Permit (73) CITY OF TIGARD ELECTRICAL PERMIT
I• COMMUNITY DEVELOPMENT Permit#: ELC2019-00420
T i C;AR n 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/25/2019
Parcel: 2S115AB00500
Jurisdiction: Tigard
Site address: 11249 SW GABRIEL ST
Project: Willow Brook,Lot 22 Subdivision: WILLOW BROOK SUBDIVISION Lot:
Project Description: Adding AC.
Contractor: GARNER ELECTRIC WASHINGTON LLC Owner: PACIFIC LIFESTYLE HOMES
402 VALLEY AVE NW, SUITE 106 11815 NE 99TH STREET, SUITE 1200
PUYALLUP,WA 98371 VANCOUVER,WA 98682
PHONE: 253-872-6051
PHONE: 360-573-8081
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 06/24/2019 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 06/24/2019 $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, 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 95 -001-0090. You ay obtain a copy of the rules or direct questions to OUNC by calling 503.2320.1987 or 1.800.332.2344.
Issued By: _t j • Permittee Signature: Se ari4. 0-25 -,
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 503.639.4176 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
City of Tigard ,..cj L'17i ta--- -I i i--•-•Y it,,,, Received
GA)fj ICI S\T Permit ei'E _.- ACA- CA:,jAs:0-c)
II 13125 SW Ball Blvd..Tigard,OR 9722107 1-:t e f.-i 11 ri--'4 F Plan Review
; 8 Phone: 503.718.2439 Fax 503.598.1960 " r Related Permit 0
Inspection Line. 503,6394175 Ready Date/By hins lin See Page 2 for
R" Internet www.tigard-or,gov YON 2 0 2 019 Notitied/Method Supplemental Information
reil:XMWACSCRAPP;;;WW747','7.7.:'''''..:1':'..:':: :7-:753illtrrillfrrtiffinigett iMi7R.417.4.A.47577575.7.747-ZWWStWe,WW•e$415A3
17: New construction 0 AddifiOnialtqatA1900611 IIIV/SION Please check all that apply(submit 1 sets of plans wiltems 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
ilftfgirri2Efgif,fZrk,r7Zrr777.7:M:Mi7FTreatgiZt-VgAtl exceeds 1"„drm exceeds a:d15(1)4v, 101:or B Floating buildings
agricultural
,a. 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps less ground,,ofor all installations buildings
0 Multi-family 0 Master builder 0 Other: 0 Fire pump 0 Installation of 150 KVA or
MIRIEFFEEITEMITIS7ZEILM22,7217,111&104-,P'14;414 BEAmd;rtgeltircyof soYes:IOnrotor load of system
larger separately derived
Job 4: Job site address: \\)l..4 &j Cack\N_Ati - 100HP or more 0 , . , -
C ityiStateli,IP: 1 0Six or more residential units 0 ZeRecreational vehicle parks
0 Health-care facilities
1
Suite/bldg./apt,4: Project name: 0 Hazardous locations. 0 Supply voltage for more than
o Service or feeder 600 amps or more 0 volts nominal
Cross street/directions to job site:
i ;$41WMAJC117427MITI70 .1Z1,: afk;
I Description` ' — - - Qty% Each Total
New residential single-or multi-family dwelling unit.
Subdivision: Lot 4: L2:2_. Includes attached garage.
1,000 sq ft or less 168 54 4
Tax map/parcel 4: Ea aml 500 sq ft or portion
33 92 , 1
4:11101;11;7.175.11Y;:-,111711, ,:,,7, e:::, ,:.:-. .,......- .;•-'..-r' , 7.il.:7,7:::: ::t: ,lifitgiffii5.7;',XegVe,;:Z Limited energy,residential
75 00 2
1- (with above so 11.)
Limited energy,multi-family , 7501) 2
residential(with above sq,(1)
Renewable Energy 0 See Page 2 ,
:;:':141624iIik:4). Z.9,,t-:1 ,"„ell,.`; (';':!'5,,V;;S: 0=,,,4e5Aliariee':"%444Vat-2.'r'•:"Vr',:1?;,9'056#`:4444:f'3•M Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133 56 ' 2
401 amps to 600 amps 2(X).34 2
City/State/ZIP: 601 amps to 1,000 amps 301 04 2
Phone:( ) 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 l
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps I 125 08 2
Owner signature: Date: 401 amps to 599 amps _ 168.54 2
' '''',0,"/•'•-"'m-i4,!,...' ,-;;;',-41--,1/1.6-*IV..-elia Branch circuits-new,alteration,or extension,per panel
fL'Ailittigin.an:cn.YLZSINiff:::•.Z.; ,S,t51?.:. :1,1 ".:1,:'.C,IL15.14 ),Aaiwriayei A,Fee for rwch circuits With
Business name:Pacific Lifestyle Homes 7 42 2
each branch circuit
Contact name:Permit Coordinator B.Fee for branch circuits without ,
service or feeder fee,first
Address: 11815 NE 99th Street,Suite 1200 i 56 18 2
circuit 1 '
City/State/ZIP:Vancouver,WA 98682 Each add'l branch circuit 742 ' 2
, Miscellaneous(service or feeder not included)
Phone:(360)573-8081 Fax: :(360)574-6401 Each manufactured or modular ' 67 84 2
dwelling,service and/or feeder
Email:permits@buildplh.com
, , Reconnect only 67 84 2
1:(Xititc,4ZAtiel,A,- ;,•: ,:.WviE;:,iii.',:.-,i-4.*.-,;:rf"i,t, ,;;;44.44,90,0A,:i.1 ,1010,2LXiNiii Pump or irrigation circle 67 84 2
Business name:Garner Electric WA LLC Sign or outline lighting 6714 , 2
Signal circuit(s)or limited-energy
Address:402 Valley Ave NW Ste 106 panel,alteration,or extension. 0 See Page 2 2
Each additional inspection over allowable in any of the above
CityiState/7117 Puyallup,WA 98371
Additional mariciition 0 hr min) 66-25/he '
Phone:(253)872-6051 Fax:(253)872-1801 Investigation(1 hr min) 90 00/hr
Email:cgentele@gweusa.com Industrial plant(1 hr mm) 78 18t hr
Inspections for which no fee is
90 00/hr
CCB Lie,: 208174 Electrical Li (21158 Supry.11,,,j4— . 7,...4c,...-..f. !; jtiea;4!tedY4tj;min,,,,;w.„yl,,,,:.:,,,,,,..,rrrlr.,,r7„ rw__,,,,,,
Suprv.Electrician signature,required: ,,V0A......./------ 1.c..(%\\Ct Subtotal:
Print name: Russell Magnuson ------__I Date: 0 Plan Review Required(25%of permit fee):
r State surcharge(12%of permit fee):
,e//-/.
Authorized signature: -
X . TOTAL PERMIT FEE:
Ibis permit application expires if a permit is not obtained within 180
Print name: Bill Daniels i Date: days after it has been accepted as complete.
* Number of inspectioosallowad-porpermiL
1113uildingtParmitakELC_PercoitApp_ELR_EREdoc novae/17/2015 440-46155(11/05/CONI/WEB
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
11249 SW GABRIEL ST, TIGARD, OR, 97224 June 28, 2019 at 7:32:32 AM
Record Type: Record ID:
Residential - Electrical ELC2019-00420
Inspection Type: Inspector:
199 Electrical final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor