Permit (258) 1111 CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT
Permit#: ELC2016-00886
Date Issued: 11/17/2016
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S108DB06300
Jurisdiction: Tigard
Site address: 15138 SW 154TH AVE
Project: Polygon at Bull Mountain,Lot 61 Subdivision: POLYGON AT BULL MOUNTAIN Lot: 61
Project Description: (1)branch circuit for A/C.
Contractor: ALAMEDA ELECTRIC Owner: KING, MICHAEL J
3415 NE 44TH YONEYAMA, NAOMI S
PORTLAND, OR 97213 15138 SW 154TH AVE
TIGARD, OR 97224
PHONE: 503-319-2192 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 11/17/2016 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 11/17/2016 $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 52-001-0090. Yoou�may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: G � 1Z�_ Permittee Signature: �''V ' " ''G' oh.0
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.
RECEIVEC)
_E_Ievtrical Perm it,Applig 1111111111111111.1111111111111111111.1
City ofTird
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13125 SW Hga
ail Blvd_Tiprd,OR 97224 ,,r r..,,,, i.,.,..,„), r-t, Plan RevMsi /
Phone: 5017182439 Fax; 503.598.1101 Y OF lik.li-•tni,/ tummy.
Inspection 1..ine: 503,639,4 175 NOV 1 4 2016
BUILDING OMSK)\RomlY OhIhatY"-
Internet www.tiprd-orvw - Notifiedhdettiott , Related Permit vi&---e:;20/6,-er7pdp-
Mit id See Page 2 far
supplemental taterwafitia
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New construction 0 Addition/alteration/replacement Pk**Cht4;diltai aPti;'ist(lanit isets of Plies wins checked)
a Service or feeder 400=plot mote 0 Billiditit over dame stones
0 Demolition 0 Other where dm available fault auxin CI Manna%lad boatyards,
• " 'T„ '''J.',-,:',.-...1:, - - ,,'`.'''.:17";:::', lir'I':,:;:i:•7:'•:"'';,,=;;N:;;;:':1:4:":".",g•,". • . .i.I. .:,1:
exceeds 10=00010P:at 150 volts or 0 Fiesints badahllts
Z.."! I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building tuis in pound,or excixds 14,000 0 Comintecial-use apiculture)
aims for all other tustallations buildings,
0 Multi-family 0 Master builder 0 Other: (3 Fire pnwp, Clinstaliationor ISO KVA or
a EvergeeeY systemlargar arParanaY aran'ca
0 Addition anew motor load of
Job#:#: Job site address • 5\AI I S 111j 100HP or incite 0-A',"E","1-r„,-1-3-,
0 six or more residential units, hhhuFancY
City/State/ZIP:Tigard,OR 97224 1:11tecreational vehicle parks,
CI Health-cm facilities.,
Suite/bldg./apt.ti: Project nam L I 1,Al , _ _,_ i, I a f . a Ili Hazardous!mations, 0 Supply voltage for more than
al Seivlee or feeder 600 amps or more 600 volts amimat
Cross street/directions to job site: ' -'-;;Iti'll.tIA ;');:;•
t,. - iacti Taut
-";
New residential single-or multi-family dwelling unit.
Subdivision // / A, I Lot# / Includes attached garage.
/ 11.4 , / I ILI.41 NV
Tax map/parcel . 1,000 sq,ft.or less 168.54 4
'„.•1'1-f'"„v":•:•17M 7"'"':''',,' ',„:" T;I: ,4 ;•";.,7,;:-;11,17.74;::417):I.Z.1' Ea.addi 500 sq.ft.or portion (
33.92 1
,149A111111111111111 Limited cc"?'res'd(Idial P75.00 2
(with above sq.ft_)
Limited energy,multi-family
75.00 2
•2‘. ';::::„:,„:J77•%Z.f':;•'•:,'„,-,' ::::".7,::1:7"IL7':.;4;C:?7::',",f7::;1-1-1L:-.;.„,.i::,,j,,7i,"::,;_.:,,:,it.'''' ',•:2.4 teidential(with ab"e sq." „
Name:ADVL Land Holdings,LLC Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Address:7600 E Doubletree Ranch Road
200 arnps or less 100,70 2
City/State/ZIP:Scottsdale,AZ 85258 .
201 amps to 400 amps 13156 2
Phone:(602)694-4031 Fax:(
Email: 401 amps to 600 amps 200.34 2
Owner installation:This installation is being made on property that I own which is not 601 amps to 1,000 amps 301.04 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701.
over 1,000 amps or volts 552.26 2
Owner signature: Date:
Tetpotservices or feeders installation,alteration,and/or
relocation
Business name:William Lyon Homes,Inc. 200 amps or less 59 36 1
Contact name:Angela Grajewski
201 amps to 400 amps 125.08 2
Address:109 East 13th Street
401 amps to 599 imps 168,54 2
City/State/ZIP:Vancouver,WA 98660 Branch circuits-new,alteration,or extension,pr panel
Phone:(360)695-7700 Fax::(360)693-4442 A Fee f°'branch circuits with
above service or feeder fee,
742 2
Email:Angela.Grajewskiagpolygonhomes.com each branch circuit
',:-' . .',...;.;.:',--.. •:... • ..:..:1-!'':',7'.:t'-!:;::7::::::. •-:.-:,,..:.J.1:.:27c:::'.:ir77:717::;:17-'''''',:';':); ":3;ff-r4a 11 Fee ft:er orbrafncil ciZilli7stith°°1
1 ' 56.18
2
Business name:*lamed*electric branch circuit /
Each sdd'l branch circuit 742 1 2
Address:3415 ne 44th
Miscellaneous(service or feeder not included)
CityIStateIZIP: Ai, ja , isia 407 ..7._/ Each manufac'ttred or modular 4
dwelling,service aridior feeder 6784
Phone:(503)3192192 Fax:( )
Reconnect only 67 84 2
Email:solarpda@me.com
Pomp Of imam=circle 67,84 2
CCB Lic.: 199188 Electrical Lic,: c923 Suprv.Lic.: 9.f7/_,S -
Sign or outline liglaing 6714 2
Suprv.Electrician signature,required:
Signal circuit(s)or limited-energy
Print name: k r it ,ise,„..‹, Date: Z3A§Il panel,alteration,or extension. 0 Ste Page 2 2.
Fawn additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66 25:hr
Authorized signaxre:
investigation(1 11((Tun/
IlaNilaintreviNuNNX_ _ELX,,EJLE40C R 061 V201 5 440-46151111/09C0MMEB