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Permit (135) CITY OF TIGARD ELECTRICAL PERMIT F . t COMMUNITY DEVELOPMENT Permit#: ELC2018-00773 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/03/2018 T f °O Parcel: 2S106DA10400 Jurisdiction: Tigard Site address: 16944 SW BIRDSONG ST Project: River Terrace East, Lot 104 Subdivision: RIVER TERRACE EAST Lot: 104 Project Description: (1)branch circuit for NC installation. Contractor: APEX AIR LLC Owner: ADLV LAND HOLDINGS LLC 2210 W MAIN ST STE 107-272 BY FORSUM, MICHAEL BATTLEGROUND,WA 98604 7600 E DOUBLETREE RANCH RD STE 1 SCOTTSDALE,AZ 85258 PHONE: 602-694-4031 PHONE: 360-342-8109 FAX: FEES Quantity Description Date Amount 1 crt Branch Circuits wo/Purchase 12/03/2018 $56.18 Specifics: Service or Feeder 1 ea 12%State Surcharge- 12/03/2018 $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, •r suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notificati• ••--3/4 : Those r,es are set forth in OAR 952-001-0010 through OAR 952-001-0090. You m nht �n opy r direct questions to OUNC by callin• :13.x3'19:7• 1.800.332.23'4. \ / c� i �( Issued By: X-027.."--, PL+'rmefee Signature: 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.Afirtlicatn'Ol; , f t, �..*OR OR 10E 11 Sr ONLY . , Received �7 v l SIC U TipQ' Date/By: /4 3 i�" err Permit 8: J./.(.,9.6 i�'r ie.)-73 't 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ®`'. Phone: 503.718.2439 Pax: 503.598.1960, -3, 't 11 Date/By: / Related Permit tl -a- i _ �-"yy j ii ;s Y 7 W 3,�I :. Inspection Line: 503.639.4175 Ready Date/By: Juds: II ee Pa e2 for t i `TIGARD,' Internet: wtvtv.tigard-or.gov Notified/Method: s c Supplementallnformltnon , E OR W©RI� t e z ' ,(. PI 4N REVIEW ' r l ®New construction ❑Addition/altt#1 tttpl7/teplacethent Please check all that apply(subtmt 2 sets of plans w/items checked) L',. ID Demolition Other: 1:1 Service or feeder 400 amps or more 0 Building over three stories. where the available fault current ❑Marinas and boatyards. : C4 J'ECO.RY OF CONSTRIJCTION '+ exceeds 10,000 amps at 150 volts or6 ❑Floating buildings. ® I-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural il amps for all other installations. buildings. 0 Multi family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or 11 JOB SITE INFO Rld)•ATION AND.:LOCATION 0 Emergency system. larger separately derived ❑Addition of new motor load of system. 1 Job#: Job site address:V._RqL.\L LAW"C--..,i.v A..(" Cr-).(k. V 1001 or more. I. City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy. Suite/bldg./apt.#: Project name:Polygon at `� ❑Haza dous locations.catiie ❑Supplytio Recreational vehicle parks. t v��=����� ❑Hazardous ❑Supply voltage for store than 0 Service or feeder 600 amps or more, 600 twos aormnal z Cross street/directions to job site: t-t� ,„,..:-V. ....-` • tv y� - FEE_,SC1EPULE 11 Description I Qty. I Each l Total I a i New residential single-or multi-family dwelling unit. Subdivision:Polygon at %•'e.„r," \, .uv--;:a..,; Lot#: .1 C Includes attached garage. Tax map/parcel#: 1,000 sq.ff.or less 168.54 4 • Ea.add'I 500 sq.ft.or portion 33.92 1 f .DE,SGRLP'I'ION t)F WORK. Limited energy, ' residential 75.00 2 1 (with above sq.ft.) I Limited energy,multi-family 75.00 2 residential(with above sq.ft.) _ ,a uPR r Renewe Energy ❑ See Page 2 1 S - OIPDR'>IY O}N1GR ❑ TENANT;.' Services ablor feeders installation,alteration,and/or relocation Name:Polygon WLI1,LLC 200 amps or less 100.70 2 Address;109 East 13th Street 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 Email: Temporary services or feeders installation,alteration,and/or i relocation II 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 i<„i1PRLICANT; CQ [] 1rITA CT PERSON, Branh -nw,altetion,or extension,per panel AB Feeeforcircuits branch circuitsewithra Business name:Polygon WLJJ,LLC (9.6 L ;,1,3,--z above service or feeder fee, 7.42 each branch circuit Contact name:Angela Grajewsici B.Fee for branch circuits without Address:109 East 13th Street service or feeder fee,first / 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 dwelling,service and/or feeder 67.84 2 Email:Angela Grajewski®polygonhomes con Reconnect only 67.84 2 -`rJ+ }ig. ,.,.,,itt:Q)0TtAC'I'Olt Pump or irrigation circle 67.84 2 Business name:Garner Electric Washington,LLC Sign or outline lighting 67.84 2 i Signal circuit(s)or limited-energy Address:402 Valley Ave NW Ste 106 . panel,alteration,or extension. ❑ See Page 2 2 City/State/ZIP:Puyallup WA 98371 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:(253)872-6051 Fax:(253)872-1801 Investigation(1 hr min) 90.00/hr Email:bdaniels@gweusa.cotn Industrial plant(l hr min) 78.181 hr Inspections for which no fee is CCB Lie.: C1158 Electrical Lie.: 208174 I Suprv.Lie.: 4496S specifically listed(Vs hr mut) 90.00/hr _ Suprv.Electrician signature,required: EI ICTRICAL PERI IF FJt*jS . �� 7 1'D'-�`�' Subtotal: Print name: Joan P Albert - Date: ❑Plan Review Required(25%of permit fee): —`: State surcharge(12%of permit fee): Authorized signature: =yam- 1 ' TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within ISO Print name: Bill Daniels Date: days after it has been accepted as complete. a Number of inspections allowed per permit. iF I1BuildingTermitstELC_PcnnitApp_ELR ERE.doc Rev 06/17/2015 440-4615T(l l/051COb1/VEa (! i 1 I 1 . - City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 16944 SW BIRDSONG ST, BEAVERTON, December 4, 2018 at OR, 97007 10:52:22 AM Record Type: Record ID: Residential - Electrical ELC2018-00773 Inspection Type: Inspector: 199 Electrical final Jeremy Burrows Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor