Permit CITY ,OF TIGARD ELECTRICAL PERMIT
Permit #: ELC2009 -00478
• a COMMUNITY DEVELOPMENT Date Issued: 09/11/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD
Subdivision: Lot: 0
Project: One Embassy
Project Description: (2) 400 amp service for replacement of chillers.
FEES
Owner: Amount
WISCO REAL ESTATE EQUITY Quantity Description Date
FUND I LTD PARTNERSHIP, BY WYSE 2 ea Services or Feeders - 201 to 09/11/2009 $213.70
INVESTMENT SRVS CO, 1501 SW TAYLOR ST 400 amps
PHONE: 1 ea 12% State Surcharge - 09/11/2009 $25.64
Electrical
Contractor:
JOHANSEN ELECTRIC INC
10984 SE VALLEY VIEW TERR
HAPPY VALLEY, OR 97086
PHONE: 503 - 698 -3417
FAX: 503 - 698 -2486
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $239.34
Required items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days ATTENTION. Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OA 95 1 -0100 You may obtain a copy of the rules or direct questions to OUNC by calling 503.246 6699 or 1 800 332.2344
Issued By: Permittee Signature: .47. 70^/
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' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that 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.
- 7r9 ibbi't y \ Po ssi BLC -1
Electrical Permit Application , I.i ul.PI( - t: t \1; \I.1
IL � City of Tigard Received C -%% PertmtNo'ez 0O "' -do v.-
g ECEIVED Date/B : 7
' 13 SW Hall Blvd ,Tigard, Dare/B view Other Pit�y�c, OO7 -ooy
' Phone. . 503.639.4171 Fax 3.598 .1960 Dame : emt
,. Inspection Line: 503.639.4175 Ready/By: El See Page 2 for
Internet www.tigard or.gov S EP 10 2009 Notified/Method: Supplemental Information
e • i n r [ � r•- ?? •r 't'9R""T I , t• l >€ pr t r rag D t'- [_
,_�•♦ usN t , :11' { .0 ..V 'i s 1 er, rvti 'c.: . : t - erbs F : , :1C 'ki��.d�n °#222i� ;p {f h,
❑ New construction y ® Additi Please check all that apply (submit 2 seta of plans whams checked below):
12 Demolition El Other: ❑ Service or feeder 400 amps or more El Building over three stones
where the available fault current ❑ Marinas and boatyards
f
r,11-' fir. 1.;-� i yi,�,,tit - r+ i°�' 'l �,e p r• +� ` o. exc 10000 1=1 Floating bt» ldvrge_
:i i ' .. r* If , cs.i,., 1, +) r' . c 4: • 6r�r i 's r I " h b y jl y , amps at 1S0 volts or
! ` . - s "1 ' 1 4 "' ! { less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations buildings.
❑ Multi - family ❑ Master builder ❑ Other: 0 Fie pump ❑ Inatalletwn of 75 KVA or
tAtr ;,r. u stn a•;r °uc+lylr[imurgp3a tltr qti *�tlua �Jjj�ja� 1:l Emergency system. larger separately denved system.
� k r ist I i(r $:Io a arhi eisiti . rMa t is+C I c al l % MRS ❑ Addition of new motor load o f ❑ A , E , "l -2 , "1.3
Job no.: Job site address: SW Washington Sq R ti 100NP or more occvpanry.
❑ Six or more residential units ❑ Recreational vehicle parks.
City/State /ZIP: 9�/� �/ ❑ Health -taro facilities.
❑ Supply voltage for more than
U G El Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: I Project name: Embassy ❑ Service or fader 600 amps or more
Cross street/directions to job site: ." �` u` , r YgL�'7.%:,,l;e'!z�.�oi P a :.• • n , i 4 y o :
j Desalinise Otv. Foe. 'Total •
New residential single- or multifamily dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq ft. or less 145 15 4
Ea. add'I 500 sq ft or portion 3340 1
Tax map/parcel no
d .+ te ��{' Limited energy, residential 7500 2
�.;i ilj f.. r` .,I'•rri}i t a li'_ t5ilii iP rti''l6itl Ij/iiotii (with above eq It)
Limited energy, multi- family 75.00 2
Replace 2 chillers residential (with above sq. ft.)
Services or feeders Installation, alteration, and/or relocation
r., rsi t F . { F ' 200 amps or less 8030 2
.r 0 3 •s 1 k 201 amps to 400 amps 2 106.85 213. 7 2 _
Name: 401 amp t o 600 amp 160 60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66 85
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 599 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
, 1 r ( •ter 1 i t { n2 ma'+r -�ryrl q , h� above service or feeder fee
i Fln'tntttt - -St t 7 .* :nvt!1® fallit8l : r ere r l)IEt s.F I�[wt6 n 6 65 2
each branch circuit
Business name: Johansen Electric Inc. B. Fee for branch circuits
Contact name: Charlynn Leifsen
without st branch c
service or feeder fee. 46.85 2
first brh ircuit
Address: 10948 SE Valley View Terrace Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Happy Valley, OR 97086 Each manufactured or modular
dwelling, service and/or feeder 90'90 2
Phone: (503) 698 -3417 I Fax: : (503) 698 -2486 Reconnect only 66.85 _ 2
E-mail: johanseneleet@nisn.com Pump or irrigation circle 53.40 2
r T r r I1. it rib I + ,y:w�t1O,"'�r+rv i t �
■ �:r �.�'•"����; :Y L ? e r t� ; ��j� ,�;.Z,�'��EjO Sign or outline lighting 53.40 2
Signal panel, alteration, tio, tanned-
Business name: Johansen Electric Inc.
energy panel, alteration, or
Address: 10945 SE Valley View Terrace extension. Describe: Page 2 2
;
City /State ZIP: Happy Valley, OR 97086 Each additional Inspection over allowable in an of the above
Phone: (503) 698-3417 I Fax: (503) 698 - 2486 Per inspection 62.50
Investigation per hour (1 hr roan) 62 50
' , CCB Lic.: 51539 ✓ I Electrical Lie.: 3 -243C 7 I Suprv. Lie.: 2053S - Irtdustnal yypllaantt�� hour 73.75 {
i '., :'Uf i:il't° # J i] 3".�i p"��'R q 1 �3':�i:"^P1i °
Suprv. Electrician signature, required r. Subtotal. 213.70
Print name: Carl K. Johansen Date: 9/10/09 Plan review (25% of permit fee):
State surcharge (12% of permit fee): "25. b 4
Authorized signature: t .. / J ` .- TOTAL PERMIT FEE: 239.34 ../
Print name: Charlynn J. Leifse Date: 9/10/09 This p enult application expires if a permit is not obtained within ISO
days after it bas been accepted as complete.
• Number of inspections allowed per permit
1. v3uddtng lPvrwls1aLC- PernutApp.dac 05/23/06 440- 4615T(1 rroucOIWWEB
I'd Xdd 13C213S131 dH Wd9E c O T 6000 0 T daS