Permit (63) qCITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2016-00728
Date Issued: 09/26/2016
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S106DC11400
Jurisdiction: Tigard
Site address: 17372 SW JEAN LOUISE RD
Project: Polygon at West River Terrace, Lot 114 Subdivision:POLYGON AT WEST RIVER TERRACE Lot: 114
Project Description: (1)branch circuit for A/C.
Contractor: GARNER ELECTRIC WASHINGTON LLC Owner: ADLV LAND HOLDINGS LLC
402 VALLEY AVE NW, SUITE 106 7600 EAST DOUBLETREE RANCH RD, STE
PUYALLUP,WA 98371 SCOTTSDALE,AZ 85258
PHONE: 253-872-6051 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 09/26/2016 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 09/26/2016 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 0 95 46090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: . Permittee Signature: l/1//' ��it el-7 7e,Al
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 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.
,i
Electrical Permit Apjaiica 1®!! FOR OFFICE USE ONLY
City of Tigard SEP 2 6 2016 Received , ' FGC / "
Date/B : eNd I47r Permit g: 6--0d 7��3
IN a 13125 SW Hall Blvd.,Tigard,OR 97223 V
Phone: 503.718.2439 Fax: 503 q Plan Review
F 1 I� Related Permit#
Inspection Line: 503.639.4175 �' Ready Date/By: �`'l>rC ►/Ia-tel,7
TIGARD UILDI GD ISIui Date/ )oris S plePent 2 lInf
� Internet: www ttgard Ot gOV >t T Notified/Method: Supplemental Information
..., ,.... TYPE OB WORD
p eme
EMMENOWEVECORECREi W
El New constructions Please check all that apply(submit 2 sets of plans w/stems checked):
Demolition ❑Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current ❑Marinas and boatyards.
:Ve%WM,:::11:gi:;:giggaMigiZSIEVAII06008000iEgOgAMOOTT.01Wingigagragianga exceeds 10,000 amps at 150 volts or
0 Floating buildings.
�� _ (♦ tbuilding less to ground,or exceeds 14,000 ❑Commerci l-use agricultural
El Master builder 0
arnps for all oUrer installations. buildings.
Other:
❑Fire pump. ❑Installation of 150 KVA or
9 ' ® • t ® ® k ❑Emergency system, larger separately derived
0 Addition of new motor load of system.
address:
100HP or more. 0"A","E","1-2","1-3",
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units_ occupancy,
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/blSuite/bldg./apt. ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCIDLILE:;
-�.. Description ........:......
1 Qty. � Each I Total
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at West River Terrrace I Lot#: 1 i q
I Includes attached garage.
Tax map/parcel#: I,000 sq.ft.or less 168.54 4
-. ,; DESCRIPTION,O1' WOR? tial tr 33.92 1
Ea.add'l 500 sq.ft or portio
IVO(� _ Limited energy,residential
U- Ac ` iJ /^t t I - c/`� ( F)a" (with above sq.ft) 75.00 2
llL///"' l/� lf� Illi J Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
I TEN Rew
® P1IOPERT OWNER f ,._ . ❑..,, A1�T rs ❑ Sge 2
Servicesneorable feedenerrs installation,alteratioeenPa,and/or relocation
Name:ADVL Land Holdings,LLC 200 amps or less 100.70 2
Address:7600E Doubletree Ranch Road 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Scottsdale,AZ 85258 601 amps to 1,000 amps 301.04 2
Phone:(602)694-4031 Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
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
l
®' tI;Ienr1T Q;CONTACT,PERSON Branch circuits—new,alteration,or extension,per panel
�-- " `• • A Fee for branch circuits with
Business name:William Lyon Homes,Inc. above service or feeder fee,
each branch circuit 7.42 2
Contact name:Angela Grajewski B.Fee for branch circuits without
Address:109 East 13th Street
service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP:Vancouver,WA 98660 Each add'l branch circuit 7.42 2
Phone:(360)695-7700 Fax::(360) Miscellaneous(service or feeder not included)
693-4442 Each manufactured or modular 67.84 2
Email:Angela.Grajewski@polygonhomes.com dwelling,service and/or feeder
r Reconnect only 67.84 2
r
�.. .,. CONTRACTOR;
Pump or irrigation circle 67.84 2
Business name:Garner Electric Washington,LLC Signor outline lighting 67.84 2
Address:6101 NE St Johns Rd Signal circuit(s)or limited-energy ❑ See Page 2 2
panel,alteration,or extension.
City/State/ZIP:Vancouver WA 98661 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(253)320-1657 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:bdanlels@gweusa.com Industrial plant(1 hr ruin) • 78.181 hr
Inspections for which no fee is
CCB Lic.: C1158 Electrical Lic.: 208174 Luprv.Lic.: 44965 specifically listed('/a hr mm) 90 00/hr
. - _ : ELECTRICAL. PR;MI' )ER$. . .4
Suprv.Electrician signature,required: 40 A • .. A .
Subtotal:
Print name: Joan P Albert • Date: 4/26/2016 0 Plan Review Required(25%of permit fee):
'` State surcharge(12%of permit fee):
Authorized signature: = — TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Bill Daniels Date: 4/26/2016 days ntmr it has been accepted as complete.
* Number of inspections allowed per penult
llBuildinglpermit$,5LC PermitApp_ELR ER6-doe Rev 06/17/2015 440-4615T(]1105/COM/WEB