 7:07AM PAGE: 98
v�O 63
SITE ADDRESS: 6280 -SW 72ND AVE B:t CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK I LOT #: 018 TYPE OF USE:
PROJECT NAME: TUFCOAT
DESCRIPTION: Work on 200amp service.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: JOHANSEN ELECTRIC INC PHONE #: 503 -698 -3417
Inspection Request Scheduled For: Date: 3/25/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
115 Electrical service/reconnect 002825 -01 503- 969.5262 N
Corrections /Comments /Instructions:
XPASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: SL D Date: 3 _2 ` USA Phone #: (503) 718 -