Permit ELECTRICAL PERMIT -
CITY OF TIGARD
RESTRICTED ENERGY
1 I; DEVELOPMENT SERVICES PERMIT #: ELR2003 -00227
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/29/03
SITE ADDRESS: 11765 SW PACIFIC HWY PARCEL: 1S136CC -00100
SUBDIVISION: ZONING: C -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: JOB NO. 8248 Tenant Improvement, audio system and data telecommunication
A. RESIDENTIAL B. COMMERCIAL
• AUDIO & STEREO: AUDIO & STEREO: X INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 2
Owner: Contractor:
WORLDWIDE REAL ESTATE JOHANSEN ELECTRIC INC
GENERAL MOTORS CORP. 10948 SE VALLEY VIEW TERR
DETROIT, MI 48202 CLACKAMAS, OR 97015 -000
Phone: Phone: 503 698 - 3417
Reg #: v LT- 698011896
LIC 51539
SUP 2053S
FEES ELE Deed Inspections
Description Date Amount Ceiling Cover
[ELPRMT] ELR Permit 7/29/03 $150.00 Wall Cover
Elect'I Final
[TAX] 8% State Tax 7/29/03 $12.00
Total $162.00
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 throuc
Issued by Permittee 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 7:00 P.M. for an inspection needed the next business day
P From: Charlynn J. Leifsen To: City of Tigard Date: 7/29/2003 lime: 9:37:26 AM Page 2 of 3
t
%
Electrical Permit Application
Date received: -
�,� ► City of Tigard RECEIVED Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: B Receipt no.:
Phone: (503) 639 -4171 JUL 2 9 2003
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: CITY OF TIGARD
0 1 & 2 family dwelling or accessory lB Commercial/industrial ❑ Multi - family O Tenant improvement
O New construction CI Addition/alteration/replacement 0 Other. O Partial
Job address: 11765 SW Pacific Hwy Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block 1 Subdivision:
Project name: Old GM Building I Description and location of work on premises: Tenant Improvement
Estimated date of completion/inspection:
IO \Ii1 \( I/)I( \l'I'I \1ll)\ II I S( WWI I_I
Job no: 8248 Fee Iran
Business name: Johansen Electric Inc. Description Qty. (ra.) Total no.Iup
Newreslie tial- decker • ns y1er
Address: 10948 SE Valley View Terr. dwdlIngewIt.ladodesatembed garage.
City: Clackamas I State: OR I ZIP: 97015 ser kelndudei:
Phone: 503 - 698 -3417 I Fax: 503-698-24661E-mail: Johansenelect @aol.cor 1000 sq. R or Less 4
CCB no.: 51539 I Elec. bus. lic. no: 3 -243C Each additional 500 sq. R to potion thereof
_ Limited energy. residential 2
M 4896 • Limited energy, non-residential 2
7/29/03 each manufactured home or modular dwelling ,
Signature of 'sing electrician (inquired) Date Service andlor feeder 2
Sup. elect name (print): Carl K. Johansen License no: 2053S Servleesor feeders — Iaslasadeo,
alteration or relocation:
200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: 1 E -mail: Beco t only 1
Owner installation: The installation is being made on property I own Temporary porker or feeders -
which is not intended for sale, lease, rent, or exchange according to lastallatioa, aursatlon , orrdoeatien
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
• Owner's signature: Date: 401 to 600 t, • s 2
I \l, l \ 1 1. 11 Branch elenits- new, alteration,
or oxteadoa per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch ei Olin without purchase
Phone: Fax E -mail' of service or feeder fee, first branch circuit 2
Each additional branch circuit:
PI \ \ I l l ' i l l 11 I I'It•a'r c lit•i•l, all mbar app): ) blase. (Service or feeder mot Mauled):
0 Service over 225 amps-commercial 0 Health-case faviity Filch pump or irrigation circle 2
0 Service over 320 amps- rating of 1&2 U Ha:urdons location Fach sign or outline lighting 2
family dwellings 0 Building over 10,000 square fed four cr Signal circtdt(s) or a limited energy panel.
0 System over 600 volts nominal more residential units in one e clue alteration, or extension* 2 75 150
ir 2
U Building over dime stories 0 Feeders, 400 amps or mare ,,Description: Audio System, Data Telecommunication Installation
0 Occupant load over 99 persons U Manuectmed structures or (tV park Each additional Inspection over tie allowable In any order above:
0 Egress/lighting Plan U Other: L I I 1
Per inspection
Sabtmlt _ sets of plans with any of Hue above. lnvestigati® fee
The above are mot applicable to temporary coortroctioa aenice. Other
Nok an jurisdictions accept credit cards, pea m
se call jurisdiction for ire information. Notice: This permit application Permit fee $ 150.00
n
u visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $
Creab cant number: _ / / within 180 days after it has been State surcharge (8 %) $ 12.00
Expires TOTAL $ 162.00
accepted as complete.
Name of cardholder as shown on credit card
S
Cardholder signature Amount 440.4613 (6/00/COM)
i
CITY OF TIGARD 24 -Hour
BUILDING 4. Inspection Line: (503) 9 -4175 MST • • A
INSPECTION DIVISION Business Line: (5 4171
BUP
Received Date Re uested F - 2 AM PM BUP
1 7t 5
Location 1 Suite MEC
Contact Person 9Ati_e_a Ph ( ) '7 ? S7 1 7 PLM
Contractor Ph ( ) SWR 3 BUILDING Tenant/Owner ELC 3 '" 00 3 S-
Footing
Foundation ELC
Access:
Ftg Drain ELR 3 - Dv a a 7
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation ()
Drywall Nailing � r �l�cyliC
Firewall S SP 0 -1/0}1 /
Fire Sprinkler V
Fire Alarm Pb in E L---
, Susp'd Ceiling
Roof
Other:
Final l(`o 4 Cr,21 /y, r a / Cc
PASS PART FAIL //
PLUMBING C t �� !�� '✓e)-
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain �' c
Shower Pan ` P
Other: /‘,2
Final Ait
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In s
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
- - UG/Slab
Low Voltage
Fire Alarm
PART FAIL
111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Please call for reinspection RE: El Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date ?^ #1 t$'t' O3., Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL