Permit G: I CITY OF T I GA^ K D ELECTRICAL PERMIT
r • V PERMIT #: ELC2004 -00503
p SERVICES DATE ISSUED: 8/11/2004
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S113AB
SITE ADDRESS: 07358 SW DURHAM RD BLDG G
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING. I -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: (7) 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: 6 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 8/11/2004 $86.75
[TAX] 8% State Surcharge 8/11/2004 $6.94 Rough -in
Elect'I Final
Total $93.69
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 -33 -2344.
Issued By: Permit Signature: C717
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: a053
Call 639 -4175 by 7:00pm for an inspection the next business day
From: Charlynn J. Leifsen To: City of Tigard Date: 8/10/2004 Time: 4:28:26 PM Page 2 of 4
Electrical Permit Application 1.1)12 OUT I( I 1 Se. tl \I.1
City of Tigard Received // 0V t3.13 Permit No.: A - b
13125 SW Hall Blvd., Tigard, OR 97? s r e Date/B : ►
Phone: 503.639.4171 Fax: 503.59 :. L •
CEIVE E I V 11 : � °' r, „ 1 ` D &C/B e Oth P
Inspection Line: 503.639.4175 . 1 F 1 D ate Ready/By: WE ® See Page 2 for
Internet: www.ci.tigard.or.us AUG 10 I I Notified/Method: SoppkmeotalInformation
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❑ New construction ® M `fn/Iilln itgrayplacement Please check all that apply:
❑ Demolition [DING DIVISION ['Service over 225 amps, comm'1 [(Hazardous location
1 ot2+ 11 +f x 3 v , ❑Service over 320 amps - rating DBuildng over 10,000 sq. ft.,
iii ,,. , -...: , 1,rilx ; 4i a , ;,,.. < -<- „ z,.,, , ill � of 1- and 2- family dwellings 4 or more new residential
El 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
El Multi - family ❑Master builder ['Other: ['Building over three stories ❑Feeders, 400 amps or more
t 1 � } rrs ; „ y ❑Occupant load over 99 persons Manufactured structures or
r: -� . 't (S *% b s t'i rn...rsr.; ss.., ., 5 ` �` J.i RV
t Job site
s t Job no.: 8501 ,,�y ,.... 'i �,?s. t �+ +,a. ,. �. .M.�. ��. . � ' �f 1 €, ❑ Eg ress l i gh t ing plan park
P
address: 7358 SW Durham Rd. ❑Health -care facility ['Other:
Submit X 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: Coram yfit,,s� ,i ``' - ._.. a t n U {_ter i, f. ' is
a "�F.'� ,Y�,� ,, - :Q...bf 1 .�'u93 bfi+2a,iiu�J ]�`1 .Est. uE k :
Description Qty. F. 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
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: y , Limited energy, non - residential 75.00 2
t ^3. I ! s if °2t ti `si. 3 � ;, s ' f. s un # X N ills J st ' t 1 3 • '.,. t9 I
>. :_�%.,,` Paz.,. �... �-., ��, Ait�ztt.,tr„r,,s;. :. .: �., s.. . :�:�,��ft,rssa,i :: ..: 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 80.30 2
aa2: , 4 n „qtr r su •� : �rt. , i utr r ? ti 1 201 amps to 400 amps 106.85 2
a _,F. , III E +t :t ' ,ni :: - U x J, �;...y.z .. :.r ,.r r vi21 :i!i,,. ;.,itf,s.... } t. r ...., . --- 7 t 1 � P P
rq , ..6. Ittt . ... ft....; 3.,3tw.F, .. �'�.�,is: � 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 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 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
..
, tv , a , O�`� � l s z � � ii1� "��' a ! tt � � i 512[8 ��, ' +li -
;411 i 4,
a s , _:3 a! " <y l�i'( � A, Fee for branch circuits with t k -; s. , ,,. ... .. _ ,. ._..7i, wi ;i[taa gi � n. . .., a..i . ra' „ro „, W;.. ,,. ,! 6: ;11 service or feeder fee, each
Business name: Johansen Electric Inc. branch circuit 6.65 2
Contact name: Charlynn Le ifsen B. without out service circuits f
without service or feeder fee, 1 46.85 46.8 5 2
Address: 10948 SE Valley View Terr. each branch circuit
Each add'I branch circuit 6 6.65 39.90 2
City /State /ZIP: Clackamas, OR 97015 Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( 503 ) 698 - 3417 Fax: : ( 503 ) 698 - 2486 Sign or outline lighting 53.40 2
E -mail: IohansenelectQmsn.com Signal circuit(s) or limited -
� E -x "V 'a Is iF -t •' f,' - R a`t. rz' ._.,k� "+pSl -t i energy panel, alteration, or
.'1 lfa7� :.! k r , t t, .;,, r' . > ,:,.E iF re. l.l...: ,s `3. "�v extension. 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
R l t31C,i£St:,L...._5>±, 5 { t: I z a # s r f,. lA '. z`.'t
CCB Lie.: 51539 Electrical Lic.: 3 -243C Suprv. Lic.: 2053S Subtotal 86.75
Suprv. Electrician signature, required: / e Plan review (25% of permit fee)
/ . . A . OA A..... .... L 4 �.
Print name: Carl K. Johansen / Date: 8/10/04 State surcharge (8% of permit fee) 6.94
TOTAL PERMIT FEE 93.69
Authorized signature: • a , `a This permit application expires if a permit is not obtained within 180
Print name: Charlynn J. Leifse, days after it has been accepted u complete
Date: 8/1 0/04 a Fee methodology set byTri -County Building industry service Board
•• Number of inspections per permit allowed.
i; 1auilding1Permiu \ELC- PermitApp.doe 12/03 440- 4615T(10N2/COM/WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: 503) b39 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
,/ BUP
Received Date Requested. /6 — " / AM PM BUP
Location 7 3 — Suite MEC
Contact Person J Ph ( ) oZ 2 3 c l 17 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner
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
Fi rewal I
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 °/1
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
Fire Alarm
uF�f►
AS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line 7/4
ADA
Approach/Sidewalk Date Inspector
Other:
Final DO NOT REMOVE this inspection record fr the Job site.
PASS PART FAIL