Permit "�G"4'1 1 OF T I CARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00134
DEVELOPMENT SERVICES DATE ISSUED: 3/7/2005
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S113AB-01201
SITE ADDRESS: 16252 SW UPPER BOONES FERRY RD
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING. I -L
BLOCK: LOT : JURISDICTION: TIG
Project Description: (6) 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: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 5 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
FEES Reg #: LIC 51539
Description Date Amount SUP 2053S
ELE 3 -243-243
C
[ELPRMT] ELC Permit 3/7/2005 $80.10
[TAX] 8% State Surcharge 3/7/2005 $6.41 REQUIRED ITEMS AND REPORTS
Total $86.51
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 -333A4.
Issued By: j , w 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 7:00pm for an inspection the next business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
From. Charlynn J. Leifsen To: City of TFIchlia M, V Date 3/7/2005 Time: 12:58:48 PM Page 2 of 4
0
Electli•ical•'?e lit' Applica*i6a 2 005 i s 1 l i< (11 1 11 1 1 ' 1►\ 1.1
City of Tigard CI1Y pF TIGAR Received
13125 SW Hal B Tiiga 5 R 97223 ctual D' VI , � I D& Revie,r - � - dam --Dr.:"..." :,. pmt: /1 •
Inspection Line: 503.639.4175 _ .g,. '�! ' Date Ready/By. See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: S upplemental Information
!I 7 "' s: a '. x i s +
S h - f 1 i d y. 2 r S - E.r - f c I ,- t,n r l. ' ,(PT. 1. �. • ::^"*nv{ .r 1 I i C , ,1, . - _ ; � - 7 4 . S., tea! s'c- .: . _ 5 : _L.. rsh! ,. .., b. . . r �#, #t ..: 9 Kiwi 3.'3a:'f
❑ New construction ® Addition /alteration/replacement Please check all that apply:
❑ Demolition ❑ Other ['Service over 225 amps, comm'I ❑Hazardous location
a:' Ft. A . '`, ilifi ii4
> ' , , Il f w l � r L- - .1 i.. s r ii Service over 320y dwellings 4 or more new residential
amps - rating Buildng over 10,000 sq. ft ,
i ,1�sk�„ ,. w k f �.,
ID 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building _of I- and 2-family
over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi family ❑ Master builder ❑Other:
t '�'ul # 11. x ,l ., . builder `. . 4f n LY i- N , . ❑Occupant load over 99 persons ['Manufactured structures or
� JIF :Ii . _. r ` ,' ri x t 1: ❑Egresslhghtsng Plan RV park
Job no.: Job site address: 16252 SW Upper Boones ❑Health -care facility ❑Other:
Submit sets of plans with any of the above.
City/State/ZIP: Portland, OR 97224 The above are not applicable to temporary construction service.
Suitelbldg. /apt.no.: Project name: Remington's ''l " . ,r * `A,. '. °: l w ' , .. .
' - .< < ... ',`: , ' _
Description Qty. Fee. Tad
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 2
Tax map /parcel no Limited energy, non - residential 75.00 2
:rI 7 . c r , q < s' ! ,. P o 1 ' v lil#gq ; ' i htri �- tea.. , ' 91
1 7' dl + '! ,: ' a a Yw a t 1 r, I. _...' : Each manufactured or modular
..z„.,a, xx;,. 4.as. .f �4w,., f . ,, -,r. .x��h ; i.a .1, ,1.: _.., �,_r - ' .h �.. ...
Tenant Improvement dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 ' 2
a"' _ t iJ - r z , n f i 1 ; °.s.ti..fi :111 r a �r 201 amps to 400 amps 106.85 2
. _ ._.. 11 I...J.: -..J . , , y �.
JL- s.�._re,f,:ll ,., , .:. _. 1_4---..‘-----=-::.,-,-•.7-;-21:110.4.!, 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
: , r I ': "t' 1'1'�li° ^i t 1 i +i r a
.j� IF i . - . ,1.,..t., ; , n a
!t( 1 9 J lil4
1 I, J ., , ft r . 1 E tin 1 . 1 A. Fee for branch circuits with
. Y.
w...-.,-.: . e..4 e... �. , ,,L t s.: .._ - n 4 service or feeder fee, each
Business name: Johansen Electric Inc. branch circuit 6.65 2
B. Fee for service or feeder Contact name: Charlynn Leifsen
without service or feeder fee 1 46.85 46.85 2
Address: 10948 SE Valley View Terr. achbranc circuit
Each add'1 branch circuit 5 6.65 33.25 2
City/ State/ZIP: Clackamas, OR 97015 Miscellaneous (service or feeder not included)
Phone: ( 503 ) 698 - 3417 Fax: : ( 503 ) 698 - 2486 Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: lohansenelecta,msn.com Signal circuit(s) or limited -
v
.L. x . ' r. �s Y1 rF".r --- 'T iirfj, y , 1 ,tf .y7 A r', x c „ `giII - Rf'.'..i .i ene Panel, alteration. c ..,ra. . ,._. t , �a,< M.., re 1 ..., I.. S�,i .r f.. K I ? . -
.s_., rnY P 4 or
extension. Describe: Page 2 2
Business namc: 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/ZIP: Clackamas, OR 97015 Investigation per hour (1 hr min) 62.50
Phone: (503) 698 -3417 Fax: (503) 698 -2486 Industrial plant per hour 73.75
CCB Lic.: 51539 Electrical Lic.: 3 -243C Suprv. Lic.: 2053S Subtotal 80.10
Suprv. Electrician signature, required: / _ , / Plan review (25% of permit fee)
,.
- " ! A. 4�_ State surcharge (5% of permit fee) 6.41
Print name: Carl K. Johansen / Date: 3/7/05
TOTAL PERMIT FEE 86.51
Authorized signature: This permit applleatlon aspires it a permit is not obtained within 180
days after it has been accepted u complete name: Charlynn J . Leifse, Date: 3/7/05 • Fee methodology set by Tri -County Building Industry Service Board
•• Number of inspections per permit allowed.
i.tDuildiaglPamiu\ELC- PermitApp doe 1 2/03 440- 4615T(10/02/COMAVED
CITY OF.TIQARD
BUILDING DIVISION PERMIT #: ELC2005 -00134
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/7/2005
Phone: (503) 639 - 4171 ° d1 �� gi� I ii��
Inspection Requests (24 Hrs.): (503) 639 -4175 F MK
INSPECTION WORKSHEET FOR DATE: 3/17/2005 TIME: 7:13AM PAGE: 46
SITE ADDRESS: 16252 SW UPPER BOONES FERRY RD CLASS OF WORK:
SUBDIVISION: FANNO CREEK ACRE TRACT S LOT #: TYPE OF USE:
PROJECT NAME: REMINGTON
DESCRIPTION: ( branch circuits.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: JOHANSEN ELECTRIC INC PHONE #: 503-6913-3417
Inspection Request Scheduled For: Date: 3/17/2005 , Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final • 002083-01 503-704-1534 N
Corrections /Comments /Instructions:
' \;C5\k1l,V1 \-- c.. I 1-1 VI Ck' il g PIA Safi
1-24 S, DI' `P 'Vb \j1;1,)
JN ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
• ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 44/7 Date: - 1/2 - Cid Phone #: (503) 718-