Permit A, CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00478
DEVELOPMENT SERVICES DATE ISSUED: 8/4/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S112DA-00300
SITE ADDRESS: 15230 SW SEQUOIA PKWY 190
SUBDIVISION: ZONING: I -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: JOB NO. 8279 Tenant Improvement
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: 2 W /SERVICE OR FEEDER: 20 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 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 8/4/03 $293.60
[TAX] 8% State Tax 8/4/03 $23.49 Ceiling Cover
Wall Cover
Total $317.09 Elect'I Final
•
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 obta copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1- 800 - 332 -2344.
Issued By: Permit Signature: 4A / _
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 7:00pm for an inspection the next business day
From: gitarlynn J. Leifsen To: City of Tigard Date: 7/31/2003 Time: 2:16:50 PM Page 2 of 3
(1
� 113 1 63
Electrical Permit A ' Lion 1 11 1 1(1 l •I , (/\I )
�r �` C Date rccci L Permit Ao 00 - ay lr:
. 1.,.. ` I
, i _� City of Tigard Project/appl. n•.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, �dgpt d,`�I� i 97651 Date issued: By: Receipt no.:
Phone: (503) 639 -4171 J�7�
Fax: (503) 598 -1960 CITY OF TIGARD Case file no.: Payment type:
Land use approval: RI Ill DING DIVISION
111'4 OF I'1.ItN111
' O 1 & 2 family dwelling or accessory, ® Commercial/industrial ❑ Multi - family O Tenant improvement
0 New construction OAddition/alteration/replacement ❑ Other: 0 Partial
Job address: 15230 SW Sequoia • ' Bldg. no.: Suite no.: 190 Tax map /tax lot/account no.:
Lot: 'Block: 'Subdivision:
Project name: West Marine jDescription and location of work on premises: Tenant Improvement •
Estimated date of completion/inspection:
( ()\ I I( 1( I (114 \1'1'1.1( 11 III\ I I '.( 11 F 1/1 1
Job no: 8279 Fee Max
Business name: Johansen Electric Inc. nnatption Qty. (ea.) Tow no.Iam
View Terr. blE1r residential -single 0, �� yper
Address: 10948 SE Valley dw aah,ladudesetsehedprase.
City: Clackamas I state: OR I ZIP: 97015 senieelaeltaded:
Phone: 503-698-3417 I Fax: 503-698-24861E-mail: Johansenelect @aol.com 1000 sq. fl. or less 4
• CCB no.: 51539 lElec. bus. lic. no: 3 -243C Each additional 500 sq. ft. er portion thereof
Limited energy, residential . , 2
e: 4896 - Limited energy, non-residential ' . 2
7/31/03 Each manufactured borne or modular dwelling
Signature of su icing electrician (required) Date Service and/or reader 2
Sup. elect. name (print): Carl K. Johansen License no: 2053S Sank" orfeeden— lastallatloo,
alteratloa or relocation:
200 amps or less 2 80.3C 160.60 2
201 amps to 400 amps 2
Name (print): 401 amps to 600 amps 2
Mailing address:
601 amps to 1000 amps 2
City: • I State: 1 ZIP: Over 1000 amps or volts 6 2
Phone: 1 Fax: 1E-mail: - Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to Imtsmatioa,aHeraUotyorrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
1 \(,I \F I. It Branch circuit. - new, alteration,
or extension per panel:
Name: A. Fee fee branch circuits with purchase of
Address: service or feeder fee, each branch circuit 20 6.65 133.00 2
-
City: 1 State: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax E -mail: of service or feeder fee, first )ranch circuit: 2
Each additional branch circuit:
1'1 \ Ill \ILIA (Pleas.. chuck all IIi:it i)ilill) Misc. (Servireor feeder ootlodnded):
0 Service over 225 amps -t enmetcial. 0 Health facility Each pump or irrigation circle 2
0 Service over 320 amps- rating of I&2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuits) or a limited energy panel,
0 System over 600 volts nominal more residential units in one structure alteration, or extension• 2
0 Building over three stories Cl Feeders, 400 amps or more • llcscription:
U Occupant load over 99 persons U Manufactured structures or RV park Each additional Inspection over the allowable In say orate above:
0 Eg eas/lighling plan U Other: Per inspection I I I I
Submit _ sets of pima with any of the above. Investigation fee .
The above are sat applicable to tesaporary construction service. Other ,
i ' Permit fee - 5, 293.60
please Not all jurisdictions accept credit cards, call jurisdiction fm information. infontion. Notice: This permit application
T
u Visa U MasterCard asterCard rd expires if a permit is not obtained Plan review (at %) $ ttr a 23.49
Credit cant number: _... _ / I within 180 days after it has been State surch 8 ( 8% ) $
Expires accepted as complete. TOTAL $ 317.09
Name of cardholder as shown on credit card
. S .
Ca folder signature Amount - 4404615 (6/00/COM)
CITY OF TIGARD 24 -Hour .
BUILDING . Inspection Line: (503) 639 -4175 MST
INSPECTION DIN Business Line; ., (503) 639 -4171. .
BUP
Received - ' /2 5 Date Requested (0/ 2- 1 n� L r A / M � PM • BUP
Location / 5- Z 3 C) 4Le i s a Suite FO MEC
Contact Person -J h Ph D - 524 2--PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner COPS `F /14 a. V'i N -Q 4/90`; ^ (Do 7.?
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear C % r ----
Int Sheath/Shear
Framing
ly
Insulation
Drywall Nailing.
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING t
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
ELECTRICAL — Q -
Service
Rough -In
UG /Slab -
Low Voltage
Fire
PART FAIL
Final Reinspection fee of $ • required before next inspection.. Pay at City Hall, 13125 SW Hall Blvd.
SI TE Please call for reinspecti•n RE: . Unable to inspect — no access
Fire Supply Line
ADA ,2. a / I / _
Approach/Sidewalk Date Inspector •
Other:
Final DO NOT REMOVE this inspection record from the j site.
PASS PART FAIL .