Permit (112) CITY OF TIGARD ELECTRICAL PERMIT
^� COMMUNITY DEVELOPMENT ELECTRICAL
ELC2018-00668
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/11/2018
T t r1 R I) g Parcel: 2S108DB04600
Jurisdiction: Tigard
Site address: 15385 SW THAMES LN
Project: Polygon at Bull Mountain,Lot 44 Subdivision: POLYGON AT BULL MOUNTAIN Lot: 44
' Project Description: Adding(2)circuits for BBQ and outdoor fireplace.
Contractor: ALAMEDA ELECTRIC Owner: POLYGON WLH LLC
3415 NE 44TH 109 E 13TH ST, STE 200
PORTLAND, OR 97213 VANCOUVER,WA 98660
PHONE: 503-319-2192
PHONE: 360-695-7700
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 10/11/2018 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 10/11/2018 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR -001-0090. Y. ay obtain a c, •f the rules or di -ct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ,
Issue
d By: L& / LQ/ PeriSignature: 772lIi/?)4 _OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application - C" m _ - FOR OFFICE USE ONLY
- City of Tigard OCT c3 �y(1 S p Received
ill tJ tJ L U I 0 Date/By: r I • ��
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598 1960 T-7 / _y i t ,(-�r1 Date/By: �A
Inspection Line: 503.639.4175 t , . Ready Date/By: kris. See Page 2 or
T 1"A R D, Internet: www.tigard-or.gov BUILDING f ' 1 3`' 1 Notified/Method: Supplemental Information
Vit... s„< „,_t JI71 O$tFVORH , L a 1 PLAN REVIEW
®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other:
where the available fault current ❑Marinas and boatyards.
'.CATEGORY'OF CONST1WCTION , exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
+,
JOB`.S1TE INFORMA'IIONAND:`T.O'CATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 15 3 SS goy iliAvAts rinse. boli or more. ❑"A","E","1-2","1-3",
^1
0 Six or more residential units. occupancy.
City/State/ZIP:�r+ 91-2$4 O j, O ❑Recreational vehicle parks.
0 Health-care facilities.
Suite/bldg./apt.#: Project name:Polygon at Bull Mountain 0 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!SCRI DIJLE ,
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at Bull Mountain Lot#:4£4 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 I
DESCRIPTION'O.F,',WORI r, . Limited energy,residential 75.00 2
w //�1�� � (with above sq.ft.)
b 2 Cl L&...TS I t. ` ,�,�+L /s biAc.� c f.CISI Limited energy,multi-family 75.00 2
I . bAc-1,-- pF ` e roti)( LAria4scorP& TZNA4r. residential(with above sq.ft.)
Renewable Energy 0 See Page 2
_El PROPERTY`.OWNER={" 0 TENANT Services or feeders installation,alteration,and/or relocation
Name:Polygon WLH,LLC 200 amps or less 100.70 _ 2
Address:703 Broadway St,Ste510 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Vancouver,WA 98660 601 amps to 1,000 amps 301.04 2
Phone:(360)695-7700 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 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
.® AI'PIIICANT„, 0 CONTACT PERSON Branch circuits-c new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Polygon WLH,LLC above service or feeder fee,
7.42 2
each branch circuit
Contact name:Jolene Smith B.Fee for branch circuits without
Address:703 Broadway St,Ste.510r
Emailfirst circuit i
City/State/ZIP:Vancouver,WA 98660 Each add'I branch circuit , 7.42 2
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
Email:permitsubmittals@polygonhomes.com Reconnect only 67.84 2
CONTRA CTOR. Pump or imgation circle 67.84 2
Business name:*lamed*electric Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address:3415 tie 44th / panel,alteration,or extension. ❑ See Page 2 2
nor./ja,„,, r /.O/Z 2,..7.--/3 Addit additional al ec inspection over allowable in2 any of the above
Ci /State/ZIF:� �
� _ Additional inspection(1 hr min) 66.25/hr
Phone:(503)3192192 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:solarpdx@me.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 199188 Electrical Lie.: c923 Suprv.Lic.: y f7/5 specifically listed(V5 hr min)
ELECTRICAL PERMIT FEES
i Suprv.Electrician signature,required:
Subtotal:
Print name: k I lc l/epv( Date: ''Z3,//,d 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
I
Print name: / �� D8ces� f j-� days after it has been accepted as complete.
l * Number of inspections allowed per permit.
I:\Building\Permits\ELC PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB