Permit (63) CITY OF TIGARD ELECTRICAL PERMIT'' COMMUNITY DEVELOPMENTN Permit#: ELC2016-00559
TJGA.RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/13/2016
Parcel: 2S108DB08800
Jurisdiction: Tigard
Site address: SW NO ADDRESS
Project: Polygon at Bull Mountain Subdivision: None Lot: None
Project Description: (1)200 amp or less electrical service for park.
Contractor: GARNER ELECTRIC WASHINGTON LLC Owner: POLYGON WLH LLC
402 VALLEY AVE NW, SUITE 106 109 E 13TH ST, STE 200
PUYALLUP,WA 98371 VANCOUVER,WA 98660
PHONE: 253-872-6051 PHONE: 360-695-7700
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 07/13/2016 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 07/13/2016 $12.08
Type of Use: COM Electrical
Class of Work: NEW
Type of Const:
Occupancy Grp:
Total $112.78
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. ATTENT• e egon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-001!through OA' 9 ;41-04•0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.23434.
Issued o- : L: -IA__- Permittee Signature: (_H t !11-4--._ ,
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' (—St....L._ .......e.440 —_,..... Date:
LICENSE NO. i-/a 9(40 5
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
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.
, .
.
Electrical Permit Application ( .,-, ‘% - FOR OFFICE USE ONLA'
,
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INCity ofrigard ta. , , Received 7"/6 zLh p.r.,,,it s: et.e... i4,-co..-..)57 ii13125 SW Hall Blvd.,Tigard,OR 97223 -Til- '' ..,i ii ;').14:t.':iew
Phone: 503.718.2439 Fax: 503.598.1960 ,\x\ 1. ' sate/Ely: ,. Related Permit 4:
,,„, Inspection Line:503.639.4175 3‘..),-- Remt.y.,, , . kris: 21 See Page 2 for
'T''''''R 9. Internet:www.tigard-or.gov .. IA,,p.T ,otheteN!,,, Supplemental Information
e
VMESTNAVV-54.:'gteligfiawcaitog:ol000,14ito-6,'74':P..-:,4- b\%41:,‘,.:77:7Hi.i '-.--.::y.-:' ,....--',;.-.: ;:,;1Z400i1.41*.REW.;t:3V-->jf. q:V: cS'.7P'd;',;New construction 0 Addition/alteration/replacerrit
V, .0 r
Please check all that apply(submit a sets of plans wfitemechedced):
fl, 0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: ILA
where the available fault current 0 Marinas and boatyards.
04.0:0„fik7W0)9#04:elto.K#91y10PV ,. 1 exceeds 10,000 amps at 150 volts or ['Floating buildings.
IE I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to mound.or exceeds 14,000 0 Commendel-use agriculbaral
amps for all other installations. buildings.
0 Multi-family • 0 Master builder 0 Other: °Fire pump. 0 Installation of 150 KVA or
40,4:Vf.C'ftigASOAWit#*litt::000.0)1c ::;:gc -i: ':.*:::';:rj,',...:-:, 0 EmeriMW 63mtm• larger separately derived
0 Addition of new motor load of system.
Job#: Job site address: 4)0 Abb i-g.... .5 . 10011P or more. '
El six or more residential units. occupancY.
City/State/ZIP:Tigard,OR 97224
0 Recreatioml vehicle parks.
o Health-care facilities.
Suite/bldgiapt.#: Project name:Polygon at Bull Mountain 0Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job sit4fa( 0 k., ..*.h C.,••(2 EGA" (,••.-• ...'. ..?'14.:'4.•'::•T,';..:•:,:i-J•: ::0.10.i.I.B.O.„-WIIII;$::.:('• .-.'::.'.?..:':-V:J';:: :',•.: ::':•-.
IS r- Le.,1--i SW f-S C ;,(- -e, \ c Description 1 Qty. 1 'End i Totol I .
New residential single-or multi-fanilly dwelling unit.
Subdivision:Polygon at Bull Mountain Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4 '
Tax map/parcel#: (2,5/0 gl....),6 0 g goo
Ea.addl 500 sq.ft.or portion 33.92 1
MAPiagtri',LOT.ii.,411?.,,.AY9A0c:i',1 -s:,:':'...::: :-:.:',:::':-',.';•.:.,.-:-:;':-.-'.::,..-.,. Limited energy,residential
75.00 2
lanK -Elic• (with above sq.ft.)
Limited energy,multi-family
75,00 2
residential(with above sq.A)
';'''''.414.a.4431--ititet*:*145-0-t-tii::•V;''':;•1Z41 ::,--.-;i:::-4::'''°';' ,I.C11;#01141W1'7:: ::'..'''''•:f'''''''''''''.•
Servicesor feeders installation,alt ratios,f :d/or relocation
Name:Polygon WW1,LLC 200 amps or less i 100.70 AOrb,Iti 2
201 amps to 400 tunps 133.56 2
Address:109 East 13th Street
401 amps to 600 amps 20034 2
City/State/ZIP:Vancouver,WA 98660
601 amps to 1,000 amps 301.04 2
Phone:(360)695-7700 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
• relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
'•.,....."•;:litii.fieita$1..Milit:Way ...i:.,1•,:M%,07;..:-;Zeril:001,140,-§tokoi,i.;-,,,,; .:-,. .. lA31.-lizItibrcibrcisunichts;rcneurt;is:tit:ration,or extension,per panel
Business name:Polygon WLH,LLC above service or feeder fee,
2 7.42
each branch circuit
Contact name:Angela Grajewski
B.Fee for branch circuits without
service or feeder fee,first
Address:109 East 13th Street
branch circuit 56.18 2
City/State/ZIP:Vancouver,WA 98660 Each edd'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360)695-7700 Fax::(360)693-4442 Each manufactured or modular
•
dwelling,service and/or feeder 67.84 2
Email:Angela.Grajewski®polygonhomes.com
T
Reconnect only 67.84 2 AgginaltillattarIg61144: 0..tiaigi\DM:g.4004.:Iilf.P.Piii'Maii Pump or irrigation circle 67.84 2
Business name:Garner Electric Washington,LLC Sign or outline lighting 67.84 2
...
Signal circuit(s)or limited-energy
Address:402 Valley Ave NW Ste 106 • panel,alteration,or extension. El See Page 2 2
City/State/ZIP:Puyallup WA 98371 Each additional inspection over allowable in any of the above
Additional inspection(1hr min) 66.25/hr
Phone:(253)872-6051 Fax:(253)872-1801 Investigation(I hr min) 90.00/hr
• Email:bdaniels@gweusa.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
91:Low hr
CCB Lic.: C1158 Electrical Lic.: 208174 1 Suprv.Lie.: 44968 specifically listed(%hrininl
__ . .
•
.;:ii:-,:Z.:::iF.,. f401ettilOfki,ifiiCE :tuiiii:MKOniinli-.:
Suprv.Electrician signature,required: V)art/p, A--1-he,c1- -•- •
Subtotal: /pp.7t
Print name: Joan P Albert .. Date: 0 Plan Review Required(25%of permit fee): -----•
.,--- _ State surcharge(12%of permit fee):
Authorized signature:'\ ----•--- - TOTAL PERMIT FEE: //„2..7?
'Sins permit application expires If a permit to not obtained within 180
Print name: Bill Daniels Date: 1 I I I is, days after it has been accepted as complete.
* Number of inspections allowed per permit.
E\litaildingkItennitRELC_PennitappDLR Jlitadoo Rev 06/1712015 4404615T(11/05/CORIN/E8