Permit CLAY OF TIGARD ELECTRICAL PERMIT
I PERMIT #: ELC2004 -00533
•,. DEVELOPMENT SERVICES DATE ISSUED: 8/24/2004
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S112DD -01600
SITE ADDRESS: 1.54.99'SW SEQUOIA PKWY 100
SUBDIVISION: PACIFIC CORP. CENTER "" ZONING: I -P
BLOCK: ED �i LOT : JURISDICTION: TIG
Project Description: 2- 200amp serv. and 30 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: 2 W /SERVICE OR FEEDER: 30 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 #: L1C 51539
SUP 2053S
FEES ELE 3 -243C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/24/2004 $360.10
[TAX] 8% State Surcharge 8/24/2004 $28.81 Elect'I Service
• Rough -in _
Total $388.91 Elect'l 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 obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344. --pp--
Issued By: d , 9L g Permit Signature: d57-1 4 "F t, G�c,(,4�7�..J
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:A06 S
Call 639 -4175 by 7:00pm for an inspection the next business day
Charlynn J. Leifsen To: City of Tigard Date: 8/23/2004 Time: 9:45:52 AM Page 2 of 4
Electrical Pte' it A lication 1 ( ) 1 ( () I I• I I I 1 1. ()NI 1
City of Tigard R gam', ,; t.
13125 SW Hall Blvd., Tigard, OR 97223 -
Plan Review
Phone: 503.639.4171 Fax 503.5 4 l' ` " ,�" Dal- : : Other Permit:
Inspection Line: 503.639.4175 11U 2 u u 7 , _�.i4. .Iii
_ Date Ready/BY ®
Internet: www,ci.tigard.or.us Notified/Mctbod: //'\ Sapp&e Page tem ental 2 lar onnatioa
! „i.`;',!1 '' y i, r + -. by f ' l
❑ New construction L+ • ■ , . . ' I 11 : ". replacement Please check all that apply:
❑ Demolition ❑Other. ❑Service ova 225 amps, comm'1 ['Hazardous location
nrb i I 6, t r _ _ ❑Service over 320 amps - rating ❑ Buildng ova 10,000 sq. ft.,
Ill hi. — 3::! f' :.+ V4... , ,:. ,• , -, i _ - , .t; �I I ,,, .._! of 1- and 2- family dwellings 4 or more new residential
El I- and 2- family dwelling ® Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Muni- family ❑ Master builder ❑ Other: ❑Building over three stories ❑Feeders, 400 amps or more
}I , Occupant load over 99 persons OManufactured structures or
:::r }E l fit. t ll
- s r f - r M. •' -. t_ r s. i DEgr� Nan RVP •
Job no.: 8732 Job site address: 15575 SW Sequoia Pkwy, 100 ark
.;. . �,:4Nk" :dl.- ^ ... - -,<, .,\ ... c _.. . c . ^ .._ - , .. �kr..�, .'�� E
H facility
Submit j sets of plans with any of the above.
City/ State/ZIP: Portland, OR 97224 The above are not applicable to ternporttry construction service.
Suite/bldg. /apt. no.: 100 Project name: Geo Design
anvlptloo Qty. Fee. Total ..
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. R or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. it or portion 33.40 I
Tax map /parcel no Limited energy, residential 75.00 2
r ,,..5`;";1, s ti i , CIS,,, I, w Limited energy, non - residential 75 00 2
' r. -x>: .,, .i ... '. ' ., . . r ; :. +r , ,; .,:r. _ — ,z .. , ' . , jli ' ,.'•: . - ' Each manu or modular •
Tenant Improvement dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 2 80.30 160.60' 2
w?_ r +i1 t 5 \--';''...T i I o ,, 11a t , ->~_ 201 amps to 400 amps 106.85 2 •;,= i=kla;:t i . ts _ . -. i A . i. ,,!..,. • ::., :, . .,:;. , _i.,r ill ,I. i <, ,I 7 =?.t q,4e! 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
a r •! "+ N , 1' ! L ,r nl lilt' , � '° A. Fee for branch circuits with
- t t ' ", .4 t; . .� r1I' , � .. . . I ,
1 (r f h � l i1 r 1 - i , I9
r service or feeder fee, each /��
Business name: Johansen Electric Inc. branch circuit 3t7 6.65
B. Foe for branch circuits
Contact name: Charlyn n Leifsen without service or feeder fee,
46.85 2
Address: 10948 SE Valley View Terr. each branch circuit
Each addi branch circuit O 6.65 l$975O 2
City/ State/ZIP: Clackamas, OR 97015 Miscellaneous (service or feeder not included)
Phone: ( 503 ) 698 - 3417 Fax: : ( 503 ) 698 - 2486 P or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: johansenelectamsn.com Signal circuit(s) or limited-
I } ' -', T y i _ f t � ,, +lf ` - ' .. energy panel, alteration, or
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/Z1P: Clackamas, OR 97015 Investigation per hour (I hr min) 62.50
Phone: (503) 698 -3417 Fax: (503) 698 -2486 Industrial plant per how 73.75
:::� ._.L . .)h . iI{l�iu. . _:' : -.:. r'NnL r,.,r: \ . r_ -_ . .. � . _ - - - :C 1
CCB Lie.: 51539 Electrical Lic.: 3 -243C Suprv. Lic.: 2053S Subtotal 360.10
Suprv. Electrician signature, required: , . / . f ,.. f ` ,, Plan review (25% of permit fee)
Print name: Carl K. Johansen / Date: 8/23/04 State surcharge (8% of permit fee) 28.81
TOTAL PERMIT FEE 388.91
Authorized Signature: 1 i/� This permit application expires if a permit is not obtained within 180
Print name: J. Lelfse Charlynn days after it has been accepted as complete
y , D ate: 8 /23/04 • Fee m ethodology set by Tri•County Building Industry Service Board
ee Number of inspections per permit allowed.
isWuildine .Permiu1ELC.FamitApp.doe 12/03 440.4615T(10/02/COM/WFD
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
/ — i
Received Date Requested AM PM BUP
Location f s s 5 Suite / MEC
Contact Person _ . A - .14 id Ph ( ) (o q F +3`' 1 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ' • ' - ELC c 9OD C I-6 ' 6)6-33
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
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm (/ .. evo
Susp'd Ceiling 7Y
Roof / �(J �— 4
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Water Service
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
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA / /
Approach/Sidewalk Date J �� Inspecto 4 Ext
Other:
Final DO NOT REMOVE this inspection recor from the Job site.
PASS PART FAIL