Permit (60) ,
71 CITY OF TIGARD ELECTRICAL PERMIT
4 ',, COMMUNITY DEVELOPMENT Permit#: ELC2017-00475
13125 SW Hall Blvd.,Ti Date Issued: 06/22/2017
T C �1R. and OR 97223 503.718.2439 9
Parcel: 2S10DC13000
Jurisdiction: Tigard
Site address: 17082 SW JEAN LOUISE RD
Project: Polygon at West River Terrace,Lot 130 Subdivision:POLYGON AT WEST RIVER TERRACE Lot: 130
Project Description: (1)branch circuit for NC unit.
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 06/22/2017 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 06/22/2017 $6.74
Type of Use: Electrical
Class of Work:
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through 0 R 952-001-00•$. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
4.- /
Issued By: 4 Permittee Signature: l lit..1'//l[r-t.7h L.
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.
Electrical Permit Appli FOR OFFICEUSE ONLY
City of Tigard
te"'�� te�is ��
w 13125 SW Hall Blvd.,Tigard,OR p Plan Review r`� w
= Phone: 503.7182439 Fax 503.599 2 2 2017 nate1B . r u c..--A. 1
T i GJ1 Ci I), Inspection Line: 503.639.4175 Ready AateBy: Tads: n gee Page 2 for
Weiner want-tigatd-org" CITY'V OF. TIGARD Notified/Method: Supplemental Information
, _
... a°.,,.s .:.. .;;1. ' sam%.a'r--1.1 i��'-
o ;er dT ", ,Kte{>_- ,',en .-a-ae -,-krAi v�j f', 'i•;5,. •.`p . i' ''rtwi: 1Xji A ;g'•
®New construction ❑Addition/alteration/replace-ft-rent Please check all that apply(submit 2 sets of plans wlitema checked):
0 Service or feeder 400 amps or more 0 Building over three ste5ies.
❑Demolition ❑Other where the available fault sonnet DMarinas and boatyards,
-,--,,,1,4."s,V �' ' k ,^1''B C if ;4M ;.sow. exceeds 10,000 amps at 150 volts or D Floating buildings.
®I-and 2-family dwelling ❑Commercial/iridtistrial 0 Accessory building lase to ground,or exceeds 14,000 D Commercial-use agricultural
amps for all other installations. buildings.•
❑Multi-family - 0 Master builder 0 Other: 0 Fins pump. D Installation of 150 KVA or
gin c g .,1-:#07010M81..,„.,.... �'' Mc?a0.i. ' `IR D Add bgencyonew motor load of system lar�m•ger parateiy derived
Job#: Job site address:!7067__ Sw j.O.n t ,/o�� loom,or more. 0"A",`B","1-2"."1-3",
Go
City/State/ZIP:Tigard,OR 97224 D Six or more residential nails. occupancy.
D Health-care facilities. 0 Recreational vehicle parks.
Suiteibidg./apt.#: Project name:Polygon at West River Ter Dliazardona locations, 0 supply voltage for more than
D Service or-feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: t ''W"- ,,,- M ,:i t'(E Utligratigage
Descried= I Qtr. Each I Total ) "
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at West River Terrrace Lot*430 Includes attached garage.
Tax map/parcel U. 1.000 .ft lesft
A _ ,C-..= ✓'g i . 6i. 0. � b.1%', `:',.;::'.4,....4.--;:: :".' ,� m. 4. i La.add en .Or tial
or 168.54 4
500 sq. portion 33.92 1
��'`� �, mow-. ,�,, _. �.:." ^t:�-_�s. s 'd 'C:�," '" '�r,( Limited energy,residential
11 STM1(e- °03Crii (with above sq.ft-) 75.00 2
r!,j l cJ� Limited energy,multi-Rattily 75AD 2
residential(with above sq.tt)
" lve"aA' sl" r s a '''., � s Renewable Energy D SeePage2
�' —t-`' ` ` `-- ' lin, y, ��F !2.1, ,- Services or feeders installation,alteration,and/or relocation
Name:ADVL Land Holdings,LLC 200 amps or less 100.70 2
Address:7600 E 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
' 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 5936 i
intended for sale,tease,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
•.` zt sc�`:�a ?: ff l's '.--'•• -• o"—'''i`r.tom - e' = ;i 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, 742 2
each branch circuit
Contact name:Angela Grajewski B.Fee for branch circuits without
' service or feeder ibe,first t 56.18 2
Address:109 East 13th Street branch circuit ...
City/State/ZIP:Vancouver,WA 98660 Each add'i branch circuit• 7.42 2 j
Miscellaneous(service or feeder not included)
Phone:(360)695-7700 • ' ' Fax::(360)693-4442 Each manufactured or modular `
67.84 2
dwelling,service and/or feeder j
Email:Angela.Grajewslti®polygonhomes.com Reconnect only 67.84 2
:iv`4ll:":, 3 !- tib e°Al 'rµ:D, �*`is1 Z4e4Z.k'a.:.,aP ,crY1 4:Y 1'.
�, � ,.--,=;�� �-+-- �c�.2 � .. Pump or irrigation circle 67.84 2
Business name:Garner Electric Washington,LLC ' Sign or outline lighting 67.84 2
4.^-.. Signal circuit(s)or limited-energy
Address:6101 NE St Johns Rd panel,alteration,or extension. D See Page 2 2
City/StatelZlP:Vancouver WA 98661 Each additional Inspection over allowable in any of the above f
Additional inspection(1 hr min) 6625/hr t
Phone:(253)320-1657 Fax:( ) Investigation(1 la min) 90.00/In
Email:bdaniels@Igweusa.com Industrial plant(1 hr rain) • 78.I8lbr
inspections for which no fee is 90 00/In
CCB Lic.: C1158 Electrical Lic.: 208174 I Suprv.Lic.: 44965 specific& listed(r%hr min) ,
1 .. x k t , - - .? ' Via. s i
Suprv.Electrician signature,required:_Leap/f C.t.6. f
�, Subtotal:
Print name: Joan P Albert Date: 4/26/2016 0 Plan Review Required(25%of permit fee):
y!...1: t' ' _____ State surcharge(12%of permit fee):
W...:,, Authorized signature: __ y ~� TOTAL PERMIT'FEE: I
:4,.:.: This permit application expires if a parmitis not obtained within 180
'i;i,' Print name: Bill Daniels Date: 4/26/2016 days after tt has been accepted a$complete. a
-11:rr baUdirgU'aratlFS,C_eamitApp t3[.It„F]tE.do:gay 06/1712015 44o.4615Tt11/05/COMIVIf,B " Number ofinspactionsauowedperparwit. �� -
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
17082 SW JEAN LOUISE RD, SHERWOOD, OR, June 27, 2017 at 3:09:13 PM
97140
Record Type: Record ID:
Residential - Electrical ELC2017-00475
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS - NoCofO
Comments:
Electrical final for AC ok.
Violation Summary:
Inspector Contractor