Permit (109) ,,II CITY OF TIGARD ELECTRICAL PERMIT
Iit COMMUNITY DEVELOPMENT Permit#: ELC2017-00563
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/27/2017
Parcel: 251080001500
Jurisdiction:
Site address: TRACT D
Project: Polygon at Bull Mountain-Park at Hawk Ridge Subdivision: Lot:
Project Description: (1)200 amp service and(2)branch circuits for controller,light and outlet at park shelter on Tract D at the SW
corner of Missouri Ave and Hawk Ridge Rd.
Contractor: ALAMEDA ELECTRIC Owner: POLYGON WLH, LLC
3415 NE 44TH 703 BROADWAY ST, SUITE 500
PORTLAND, OR 97213 VANCOUVER,WA 98660
PHONE: 503-319-2192 PHONE: 360-695-7700
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 07/27/2017 $100.70
Specifics: amps or less
2 crt Branch Circuits w/Purchase 07/27/2017 $14.84
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 07/27/2017 $13.86
Electrical
Type of Const:
Occupancy Grp:
Total $129.40
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 952-0 1-009 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: j % . Permittee Signature: /.lfAC P Al (147-70A
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 Application RECEIVE_, .. R��ElVE _ 7,01i,w �r .FOR OFFICE USE:O\Ll �`�' 1s-0(":
City13125 SW ojTigarBlvddTigard,OR
JUL 2 7 2017 :Ive47.27 /7 % Permitlk�Gr /' -0054
11? Hall 97223
oSP9t i09t13?3 :2439;•Pax. 503.59811960 44' 195111111111111111111111111
Related Pesmitfl:.
�pedi nLine: 503.639.4175.4�dCITY OF TIGN' ;0 Dattel kik H dee Pagel for
T i G A R D .it 1 g"' vi",, , ,etbod : Supplemental Information
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®New construction 0 Addition/alteralion/replacement Please olwrc all that apply(submit a sets ofplans wfttetns checked):
❑Demolition 0 Othe ❑Service orfeeder 400amps ormore ❑Building over three stories.
'� '' !'1 t`�ilti'�O `CO where tbe.available fault current O Marinasaad boatyards.
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