Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2008 -00465
COMMUNITY DEVELOPMENT DATE ISSUED: 8/11/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S112AB-02300
SITE ADDRESS: 14150 SW MILTON CT ZONING: I -L
SUBDIVISION: BONITA INDUSTRIAL PARK LOT : 005 JURISDICTION: TIG
PROJECT: NORTHWEST MEDICAL TEAMS
Project Description: Installing (1) branch circuit for indicator light.
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: 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:
SHEININ - MENDENHALL LLC I JOHANSEN ELECTRIC INC
BY PARROTT PARTNERHIP 10948 SE VALLEY VIEW TERR
12725 SW 66TH AVE #202 HAPPY VALLEY, OR 97086
PORTLAND, OR 97223
Phone: Contact #: PRI 503- 698 -3417
FAX 503 - 698 -2486
FEES
Description Date Amount Reg U: ELE 3 -243C
[ELPRMT] ELC Permit 8/11/2008 $46.85 LIC 51539
[TAX] 12% State Surchar 8/11/2008 $5.62 SUP 2053S
Total $52.47 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: se-e_ /
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.
•
Electrical Permit A E
City of Tigard Datrived .,4�
13125 SW Hall Blvd., Tigard O 9,7213 DatrJB .
111 _6 18 0 0 .few -
Phone: 503.639.4171 F 5 Other Permit:
t . 1 , ; +. ; ; Inspection Line: 503.639.4175 Date Ready/By: Page 2 for
Internet: www.tigard -ord ik , i s D NotifiedlMethod: Supplemental
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❑ New construction 02 Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w/iienn checked below):
0 Service or feeder 400 amps or more 0 Building over three atones.
❑ Demolition ❑Other.
where the available fault current 0 Marinas and boatyards.
' Y'fti�ra IM i a a•.�'la � a a •. t 43 13 fry ii I 1� �' K•�r., exceeds 10,000 am at 150 volts or 0 Floating buildings.
'i . +'� ,astii,rc�lwi, :b,64. id`m�c rir,eti . (. •- wJ
st� " , 1 1i1 less to ground. or exceeds 14.000 0 Commercial -use ag :mho:al
❑ I- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other. O Fire pump. 0lnsta0ationof KVAor
r a .i ,� , l i ,�4, 'v l 'Y.I Imo: �C��: {j lit) t t l ., :irl'!ip s l 4t , , ' .,,1 ' r . ■ . L i 1 0 Emergency system. larger separately derived system.
��v7 '�aZ:.10J,�LS ( �L II roBly d. 1 IrC10_{
,(,`{ i t cr' _: • :1 IauAr Nzt :?J�rriit�n'1 S ' �; . r "h��i.''. 0 Addition of new motor load of ❑ "A" "1: "1 -3"
Job no.: Job site address: 1415 0 se m i 1 t On C t 100HP or rents. oeeepency.
El Six or more residential units. 0 Beaeaximtal vehicle parks.
City / State/ZIP: (Q Heahh - care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: Medical Teams Int . l O , Sem fee
ce orda600ampsormore.
l
�I `' 1 4 ' IMO. " al j •TrEAT. 1 t I {!inrilRf,'4;.'l 4
Cross street/directions to job site: Abel /}y l �( Teel'''. naeriptloa •b Pre • Total •
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential
Ul6 'ri "'1 I F r. :w'sanv,va." "fu"t9�i yir� ;' ?MN 75.00 2
1' -s . a : . 11 l l:il' ZIME ` 1. L It tl .'h' . Vsir� (with above sq. ft)
Limited energy, multi- family 75.00 2
install indicator light residential (with above so. It) _
Services or feeders installation and/or relocation
�t`��I murxya�, , t 200 amps or less 80.30 2
tS Ili 'i': t 1 JI • -i u s ,�; 1:� ' l : ti r ti !'3 �, 1 ( I 1
.�i�a���1 ., ... ��ii ��rl. �1di�l�l1' ;+',�` 11�91�' � , ' i'::` 201 amps to 400 amps I06.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State/ZIP: Temporary services or feeders instaWtlon, alteration, and /or
• relocation
Phone: ( ) Fax: ( ) 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 I 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps I 133.75 2
Branch circuits - new, alteration, or extension, er panel
{ Owner signature: Date: A. Fee for branch circuits with
A':kia � �_ 1ral,• I�,eti'l i:A�a to Lltl ' ;j
.l t✓bll i.11d :�-.IS 1i 1 ig AI Eli : Ici,:` ::: �*° , , 'ht . i above service or feeder fee, 6.65 2
each branch circuit
Business name: Johansen Electric Inc. B. Fee for branch circuits
Contact name: Charlynn Leifsen without service or feeder fee. 46.85 2
first branch circuit I y V -
Address: 10948 SE Valley View Terrace Each add'I branch circuit 6.65 2
• Miscellaneous (service or feeder not included) _
City /State/ZIP: Happy Valley, OR 97086 Each manufactured or modular 90,90 2
dwelling, service and/or feeder
Phone: (503) 698 - 3417 I Fax: : (503) 698 - 2486 Reconnect only 66.85 2
E -mail: johansenelect@msn.com _ Pump or irrigation circle 53.40 2
1 '• I �$hs?! !1E i ' :1• t . �IQ�! .' y1 `l'4 u Ir ' (>il " l I } ii signor outline lighting 53.40 2
Business name: Johansen Electric Inc. Signal circuit(s) or limited
energy panel, alteration, or
Address: 10948 SE Valley View Terrace extension Describe: Page 2 2
City/State /1P: Happy Valley, OR 97086 Each additional Inspection over allowable in an of the above
Per inspection 62.50
Phone: (503) 698 -3417 Fax: (503) 698 -2486 Investigation per hour (1 he ruin) 62.50
CCB Lic.: 51539 I Electrical/ � Licc.: 3-243C I Suprv. Lic.: 20535 Industrial •lam • hour 73.75
\�.iV �v �Jr 1 i 'i "'.' Subtota ��T '.}dpi Mani
Li
Suprv. Electrician signature, required: l it i 1 I I 14 ' ; .w ' „ }:; t dtt 111�1`z�'ilitt�
Subtotal: J 6 • e
Print name: Carl K. Johansen 1 Date: 8/11/08 Plus' review (25% of permit fee):
1 State surcharge (12% of permit fee): SO.. •
Authorized signature:
K CL— TOTAL PERMIT FEE: SZ, e/ 7
Print name: Charlynn J. Leifsen 'Date: El/11/08 This permit appacation aspires if a permit is not obtained within 1110
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I msuitdiegwPerminu ELL- PaoohApp.doe 05 /21/06 440- 4615T(i 1/OS/COM/WEB
T - d Xki3 13C213Sd1 dH Wbb'S : 6 8002 I T 2n1=1
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2008 -00465
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/11/2000
Phone: (503) 639-4171 4 ' 1 el
Inspection Requests (24 Hrs.): (503) 639 -4175 r L. 1
INSPECTION WORKSHEET FOR DATE: 9/18/2008 TIME: 7:00AM PAGE: 14
SITE ADDRESS: 14150 SW MILTON CT CLASS OF WORK:
SUBDIVISION: BONITA INDUSTRIAL PARK LOT #: 005 TYPE OF USE:
PROJECT NAME: NORTHWEST MEDICAL TEAMS
DESCRIPTION: Installing (1) branch circuit for indicator light.
OWNER: SHEININ- MENDENHALL LLC I, PHONE #:
CONTRACTOR: JOHANSEN ELECTRIC INC PHONE #: 503-698-3417
Inspection Request Scheduled For: Date: 9/18/2008 Pour Time:
P q
Code # Inspection Description - • ' # Contact # Message
199 Electrical final 075626 -01 503 - 969.5262 N
%
Corrections /Comments /Instructions: ��
N\
QV
PAS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I L ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 6 'V 6 el L� Date: if Vitt ' Phone #: (503) 718- 'AIL