Permit (47) CITY OF TIGARD ELECTRICAL PERMIT
I COMMUNITY DEVELOPMENT Permit#: ELC2019-00168
Date Issued: 04/01/2019
T I(;A it.ID 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S 107AA14600
Jurisdiction: Tigard
Site address: 16537 SW SUNSHINE COAST ST
Project: Polygon at Roshak Ridge,Lot 146 Subdivision: ROSHAK RIDGE Lot: 146
Project Description: Temporary power for sales trailer.
Contractor: ALAMEDA ELECTRIC Owner: POLYGON WLH LLC
3415 NE 44TH 703 BROADWAY ST STE 510
PORTLAND, OR 97213 VANCOUVER,WA 98660
PHONE: 360-695-7700
503-319-2192
FAX:
FEES
Quantity Description Date Amount
1 ea Temp Services or Feeders- 03/19/2019 $59.36
Specifics: 200 amps or less
1 ea 12%State Surcharge- 03/19/2019 $7.12
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $66.48
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 yo to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 001-009 . You obtain�aiinaaccopyy oftherules or direct questions to OUNC by calling 503.232.1 87 or 1.800.332.2344. •
�j
Issued By: ,G "(/� `6�" Permittee Signature: CT OL7r��d� ll/-.
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.
t,
- d
Electrical Permit Application 1,1 A 0 , FOR OFFICE USE ONLY
City of Tigard Received AM/III
IN • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
2, Phone: 503.718.2439 Fax: 503.598.1960'- i y,, Date/B • Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: furls: ® See Page 2 for
T I G A R D Internet: www.tigard-or.gov Notified/Method: Supplemental Information
,z = TYli OF s'ORK FL , --.-. _ *a_. P)yA1\( REVIEW; -'T -;,
E New construction 0 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.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
: ;•C E(QRYY QF CONSTRUCTION = , ,:,..:-. amps at or 0 Floating buildings
exceeds 10,000 150 volts
E 1-and 2-familydwelling ❑Commercial/industrial 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 ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
l _(: : 3tiB 51TT. N1`OIiMAtiONAsito'LomOCATIQN ...; .:• ['Emergency eecY system. larger�
Paratel
derived
0 Addition of new motor load of " tem.
Job#: Job site address: 1 te°531 G1 ) � \ re Cali- looBPor more. 0"A",
"E","1-2","1-3",
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occiPancY•
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Polygon At Roshak Ridge 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominaL
Cross street/directions tosite:
J .:,: FEE;:SCAEAULE t' -
Description I Qty. I Each I Total I "
New residential single-or multi-family dwelling unit
Subdivision:Polygon at Roshak Ridge Lot#: \y(p Includes attached garage.
' 1,000 sq.ft.or less 168.54 4
Tax map/parcel#
Ea.add'1500 sq.ft.or portion 33.92 1
.:..DE3cRIVTION;OF`WORK. Limited energy,residential
_t€ (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
® PItOPERTY:OWNER- •i_ . ❑;TENANT; Services or feeders installation,alteration,and/or relocation
Name:William Lyon Homes,Inc. 200 amps or less 100.70 2
Address:703 Broadway St Suite 510 201 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:(360)693-4442 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 1 59.36 9/3 a 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
APPT ICAIVT ❑.CONTACT PERSON.
Branch circuits—new,alteration,or extension,per panel
. ;
A.Fee for branch circuits with
Business name:William Lyon Homes,Inc. above service or feeder fee,
7A2 2
each branch circuit
Contact name:Nichole Thorpe B.Fee for branch circuits without
Address:703 Broadway St Suite 510
service
Mr nch circuitfee'first 56.18 2
City/State/ZIP:Vancouver,WA 98660 Each add'l 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:permitsubmittais@polygonhomes.com Reconnect only 67.84 2
:CONTRACTOR
`= - � T': : Pump or irrigation circle 67.84 2
Business name:Alameda Electric Sign or outline lighting 67.84 2
ial mited-energy
Address:3415 NE 44th panneel,alteration,)
l eratiosn,ororlextension. ❑ See Page 2 2
City/State//.IP:Portland,OR 97213 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 6625/hr
Phone:(503)319-2192 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:solarpdZ@me.com Industrial plant(1 hr min) 78,18/br
/ Inspections for which no fee is 90.00/hr
CCB Lie.: 199188,1 l sft4 Electrical Lie.: c923 Suprv.Lie.: 48715 specifically listed(h hr min)
ELECTRICAL'ERIVIIT:FEES `..', ..
Suprv.Electrician signature,required: Subtotal:
Print name: Kile Rood I Date: 03/08/2019 0 Plan Review Required(25%of permit fee):
f State surcharge(12%of permit fee):
Authorized signature:
../ t--6?::,...--"'"--------- TOTAL PERMIT rte:
Print name: Kile Rood Date: 03/08/2019 This daaysn it has
acceptedas compermit is not plete.
within 180
* Number of inspections allowed per permit.
1:\BuIdingTermitstELC PermitApp_ELR ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB