Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00222
DEVELOPMENT SERVICES DATE ISSUED: 4/18/03
r � I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 2 S 112 DA -00800
SITE ADDRESS: 15055 SW SEQUOIA PKWY 120
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
BLOCK: LOT : JURISDICTION: TIG •
Project Description: Relocate (1) 200amp service.
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: 1 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
PACIFIC REALTY ASSOCIATES JOHANSEN ELECTRIC INC
15350 SW SEQUOIA PKWY #300 -WMI 10948 SE VALLEY VIEW TERRACE
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 4/18/03 $80.30
[TAX] 8% State Tax 4/18/03 $6.42 Elect'I Service
Elect'l Final
Total $86.72
This Permit is issued subject to the regulations contained in the Tigard Munidpal 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 -80e • 2 -23 4. .
Issued By: /A j j _) • IL Permit Signature: L 1 + (IL.G-,
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: c:=Z 5 3 S
. Call 639 -4175 by 7:00pm for an inspection the next business day
From: Charlynn J. Leifsen To: City of Tigard Date: 4/14/2003 lime: 2:50:20 PM Page 2 of 3
4n�r ti
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4•
y Electrical Permit Application 1 11 1 1( f 1 1 s )\1 )
Date received - , -0 308 Permit no.: # Q3 —D U io
, 4. - 1_ City of Tiger I Pmject/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blv gagd, [ j (IJ Ql;„Qdi23 Date issued: By:. /6 Receipt no.:
Phone: (503) 639 -4171 Nor'' jj
Fax: (503) 598 -1960 Case file no.: Payment type: .
CITY OF TIGARD .
Land use approval: PUILn1NG•DIVISION
I1I'1 OI 19II\I11
O 1 & 2 family dwelling or accessory 10 Commercial/industrial Cl Multi - family 0 Tenant improvement
O New construction OAddition/alteration/replacement Cl Other. Cl Partial /
.toll -I I 1 I \ h (*(\l \ I I
Job address: 15055 SW Sequoia Pwky Bldg. no.: Suite no.: 120 Tax map /tax lot/account no.:
Lot: Block: 'Subdivision:
Project name: 5 F._, 1 35 I Description and location of work on premises: Relocate Service
Estimated date o completion/inspection: 04/16
4 U\ I le \( I UI2 \I'I'11( 1 I IU\ iii ..( 111. 1)1 i.i
Job no: 8176 Fee Max
Business name: Johansen Electric Inc. Dsaiptloa Qty. (ea.) Total ao.Iasp
New reshicatial-sktgk or moiti-thmily per
Address: 10948 SE Valley View Terr. t�
_ City: Clackamas. !State: OR I ZIP: 97015 Ser.kel.Aaeed:
Phone: 503 -698 -3417 I Fax: 503- 698 -24861 E -mail: Johansenelect @aol.com 1000 s0.. R or l ess 4
Cal 51539 , 1 Elec. bus. lic. no: 3-243C Each additional 500 sq. a at portion thereof
limited ma reside°tial 2
• /me kno.: 4896 energy. Limited gy, non - residential 2
04/14/03 Each manufactured home or modular dwelling
Sigetateue of ising electrician (required) Date Service and/or feeder i 2
Sup. elect. name (print): Carl K. Johansen License no: 2053S Services or feeders —installation,
1' It (11't It I 1 0%% NI . it alteratlonorrtloratloa 1 80.30 80.30
200 amps or less 2
-
Name (print): a L 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 2
amps to 1000 amps
City: I State: I ZIP: over 1000 amps or volts 2 '
Phone: I Fax: I E -mail: Reconnect only I
Owner installation: The installation is being made on property I own Temper ryserviceaorfeederr
which is not intended for sale, lease, rent, or exchange according to imfatlatloa,akeratbn,orrdontlon
ORS 447, 455, 479, 670, 701. 200 amps or tors 2
201 amps to 400 amps 2
Owner's signature: • Date: 401 to 600 ,, .s 2
I \(. 1 \ t I . It Branch deadly - new, alleratloa,
. or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee. each branch circuit 2
City: 1 State: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax E service or feeder fee. fiat branch circuit: 2
Each additional branch circuit:
1'1 \ \ It I ■ 11. (I'I &:i.c lick ail I li:u :brill') Misr- (Serttmor feeder sot ineladed):
O Service over 225 amps-commercial 0 Health-cam facility tiach pump or imaatiOn circle 2
0 Service over 320 amps-rating of I&.2 U Hazardous location Hach sign or outline lighting _ 2
family dwellings 0 Building over 10.000 square fed four or Signal citcuit(s) or a limited =an panel.
0 System over 600 volts nominal mom residential units in one structure altuMioq or extension* 2
0 Building over three stories 0 Feeders, 400 amps or more *Description:
0 Occupant load over 99 persons U Manufactured muctures or 1tV part Each additional inspection over the allowable In any older above:
0 Egromfighting plan U Other: Per mspeetiou L I I I
Submit sets of plane with any of the above. investigation fee
The above are Not applicable to temporary construction serelee. Other
Not an jurisdictions accept credit cards please call jurisdiction for more information. Notice: This permit application Permit fee $ 80.30
U visa O MasterCard expires if a permit is not obtained Plan review (at _ %) S
Credit card number: / / within 180 days tier it ha, been State surcharge (8 %) S 6.42
Expires TOTAL S 86.72
accepted as complete.
• Name of cardholder as shown on credii card
' S
Cardiolder signature Amount 4104615 (6/00/COM)
•
CITY OF TIGARD 24 -Hour •
Inspection Line: (503) 639 -4175
BUILDING MST -
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Received Date Re uested I Z AM PM BUP
Location / Sb Lc(S 4 Suite dad MEC
Contact Person C4-11.1 Ph ( ) 71) ' / q PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 3 - 00 a• Z,
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation r;� Y/e Drywall Nailing \/ rJ �� J J j f(�j c ( 1j / 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
EL ICAL
rvice
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: , ;ice Unable to inspect — no access
Fire Supply Line
Approach/Sidewalk Date • ° Inspector 1 t 4 " I ` 1 �� Oct
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
Inspection Line: 639 -4175 %h. ;, BUILDING 503 - ° P ( ) MST
INSPECTION DIVISION Business Line: (503) 639 - 4171
BUP
Received Date Requ:` ted L _ 1 1 AM PM BUP
Location /.c13 SS !�-�� ' Suite L2_ � 2. 0 MEC
Contact Person eeti 9 ' Ph ( ) 6 f- S.P(a o2 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner - ELC
Footing ELC 3 — b a o2 a`
Foundation 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 (j (-
Post & Beam
Under Slab
Rough -In i7C1
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam •s
Rough -In
Gas Line ■,
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
ery
Rough -In
UG/Slab
Low Voltage
Fire Alar
,,Firral
El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
ASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
, d / / r
Approach/Sidewalk Date Inspe or 4 . Ext
Other:
Final DO NOT REMOVE this Inspection r : ord fro e job site.
PASS PART FAIL