Permit CIT OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00718
, DEVELOPMENT SERVICES DATE ISSUED: 12/12/03
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639-4171 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: (2) 200 amp or less services and (10) branch circuits. Job No. 8412
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: 10 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 12/12/03 $227.10
[TAX] 8% State Surcharge 12/12/03 $18.17 Elect'l Service
Rough -in
Total $245.27 Elect'l Final
This Permit is issued subject to the regulations contained in the Tigard Muniapal 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 -23 .
Issued B y: / /, i Permit 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: goee5O S
Call 639 -4175 by 7:00pm for an inspection the next business day
From. CharlAr Leifsen To: City of Tigard Date: 11/26/2003 lime. 15356 PM Page 2 of 3
..-
Me:Arica! Permit Al."; N A ion
`..- ' Rece ived Electrical
Dati.:43 / AID Permit No.: EL.-ePi/V3 7/ g
_....
City o f 'Tigard ck [)1/By: ermi
Planning Approval
aai0.- Sign
Pt N.
.o .
. , __..
3 7
3 125 SW Hall Blvd. Flan Re . O
Tigard, viev.ther _......._
igard, Ort!,gon 97223 \N\ZO ° r. (4!. 1 .0411 * ' i °
C C.-. 0 ate/B)L
-____ ...
Post-R Land use
eview ?emit No.. I
Phom: 503-639-4171 Fax: 50:101).9 \AS ... 66,,szek „ r ,,
I
Dateif3y: Case No :
ir met w.
In v.'wc.i.li A trd.ot.uS C 1 .0 I
,‘G / r. r i 1 .
- .P 44 couteet . • • 0 See Page 2 for ----
24-hour laspec tioa Request. 5tX.,% 1.75 - i Name/Method ._ ., I ( - Supplemental Infor:mation.
;L ,.',.::-..,.,_,
.,_ .
j New construction a Demolition . 0 Service over 225 amps- I nealth-cait facility
- . Lommerc.ial 1 0 Razurdous 1.6.
13 ,A dditionIalteratiorire lacement Other: , I 0 0 -32O amos-rting rif t r Li ,
service ov, Building over 1,0,00win
1) sit feet,
V.FSIFTWIV:11RP,OJOIN:1ri,: ,t 1 &. 2 fardly thaellings UT Or mitt c residential units !II.
i & 2-Family dwelling 11 Commercial/Industrial D vsleni ovet 600 volts nominal, ow: shear:1re.
i '
I- il , 0 Iluilding over three stories 0 FUOUUTS, 400 amps IF !roc-
• . Aecessory Budine 0 Multi-Family
.....-__ - , r 0 Occupant load over 99 persons 0 1.14nratfactured structures or RV park
1 KI aster Builder 0 Other: ; , 0 Egress/lighting plan 1 0 Other: ..._,„, .
. , Submit sets of plans with any of the above.
,,!,14€)fic':51.1-1,E4flq..ORMATjWiatfckl ,:f0T,1,0r4.. :
= The above are not ae ary construction situ vice.
rjob site addrass: 16252 SW Upper Boones
_ --- -------1 ........■:.1 ' ..'''', ' ."..■..., - ....i' °''■;;_1;:,...4............ '....:.:1 , ' '' V ' '
Suite 0: I
/An Bldo .#: r
c ,- . Number of inspections per permit allowed
1
p ro - vo. N ame: zygo vacancy 0 eseri ti o rp■ 1. Qty Fee ta.) Total I !
. New residentfal-single or intiltr-family per 1 4'
Cross street/Directions to job site: dwelling unit. Includes attached garage. I t
Se-ire included: 1
1000 sq. ft. err less _ 145,15
4
Each additional 500 sq. ft. ormrtion Thema i 33.40 1 1
--- . . I __Limited ensay, resident ial 1 75.00
Subdivision: o
1 Lt ti-: --i
...„ _ ... .... 1.1mireci etim, non rcsiderniul ' 50(71 2
,- -
Tax man/ ?areel #: Each munufactured home or -modular dwelling il
1..e. rind/or feeder
ii!!'g',V,,i)111R:07;171,K1P4P,T[OM:61,',INVIAX - ' ‘iiili;:1 I'l:,I0.grI. , - ' I 90.90 I
. 2,
Services or feeders - Installation,
Tenant Improvement alteratioil or rolocatin
oi i 1 Art An ,
..,...... - -- 20'0 amps c: less 2 80 .--.--
_...._ _____.... ____-. '''' --____..- 201 ;imps to 400 amps 105.85 i 2. 1
412).2pm to 00 amps
160.60 1 2j
r;= 1 - 1 - - - -- 4 v 601 amps to 1000 arnus
j*,:cers.• ,„'uo - 10-' 0 --7..g.': 4.g-MNAr141,-..:-.. ,.,EA -__ - --- - - 240.60 2 I
i Over 1000 amps or vOjtS 454.65 _.... . 2 i
Name: Pp \ -A...Li-5r i Roman:xi only. I 60.35 I 2
Address: ; Temporary services or feeders - Installation, ! ,-
-----' I alteration, or relocation:
[ City/State/Zip: _________1 1 Maws or less 66.35 .. _ 1
I Phone: I Fax: .. _ 1 ! 201 amna to 400 amps 100 7
30 .. - -- 21
.„1 i 401 io
Branch 600 ampa 1 75 , 2 I
WrIF.-13:f6W.V.1'''''''T.T-EaWj.14..ftgOrla-00,1N-SP,W.-1 : ' ,
circuits - new, alteration, or
I Name: Johansen Electric Inc. 11 extemsion per panel:
- -- 1 A. Fee ler braoch circuits with purchase cif
I Address; 10948 SE Valley View Terr. service or feeder fee, each branch circuit i 10 6,65 66.50 i
Citv/State/Zip
Clackamas, 97015
., mas,
.- . _..._ _....._.... ________.. - 0 Fee fill' 1)1'111S:11 CitC1.1111; W1,0101It c urchue , or
i
savice or rceder fix, first branch circuit I 46,85 2 "
Phone: ( 698-3417 t Fax: (503) 698-2486 . Each additional branch circuit '--- --- 6.
E-mail: Johansenelect@aol.com Nfisc.(Scrvice or feeder not inatitedi
or irriaatfort circle
,fwo,w.mzf7 Tiad --- / -M 3 P- , -v-7'- - . , I '53
u:,..e.d, , ' -- --,.____-_... ,, ...a.,ak ,==::&-='. "---- '''-' ,e..c.1. sign if outline lighting I 33.40
....
E Signal eircinita) or a limited enerTi panel, _--1.-
Job No: 8412
alteration, or tAlerISIGII Pa -n- 2 I 2
Business Name: Johansen Electric Inc. .._...._. otsc:rr I
Address: 10948 SE Valley View Terr. i I
_
... - Each additional 11151PC:4:1km over the alrowable in mix of tile above:
Citvtat
iSeiZip: Clackamas, OR 97015 -
-J• - for inapecticn per hour (min. 11 _. 62.50 I ,,.
Ph one: (503) 698-3417 #153 43 Fi.IX: ( 503) - 698-2486 ----- ------
Invmsritration f.•• . _____
_ _.--____ --- 1
(CB Li 1 1
i.c. 6 -- § Lie. 0. 3-2 „.-
. ' - -- ------
icu
Supervising Lt„tr..iari
Supervising ' .-.. ---.7 - Subtotal S 227.10
......_
signature required: Plan Review (25% of Permit Pee). $
- - . __
Print Name: Carl K. Johansen Lie. 4: 2053S State SurcharE18_% of Permit Fee) $ 18.17
.....
11/26/03 Notice: This permit application expires if a permit is not obtained within
Signature:
" ------ .--i , ‘ ,..ii.unte: IN days alter Rims been accepted as complete.
*Fee methodology set by Tr-County Building Industry Service Board.
Charlynki Leifson (i
(Please print rannr.) .
i:\Dsrs\Pemul Forms\ FloPerrnitA op.doe 0 1 f 0.5
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 - MST
�y BUP
Received Date Requested / / b AM PM BUP
Location / (o -s o it- /J Suite • MEC
Contact Person (2441' Ph ( ) '2" y /5 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC , 3 40 9/ r
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
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
rna ❑ 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 ��22
Approach/Sidewalk Date C u L <, w Inspector / Ext
Other:
Final • DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL