Permit A - CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00369
7r11, DEVELOPMENT SERVICES DATE ISSUED: 6/22/2004
�.lI� 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
la PARCEL: 2S112DD -01600
SITE ADDRESS: 15575 SW SEQUOIA PKWY 160
SUBDIVISION: PACIFIC CORP. CENTER ZONING. I -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: 2- 200amp. services w/ 60 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: 60 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: 503 - 624 -6300 Phone: 503 - 698 -3417
Reg #: LIC 51539
SUP 2053S
FEES ELE 3 -243C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/22/2004 $559.60
[TAX] 8% State Surcharge 6/22/2004 $44.77 Elect'I Service
Rough -in
Total $604.37 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 obtain copies of these rules or direct questions to OUNC at (503)
246-6699 or 1 -800- 332 -2344.
Issued By: 4,14 �L � _ _�� Permit Signature: i ff) 644
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: O 6 3
Call 639 -4175 by 7:00pm for an inspection the next business day
From: Charlynn J. Leifsen To: City ofjllQaf'd-C E I V E D Date: 6/17/2004 lime: 10:23:00 AM Page 2 of 3
. a V ;..�I ti/' vl/gl
Electrical Perm Application Re�ts�a FOR9ItJIC . 1 1 Sr ON EN ;'
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uaturo4 i vy • :- : : l�t:rrmlil aq . . 6f
CITY OF TIGARD Planning „roe 1 Sign
City of Tigard BUILDING DIVISIO , Detert3}': Permit No.: ______
33)25 SW Ball Blvd. Plan Review Other
Tigard, Oregon 97223 Dam1B ': . ... Permit No.: .
Phone: 503 -639 -4171 Fax 503 - 598 -1960 Post - Review Land W • • -
�+a' : = ' � c , I ! � t• ; Date/By: ': Cosc Nn.:
Internet www.ci.tigard..or.us t Y ( ' Contact J : :li� S'eet'agC.2'for..
24 -hour Inspection. Request: 503 -639 -4175 Name/Method: / Supplemental Information.
__ Ik - r.;:rA : ' . ' Y ,��d'i x,¢q�:.; i' 1 . 2 ., " I 'i. !r'a ;.�'�hH. :'. ...
'" . '"_"-" S ” : ; a ,� . _y, , .: ++gi C't.
- .•Y2� ..A'1:'': i,.A. .Ii'.r.F,,. ;� ..1 " :' .iM1: r�.N "!'!� a. u , 4 ,. .� � 7 �l�.r' .. .
.� :. .:.. �,�r..: .!_.... ,.:. .. u. .. : M.J4•� :�Fl.i.•!}Ii n..l::.'a •)'•BAR' _ - ,`L`�k����A'F P���.
• New construction Demolition, 0 Service over 225 amps Beal th- eare.facilily . _lj commercial ❑ l4a2ardotrs location
1113 Additior )falteration/r-•laccnent D Other: ❑ s ervice Over 320 amps-rating of ❑ Building .over10,000siu feet,
" " b a • A - M EM u AS ., " ;` .. a i ;,'t. '. 1 & 2 family dwellings four or more residential aM in
p
IN I & 2-Famil d�velllil x CommerGlaL 0 System over 600 volts nominal Vine 9iructur. -
JUStrial 0 Building over three stories ❑ Feeder, 400 amps or mom
0 1 Accessory Building El 11(lulti -Fami1 ❑ Occupant load over 99 persons ❑ Mnnttfaetured structures or R4` ark
j j : : ) Master Builder 0Other: : 0 egress/6061v, plan . : ... • 0 Other -- _- . -, ..___
} Submit _ sets of plans with any of the atrov e.
: : }. r {...."..aa2' . 71 r urtgrstctionservice -_
Job site address:
,t: above are not s likable to tr: ary.
1 —....i , °_ -, ;, t - .a'., "E �� y ,rr,.... -+,
•• �� 'A.•...,le :��A,.. Fwd, nµ/ ., ' : �I ,...YUre.
. 5575 SW Sequoia Pkwy .... �..:d�l.ti_..!//1�ip':'
.. _ `�^T.G.G ^l_f'A"PZ- ..��'�� . a, �.= .:.5:• = '�f�F'� :_�....: ...
Suite it: 160 I Bld /Ap* #: — Nitntller ofIttsp " tit,ns put= -perr it'allowed
' Description Qty $ee(ca) ' lot
Pro Name: Captari's
New residnntiafrsingle or Inuitl- family per
Cross strcet/Directions to job si.le dwelling unit. Includes attached garage. .
Service included: __. . i
. II1e0 ft or less j • 445,15. ... 4
ach Cdtlitinnal500 sq. ft or thereof ereof t ; 33:40 • I
- -- Limited energy. resideui:al 75.00 3.
Subdi.virion: I Lot #:
., lrimited
'Tax ma43 rce1. #: Each manufactured hone or modular dwelling t r ihn$
Y F�Yy�� ' ,-sy AA ; . _ �/y ■.... .. ...rt... �J ' '_' •. ;, ,./�,E..: servtec errdior feeder 40 9fl 2
. :ii A it• .x �' it 1•C.. l r�7f] dM'.i� 'r ... -��•.73f- t A' ~ .4TF1 M ( "P+'.M A Y ..
;S7�;fr Services or feeders - installation, .
.. altcrotion'or relocation;
_ . . 2 (til amps or icss 2 • 80.30 160.60 2
Tenant Improvement 201 anapsto40Gan , ps . - - 106.85 a 2
ra . . wow'. !z 601 am n 3000 amps
�` ). Ol.) .i,. v - i ' ' #^ P',, 1"Flk•.'" .. v , , :' : .;,0 7 . 'Zl' ::: „.p ./v' s
240.60
.
i Over 1 amps or volts 454.65
Name: _ . , rtect only ( 1.85 1 ] 2
•
Address: I Temporary services or feeders - installation, ...
alteration, or relocation:
City /State/Zip: zoo amiss or feu 66.35 l
201 amts to 4(10 amps ( 100.30 2
Phone: [-Fax: ,, t 401 to 6110 amps 133.75 2 •
'�,�. Name: ,�/ * - new, alteration, or
Id�4••i; iii ir�fi�~ • : �i�• }k. : , ;� IT ,,�y.7�.'71��F1�V ^,1't' 'It � . � 1: I4 urtch circuits
: Johansen Electric Inc. extenciooperpanel: .. ..
A. Fee &N branch circuits with purchase of
Address, 10948 SE Valy View Terr. • _ service or feeder fee, each branch circuit { 6.65 2
Cit ' /State /Zija: Clackamas, OR 97015 , B Feee for branch circuits without purchaseof I
']I •. - -. - service or feeder fee, first branch circuit 46,85 .. 2
Phone: 698 -3417 Fax: (503) 698 -2486 Each additional branch circui so : 6,65 399 2
E_ Johansenelect@msn.com Micc(Service or feeder cwt ;nchaied). •
m: r. .7 i e A : il tk 7 { Each pun” Or nu ,tier circle _ 53.40 2"
:`±ic .: , .' r ,', ..` c .r. ,i € +f . " '+•; K.,d ' -• - 1, . s Each sigpor outline 1i h$ Flag 5 3. 4 0 2
Sigma]. : Job No: 8657 Sil eirmit(a)ur a limited energy panel,
alteration, or extension page 2 • 2
Business Name: Johansen Electric Inc. raeseription: - I
- Address: 10948 SE Valley View Terr. - • •
. Cl OR 97015 F.eph additional Inspection over the anaerobic in an • oftlte above:
City i'cr inspection.perhour(min. I hour' 62.50 i .
...._ i Dm . l
Phone: (503) 698 -3417 Fax; (503) 698 -2486 c m est/ation _
CCB Lic. #:51539 Lic. /#: 3- 243 other: u . _
��ni1: 33ySi�4�i'�'.t.1" r;�^1i' :'_ �.3.`?7�.•.�:.L:R� �.. i S�?3;i.�'�� : � . a�r+' '1'7''s.)A% r Th
Supervising electrician Subt„tal. .x.559 ;6.0..
signature required: Plan Review (25% of Permit Z ee :. ...
Print Name: Carl K. Johansen Lie. #: 2053S - State Surcharge {8% of Permit Fee S 44.77
TOTAL PERMPP.PM $.• 94.37 • r
Stgrtalure: .
Authorized (. Nutic4: This pernnit.application cipires-If a permit is not obtained withi
r lie: 6/ 17/04 180 days after Kites been accepted as complete -
—
*Fee methndalogy by 'Uri-County Building Industry Service Board.
Charlyn . Leifs - n )
(Please printnurne) -� - --
i:\1)sts\Perrnil Forms\ FloPermitApp.doc 01(03 _
CITY OF TIGARD 24 -Hour
BUILDING Inspection L,: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested /7 AM PM BUP
Location ) S — Suite /4 (2 MEC
Contact Person UU � Ph ( ) j - 3y/ 7 PLM
Contractor Ph ( ) SWR /
BUILDING Tenant/Owner ELC a00/ 7"Jac
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Ext Sheath/Shear MA
Ext eah/h
Int Sheath/Shear
Framing
Insulation Pei n 1 n —
Drywall Nailing ►1 (Lei) rO'b`-
Firewall
Fire Sprinkler I
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
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.
ASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line �7 AAoach/Sidewalk Date 8 - � (� Inspector c - �f�( 4LE?Jy Ext
PP Y
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL