Permit (158) CITY OF TIGARD ELECTRICAL PERMIT
Ill q
COMMUNITY DEVELOPMENT Permit#: ELC2018-00807
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/12/2018
f g Parcel: 2S 106DA00500
Jurisdiction: Tigard
Site address: 13335 SW 169TH AVE
Project: River Terrace East,Lot 5 Subdivision: RIVER TERRACE EAST Lot: 5
Project Description: (1)branch circuit for A/C installation.
Contractor: PRO HEATING AND COOLING INC. Owner: WILLIAM LYON HOMES INC
2095 NW ALOCLEK DR, SUITE 1103 703 BROADWAY ST STE 510
HILLSBORO, OR 97124 VANCOUVER,WA 98660
PHONE: 503-443-5692 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 12/12/2018 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 12/12/2018 $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 ap licable 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 ispended for more the 180
days. ATTENTION: Oregon law requires you to foil• the rut 5-4dopted by the Oregon Utility Notification Center. Those, les are set forth in OAR
952-001-0010 through OA' 952-001-0090. Yo of the rules• direct questions to OUNC by calling 503.23 !•87 or 1.800 3 .2344.
Issued By: `rte , - ••- 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.
•
E1 Iectlrica1 Permit Application :•,J oR oFucE ush ONLY
Received J y r
Pr City ofTigard a it • /aC//�r�iP Petnul f1: �C, /'l�r: ii ir
13125 SIV Hall Blvd.,Tigard,OR 97223 ,111!4 i•,,
1
Phone: 503.718.2439 Fax: 503.598.1960 s tlRl� Related Permit 8li
:
B'htiL:?l C.fes
T1CARD' Inspection Line: 503.639.4175 Ready Date/By: Juris: 121 See Page 2 for
Internet: www tigard of gov DEC /1vletIiod:
C.I 9 a 44tk Supplemental Information ft
$ • TSE OF'WORI{ 1 l,v Lt' .`�'y :?' PL4;N'RI6VIEW
®New construction ❑Addition/alteration/replac l l t T K. AF� Please check all that apply(submit 2 sets of plans w/items checked):
1
❑Dem01it10ri ❑Other 11'� �� n/IQI� ervice or feeder 400 amps or ma Building over thrstories. i
❑where the available fault current r Q Marinas and boatyards.
P"
CA,rEGORY OF CONSTRUCTION _ exceeds 10,000 amps at 150 volts or ❑Floating buildings.
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural K.
amps for all other installations. buildings. 11
0 Multi-family 0 Master builder 0 Other:
0 Fire pump. ❑Installation of 150 RVA or i`
''.r:JOB SITE INFORMATION.AND LOCATION ❑Emergency system. larger separately derived li
' ['Addition of new motor load of system. E
t.
Job#: Job site address: 3 s„, ,t'T�+ IOOHP or more.
City/State/ZIP ❑Six or more residential units. occupancy,
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name:Polygon at Bull Mountain ❑Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 Volta nominal.
Cross street/directions to job site: S°GI L L S
'� FtC$0.FILAULE :, 1
Description I Qty. I Each I Total I '.. 5
New residential single-or multi-family dwelling unit. R
Subdivision:Polygon at 5T R-W 1 12 AtC t Lot#: 5 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'I 500 sq.ft.or portion 33.92 1 I
`AESCKIPTION OP WORK. Limited energy,residential _ 1
(with above sq,ft.) 75.00 2 1
,.Q'�D akI'c 4 .A C_ u)1— _ i
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Enemy ❑ See Page 2
rYI�LOkEY O�VL(ER ❑ "TENANT Services or feeders installation,alteration,and/or•relocation
Name:Polygon WLH,LLC 200 amps or less 100.70 2 I
Address:109 East 13th Street 201 amps to 400 amps 133.56 2 1
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
tt
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 less 59.36 _1
intended for sale,lease,tent,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
,r;1?,A,:o.ko NT, CONTACT PERSON an , ltor extension,per panel
BrA-Feendt forcircuits—branch circewuits with
Business name:Polygon WLH,LLC above service or feeder fee, 7.42 2
each branch circuit
Contact name:Angela Gra jews[fi B.Fee for branch circuits without
Address:109 East 13th Street service or feeder fee,first 56.18 Sz I g 2
branch circuit
City/State/ZIP:Vancouver,WA 98660 Bach add'I branch circuit 7.42 2_
Miscellaneous(service or feeder not included)
Phone:(360)695-7700 Fax::(360)693-4492 Each manufactured or modular
67.84 • 2
dwelling,service and/or feeder
Email Angela Gralewsln@polygonhomes coo
Reconnect only 67.84 2
. , A l ' r• OTQR _ . . .. .., _ 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: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 mm) 66.25/hr
Phone:(253)872-6051 Fax:(253)872-1801 Investigation(1 hr min) 90.00/hr
Email:bdaniels@gweusa.com Industrial plant(1 hr mut) 78.18/hr
Inspections for which no fee is 1
CCB Lie.: C1158 Electrical Lie.: 208174 I Suprv.Lie.: 44968 specifically fisted(V2 hr min) 90.001 hr
Suprv.Electrician signature,required: 1:1b2/1/jai kt L v, L EI)GTRIt Ai P112tYi[T FIiS
_ Subtotal. ::,-.Z.
Print name: Joan P Albert Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: _ ...... ._. TOTAL PERMIT FEE: r
This permit application expires if a permit is not obtained within iSO
Print name: Bill Daniels Date: days after ithas been accepted as complete.
* Number of inspections allowed per permit.
I:BBuildIog\Permits\ELC_PermitApp ELn ERE doe Rev 06/17/2015 440-4615T(it/OS/COM/LVEB 11
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13335 SW 169TH AVE, BEAVERTON, OR, 97007 December 13, 2018 at
2:08:48 PM
Record Type: Record ID:
Residential - Electrical ELC2018-00807
Inspection Type: Inspector:
199 Electrical final Jeremy Burrows
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor