Permit CITY OF TIGARD . ELECTRICAL PERMIT
PERMIT #: ELC2004 -00218
DEVELOPMENT SERVICES DATE ISSUED: 4/29/04
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 2S113AB-01201
SITE ADDRESS: 16505 SW 72ND AVE BLDG F 16505 -16535
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING. I -L
BLOCK: LOT : JURISDICTION: TIG
Project Description: Job No. 8607 Tenant Improvement
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: SIGNALJPANEL:
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: 3 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 4/29/04 $66.80
[TAX] 8% State Surcharge 4/29/04 $5.34 Elect'I Service
Rough -in
Total $72.14 Elect'I Final
This Permit is issued subjed 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:
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: 4/28/2004 Time: 12:03:16 PM Page 2 of 3
• -.. .
Electrical Permit . it Application Rece,iiiid"".. - Elerliie41 .. , A ... . .. . -...... ...,) ..; ..
, : , . Date/By: . . : : .. •.. • : ::
Ci PertnitNO4F21,..e200q,-,90 e*” v. '
' ' _ _, , _, , ,,
, - Planning Approval
Date/By: Sign
ty of l igard , ,
'
. Permit No.:
, \--
13125 SW Hall Blvd. --- :.-_- 7 . Plan Review Other ---
„,..
Tigard, Oregon 97223
„, - Date/By: .. No.664.12:400q k'
Pne: ho 503-639-4171 Fax: 503-598-1960 ‘ - . timtIiieiof .
" Land cite
• 5tY=P16,,1'''' Date /By: Case No :
Internet: www.ci.tigard.or us -. .--. • ' 13 1 7- 4
...r.414w- t%....-- Contact Am
is.:- • 1.21: See Page 2 for . !
24-hour Inspection Request: 503, " y . Name/Method: _ Supplemental Information.
..:: • ',,I,„ ,
• -
. ••
: :. : ;,7 : ',:.:,'::::; 7 .:,; , ::!77:1 . .. 4 !.: : :0:';:;7.;:!:';;MY.000 AW..1211(104:;i1....:4:.:;W:::::',R*QiiFFM:0, L„:44,V.44;i:!4;.;;:g101.n:VIVA . .......,:terai r .04 11 •ItUarPl!kY :: : : ::il
• New construction III Demolition 0 Service over amps- -11j1 Health-atre facility:
commercial 0 Hazardous location
ei Additiorialterationfr ilacement • Other: 0 Service over anips-rating of 0 Building over 10,000 SqUilre feet,
77 :771' . 4tkcp . v.0: .vs1a4MIT--.: tocnvwg:t..1 1 & 2 family dwellings four or more residential ants in
Ej 1 & 2-Family dwelling El Commercial/Industrial El System over 600 volts nominal 4 structure
t, 0 Building over tame stories 0 Feeders., 400 amps or more
1
1 Accessory Building • Multi-Family El Ocermant load over 99 persons 0 Manufactured structures or RV part
LI II_Master Builder • Other: 0 Egess/lightMg plan • - • • . • 0 Other •• • ...„,,,,:.. , . .
..•roto.1..._:,74iiiii0500XTR`i .-:',4P'',:';L.,4:0;',- submit 5cI9 of plans with any of the above.
The above are not applicable to teniporarv.eonstruction service.
,1:)b site address: 16505 SW 72nd .. . ... L7 7W-4.V0.1.44.',IgiriL-Wi 7LMFt.;.:.:::::::::$:::,.,a:..5,:;.:.,:7:1
.. B ldg ... ... ._. ..
7 ./Apt.#: Number oflaspeclians per.permit allovved
r-Fro.ect N Flir 1: ,,,.. iptio , . Qty fee (ez.) l'Ot.4 1 1
__ New residential-single or toulti-fandly per
Cross street/Directions to job site: dwelling unit Includes attached garage,
v
Serke included:
•
, •
I1300 q. ft or less . • 145,15 • .. 4
Each additional 500 siLft.orportion thereof • • 33A0 • KU
Limited_emy. residential Nil 75.00
Subdivision: I Lot #: , Lim ited eheray, non resident/el
Tax ma . reel #: Each manufactured home or modular dwelling • .
Services ea feeders - Installatton, .
. . altera ilea or relocation; •
- • 80.30 •
_ •
Tenant Improvement 200 ampscr kss • • .. • • •• • • • • ••
• - —, amps to 400 amps 106.85 2
401 amps to 600 ampa = •• •• 16040 - , 2
---
Uo 1 .. .:,‘ e. a7..t..... ,R4OfFti;.§i0Mfairl0....P1 ,, , '.1 - .:,,t::4 601 int 1000 am 240.60 2
OM i000 amps or volts • • • • • - - 111111: :: .74 . 2
Name: . Reconnect only 66.85 2,
. . .
Address: Temporary services or feeders - installation, • • : • • . 1
alterolion, or relocation:
[ City/State/Zip: 200am or lesms 6635 1 i
Phone: I T ax: 201 amps to 400tunps 100.30
, ,,,,+,,,.. ...--- .. . .,... 401 to 600 amps 133.75 2
M VF,V1(kreiRTE: 7 ,3)' , .::•:4',4:P.F.,::,._:•:. : . ' .,/,5314V g &tutu- new, alteeallon, or
I Name: Johansen Electric Inc. , extension per panel: • . .
r----- _ A. fee fot branch circuits with purchase of •
Address: 10948 SE Valley View Terr. . screke or feeder fee, each branch circuit 6.65 2
..__
CitY/Stateili : Clackamas, OR 97015 , IL Fee Mr branch CIECUitS Witiltr4t purchaSe•Of • • - .
...... servfce or feeder fee, first branch circuit 1 46 135 46 2
Phone: 698-3417 Fax: (503) 698-2486 Each edditional branch circuit 3 . ,5,65 19.95 :I
1 E„ Johansenelect@aol.com Misc.(Serviee or feeder not includea
•
' - '''' - .77772.4..: - r;r . P 4 . ‘. t•I'V ' li ''',NEMIN.4. Each 13m1J) °T13,ati 4:ircte . . 53 40 2
' - ' . Each signor outhnellf,burtg 53.40 2
fob No: 8607 Signal eircult(s)or a limited energy panel,
alteration, or estension Pao 2 • 2
'. Business Mune: Johansen Electric Inc. Desc.i .
._... ........
Address: 10948 SE Valley View Terr. .... . . . .
FAC addidonal Inspection over the allowable in an 'alike above: - -
City/State/Zip: Clackamas, OR 97015 fer inspection ner hour Nat 1 hour) 62.5701 -
Phone: ( 698-3417 F ax: (503) 698-2486 Investigation fee, ,
—___.. Other. I
CCB L
Lic. #., 51539 ic. #: 3-243 .. . ..
,,, , r,,,,,+;,"7777,777" ... ■;,, , .1 . ,. ,. .7% . .;.,,, 7, .7.7.4. f'" , - 14.;,..o31: , : 1 ;le , : r.t -,--,r 1:
, - ----7---- , ,i- , •••" 0 .45; 4, 4-gh..'.......t.o . - ..P 0 ' - ' ' . " ' • . 4 ' f'' 4 —' - e . ', 'i ..i.q. , •.{"."'s
:7.1,uperfising electricia n : - : :..:: 1:::::::-.-: . . : :-.:•:.:: :-.... :- . ..,:: subtotal. .s.66.80 .
— i
signature require . . d: . Plan Review (25% of Pemlit Feel: $ . _ _ ___ • r
Print Name: Carl K. Johansen 1 Lic. #: 2053S State Surcharge (8% of Permit Fee) , S 5.34 .
......_.. —
.--- TOTAL PERMIT PEE ...$ 7-2.14 - .
i
Authorized i t ( / 4/28/04 Notice: This permitapplication ria•Pires•if a permit is not obtained 'villain
Signature: , < „ .,,,„C,,,, I A e: 180 days after itbas been accepted as complete-
/
•Fee methodology set by *Fri-County Building Industry Service Board.
Charlyn . . Leifs - n
--,-- -
(Please print mune) . . - -
• • •
iADstsTemat Fornis\EloPermitApp.doc 01103
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line' (503) 639 - 4171 MST
BUP
Received ' 31' 4 Date Requested � � AM PM BUP
Location � d S � /4) Suite MEC
Contact Person )V'Z Ph ( ) fk 9 3 Z PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner /Z . ELC O c2 D 0 ? / 2
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
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
i , El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SS PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line '� . ��
ADA � M Lt
Approach/Sidewalk Date � Inspector C Nog Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL