Permit (69) CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMENT Permit#: ELC2017-00870
T G,ri R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/22/2017
Parcel: 2S106DC00100
Jurisdiction: Tigard
Site address: 17096 SW ROCKY RAMBLE LN
Project: Polygon at West River Terrace,Lot 1 Subdivision:POLYGON AT WEST RIVER TERRACE Lot: 1
Project Description: Adding(1)branch circuit for NC installation.
Contractor: GARNER ELECTRIC WASHINGTON LLC Owner: WILLIAM LYON HOMES INC
402 VALLEY AVE NW, SUITE 106 109 E 13TH ST
PUYALLUP, WA 98371 VANCOUVER, WA 98660
PHONE: 253-872-6051 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 11/22/2017 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 11/22/2017 $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 0 952-001-0090. You may obtai a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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Issued By: .r/li{ Permittee Signature: Z'� CCel >cr/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.
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Electrical Permit Applicati. FOR c USE ONIXr
71 't 1C3�1 SW Hality of l B�1�vd Tigard,OR 972k30V 21 2097 D rd Received I �/ iJ
3 Plan Review r
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : / C�
TIGARD Inspection Line: 503.639.4175 CITY Y O TIGARD ReadyDateBy: Aids: l l See Pege2 for '"� /
uInternet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
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®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/item checked):
❑Demolition 0 Other: 0 Service or feeder 400 amps or more ❑Building over three strides.
where the available fault current 0 Ivfarinas and boatyards.
4 € xC5Tik Ct) YO �a.M � exceeds 10,000 ampsat 150 volts or �Floatin buldin
$s.
®1-and 2-family dwelling ❑Commercial/ilidustrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.•
0 Multi family 0 Master builder 0 Other: ❑Fireum .
p p ❑Installation of 150 K VA or
.x. .c;' 'r'„.>.r-a1Ol txg I Et(� ,I {) t p3 C t1 C t)m.x_ y.. _ . -i_. 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address:1 1 all t,sof gob,/ gam12 team, 10011P or more. ❑"A",`> ',`1-z,-r-s°',
i ❑Six or more residential units. occupancy.
City/State/ZIP:Tigard,OR 97224 ❑Health-care facilities. 0Reoreattonal vehicle parks.
Suite/bldg./apt,#: 1 Project name:Polygon at West River Ter 0 Hazardous locations. ❑Supply voltage for snore than
0 Service or feeder 600 amps or more. 600 volts Homme!
Cross street/directions to job site: K3x,- 1 . tel
Description l Qty. I Earl, 1 Total 1
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at West River Terrrace Lot#:1 Includes attached garage.
1.000 sq.ft.orless 168.54 4
Tax map/parcel#:
Ea.add'1500 sq.ft.or portion 33.92 1
- "n t W QMi "`^ J'.`s � r k ....s. < Limited energy,residential
44 t ° Yt dt r (with above sq.R) 75'00 2
V Limited energy,multi-family 75.00 2
residential(with above sq.tt.)
rENVW : nergy ❑ See Page 216 f ":9�MMr K - - RSevevasboer Eeders
installation,alteration,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 I 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 Iess 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 .
...� �_ '"m gar R P o m ' Araee for branch circuits alteration,or extension,per panel
s- n ate. r .,ass?; 'z.. ;
Business name:William Lyon Homes,Inc. above service or feeder fee I
each branch circuit 742. 2 I ,
Contact name:Angela Grajewski B.Fee for branch circuits without
service or feeder fee,first
Address:109 East 13th Street , 56,18 2
branch circuit
City/State/ZIP:Vancouver,WA 98660 Each add')branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360)695-7700 • . Fax::(360)693-4442 Each manufactured or modular
Email:An e[a.Gra'ewski dwelling,service and/or feeder 67.84 2
g ) ®polygonhomes come
a �u Reconnect only 67.84 2
r�
-. -:-a`r,' Q1M f _" a.-�':'-F' 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:6101 NE St Johns Rd panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP:Vancouver WA 98661 Each additional Inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:(253)320-1657 Fax:( ) Investigation(I hr min) 90.00/hr
Email:bdaniels@gweusa.com
Industrial plant(1 hr min) 78.18/hr
Inspections for winch no fee is
CCB Lie.: C1158 Electrical Lie.: 208174 I Suprv.Lic:: 4496S specifically listed('h hr min) 9000/hr
Suprv.Electrician signature,required: ,A�A t� .f Subtotal:
,E
Print name: Joan P Albert Date: 4/26/2016 0 Plan Review Required(25%of permit fee):
l — State surcharge(12°%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a petvittis not obtained within 180
Print naive: Bill Daniels Date: 4/26/2016 days after It has been accepted as complete
* Number of inspections allowed per permit.
I:SBuildingtPermtu Lc.PermitApp_ELR ERE.dao Rev 06/172015 440-46151(1I/OSICOM/WEB
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