Permit '
CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00390
;.i DEVELOPMENT SERVICES DATE ISSUED: 6/8/2005
-='1'` � , 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2 S 113AD -01800
SITE ADDRESS: 16798 SW 72ND AVE B14 ZONING: I -L
SUBDIVISION: OREGON BUSINESS PARK I LOT : 011 JURISDICTION: TIG
Project Description: (12) 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: 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: 11 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: 503 - 624 - 6300 Phone: 503 - 698 - 3417
FEES Reg #: LIC 51539
2053S
Description Date Amount SUP 3-243
ELE 3 -243C
[ELPRMT] ELC Permit 6/8/2005 $120.00
[TAX] 8% State Surcharge 6/8/2005 $9.60 REQUIRED ITEMS AND REPORTS
Total $129.60
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: A
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 J. Leifsen To: City of Tigard Date: 6/7/2005 Time: 2:01:00 PM Page 2 of 4
RECEIVED
Electr Permit Applies on i e > ' ()I 1 1 ( i 1 r. t) \ I. N
City of Tigard JUN 0 7 2005 , 0 -9-6Z Petrel No.. (.G_ ao 00 AD Rec
13125 SW Hall Blvd., Tigard, OR 9722 Plan Review
Phone: 503.639.4171 Fax: 503.598. Y OF TI G A R D �' f , ,. "' I I °ffi : Other Permit:
IV101 •
Inspection Line: 503.639.4175 BUILDING '.- _. �eReady/By: 65 See Page 2 for
Internet: www.ci.tigard.or.us ' Notified/Method: Supplemental Information
� rF � Z .4,1,),,,'..:1',N,,,,,- E ' ' J - .� --;:i-1:',...: ,� � , -':0',..s..., 5 _
';x -,•'-'' f 3 4 .::... . .. , . . : _ x_. ... �. , k-,� •
❑ New construction Addition/alteration/replacement lacement Please check all that apply:
❑ Demolition ❑ Other Service over 225 amps, comm 'l Hazardous location
❑Sem amp s ce over 320 rating ❑ Buildng over 10,000 sq. R,
)11 ' «
�. . _ _ "y.
t i., _ , r ' - , ,cli '.W' of 1- 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
El Muni family ❑Master builder 111 Other: ❑Building over three stories [Weeders, 400 amps or more
:Occupant load ova 99 persons ❑Manufactured structures or
'tor, 4 .• ..;: -.! l,. ,i. = . :, ., r .v . _ ,. ` $ . T i s ,- . . It ❑ Egress / hghting plan RV park
Job no.: Job site address: 16798 SW 72nd ❑Health -care facility ❑other:
Submit 2 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: Cooksen y. Fee. Total ? . ot f'.'".%;.:
Drs crlptl•o Qty. • •
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. R or less 145.15 4
Subdivision: Lot no.: Ea. adds 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 2
Tax
map/parcel no.: ( Limited energy, non - residential 75.00 2
t , /i,' , .. i∎..,nrc... . 4 [.r " / + _ � . � }i1C '1;1 ; ' . . . - : :,,..; : Each manufacturedor!nodular
Tenant improvement dwelling service and/or feeder 90.90 2 ,
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 t 2
n;. �� 'iii , } ,« 1 „ 201 amps to 400 amps 106.85 2
f 1t ' � -
. �,._ �, r - - . _ . sot 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 relocatlon
200 amps or lest 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 1 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
-� t r- , E �t;`iA } {, 1 T ,yam' A. Fee for branch circuits with
,::`,''''',.. _ . . - . - '2.'" . li . _ ,�u , service or feeder fee, each
6.65 2
Business name: Johansen Electric Inc. branch circuit
B. Fee for branch circuits
Contact name: Charlynn Leifsen without service or feeder fee,
each branch circuit 1 46.85 46.85 2
Address: 10948 SE Valley View Terr. Each add'I branch circuit 11 6.65 73.15 2
City/State/ZIP: Clackamas, OR 97015 Miscellaneous (service or feeder not included)
Pump or irrigation li g circle 53.40 2
Phone: ( 503 ) 698 - 3417 Fax: : ( 503 ) 698 - 2486
Sign or outline lighting 53.40 2
E -mail: lohansenelectamsn.com Signal circuits) or Iimited-
r , , ,i t� ? , � /. Nil !. b ill_ .. F ... ,- it .1.... ` ; energy panel, alteration. or
extension. lkscribe: 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 (1br min) 62.50
Industrial plant per bout 73.75
Phone: (503) 698 -3417 Fax: (503) 698 -7486 ; ,., r i 7V -- t
CCB Lic.: 51539 Electrical Lic.: 3 -243C Suprv. Lic.: 2053S Subtotal 1 20 .00
Suprv. Electrician signature, required: / / / Plan review (25% of permit fee)
Print name: Carl K. Johansen / Date: 6/7/05 State surcharge (8% of permit fee) 9.60
TOTAL PERMIT FEE 129.60
Authorized signature: �• Thb p ermit application expires if a permit is not obtained within 180
days after it has been accepted as complete name: Charlynn J. Leifse Date: 6/7/05 • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ 9uitdine Pamits\EL.c- FermitApp.doe 12/03 440-4615rp0/02/c0MVWEe
4 iii w_ OFTIGARD ;
U ILDING DIVISION PERMIT #: ELC2005 -00390
13125 SW Hall Blvd., Tigard, OR 97223 • DATE ISSUED: 6/8/2006
Phone: (503) 639 -4171 ,140141# I
Inspection Requests (24 Hrs.): (503) 639 -4175 :% ' 1 .. :_
INSPECTION WORKSHEET FOR DATE: 7/13/2005 TIME: 7:10AM PAGE: 64
SITE ADDRESS: 16798 SW 72ND AVE B14
SUBDIVISION: OREGON BUSINESS PARK I
PROJECT NAME: COOKSON 5--- b O / I 0 O 7 DESCRIPTION: (12) branch circuits.
OWNER: PACIFIC REALTY ASSOCIATES, •6300
CONTRACTOR: JOHANSEN ELECTRIC INC
i 1,c , 7 3417
Inspection Request Scheduled For: Date: 7/
Code # Inspection Description # e( /
199 Electrical final I711311 -01
Corrections /Comments /Instructions: .�U l u\4-" .
leuc.NftviA, ®72 r/f
A PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
■
Inspector: 1168LE Date: 1 7 l 3 6 Phone #: (503) 718- 2,1111
" ItY OF TIGAR®
BUILDING DIVISION PERMIT #: ELC2005-00390
13125 SW Hall Blvd., Tigard, OR 97223 - DATE ISSUED: 6/8/2005
u'
Phone: (503) 639 -4171 ` 1\
Inspection Requests (24 Hrs.): (503) 639 -4175 'I I� `.
INSPECTION WORKSHEET FOR DATE: 7/11/2005 TIME: 7:07AM PAGE: 79
SITE ADDRESS: 16798 SW 72ND AVE B14 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK I LOT #: 011 TYPE OF USE:
PROJECT NAME: COOKSON
DESCRIPTION: (12) branch circuits.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503 -624 -6300
CONTRACTOR: JOHANSEN ELECTRIC INC PHONE #: 503 - 698.3417
Inspection Request Scheduled For: Date: 7/11/2005 Pour Time:
Code # Inspection Description • • • # Contact # Message
130 Ceiling cover 011120-01 503 - 969 -5263 Y
Corrections /Comments /Instructions:
P
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: GAR6. N 0 e LA---- i Date: 1 7 1 10 Phone #: (503) 718-
CITY OF TIGA►R® �_.
BUILDING DIVISION PERMIT #: ELC2005.00390
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8120055
Phone: (503) 639 -4171 Pfil . Ins pection Requests (24 Hrs.): (503) 639 -4175 ._
INSPECTION WORKSHEET FOR DATE: 6/23/2005 TIME: 7:10AM PAGE: 84
SITE ADDRESS: 16798 SW 72ND AVE B14 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK I LOT #: 011 TYPE OF USE:
PROJECT. NAME: COOKSON
DESCRIPTION: (12) branch circuits.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503- 624 -6300
CONTRACTOR: JOHANSEN ELECTRIC INC PHONE #: 503 -698 -3417
Inspection Request Scheduled For: Date: 6/23/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
125 Wall cover 009941 -01 503 -969 -5263 N
Corrections/Comments/Instructions: G
v
P .�
=°U PASS ►;'/ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
../
Inspector: Afiti r c,- Date: 6-,-2-i- (. Phone #: (503) 718-